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Teamwork Pays as Officers, Therapists Combine Expertise

Copyright Joe Shearer, The Daily NonPareil

​​This article is written by Tim Johnson. It was posted June 18, 2016 on

A growing relationship between local law enforcement agencies and a mental health crisis team is paying dividends, officials say.

The Crisis Response Team is made up of therapists and social workers from ​Heartland Family Service, Veterans Affairs, area schools, CHI Health, Boys Town and private practice, according to Director Jenny Stewart of Heartland Family Service.

Counting Stewart and two lead therap​ists – one for Iowa, one for Nebraska – there are 18 on the team.

The CRT responds to calls from law enforcement officers when they see signs that someone involved in an incident is in a mental health crisis, Stewart said. The team always has at least one person on call.

“We typically have one assigned, and then there’s backup,” she said. “There’s four who could go out.”

Team members try to be on scene within 30 minutes, Stewart said.

“The therapist will go out and will be debriefed by the officer on what’s happened,” she said. “The therapist will do a safety risk assessment.”

The team member tries to determine how likely it is that the person might hurt himself or herself or someone else, Stewart said. They consider whether the person has a plan to do that and a weapon, whether they have support people who can stay with them for the night and other factors.

Then, the therapist makes a recommendation to the law enforcement officer on what level of care the person needs.

“Law enforcement makes the final decision on what happens to that person,” she said. “If that person goes to the hospital, the therapist will follow that person to the hospital to speak to the doctor or medical staff.”

The goal is to avoid unnecessary incarcerations and hospitalizations, Stewart said.

The relationship between law enforcement and the CRT has changed the way suspects in mental health crises are handled, said Officer Ben Lake of the Council Bluffs Police Department.

In the past, officers’ options were limited.

“We can’t solve their problem in 15 minutes on a call,” he said. “We would just immediately take them to the hospital.”

There, they would see an emergency room doctor who could not help them immediately – only hold them to see a psychiatrist the next day (if there was a bed available) or refer them to someone who could provide outpatient treatment, Lake said. If the person was admitted to the hospital, taxpayers would likely have to pay the bill.

“The CRT helps us connect that person with other resources, instead of us just taking them to jail or to the hospital,” said Pottawattamie County Sheriff’s Office Deputy Jerome Stewart, Jenny Stewart’s husband.

The team was formed in 2008 and initially served only Sarpy County, Nebraska, Jenny Stewart said. Pottawattamie County was added in January 2011 and Cass County, Nebraska, in June 2011. Some team members are only licensed in one state or the other.

“We have a number of therapists who are trained in both states, so they sit on every county’s team,” she said.

Sometimes Stewart or one of the lead therapists debriefs a team member after a call, she said.

“Crisis response can be really intense,” she said. “We’ve had tables flipped on us, people charge us. There is always at least one law enforcement officer there, but things can change quickly – and there are often several people on site.”

The CRT is in the process of adding eight more counties, all in Iowa: Cass, Fremont, Harrison, Mills, Monona, Montgomery, Page and Shelby, Jenny Stewart said. Because the team doesn’t have members in all of the counties, members respond to calls from rural counties via telehealth – a live video broadcast between the officer’s cruiser and the therapist’s computer or smart phone.

“There’s not enough therapists in those areas,” she said.

With the video hookup, the therapist can still look for body language and other visual cues, Jenny Stewart added. Telehealth may be used for calls from eastern Pottawattamie County, too, depending on whether the officer is willing or able to wait for a therapist to get to the scene.

Two deputies are currently ​testing reception in the rural counties, she said.

The team trains law enforcement officers annually on dealing with people with mental health issues, she said. In turn, law enforcement officials train CRT members on what they might encounter on a call.

“We really need that situational training everywhere we go,” Jenny Stewart said. “There’s no charge to our agency, and we, in kind, don’t charge them for our training. It’s a great partnership.”

Added Jerome Stewart: “I have found in my years the more I have learned about mental health or behavioral health, the better I have been able to communicate with people on the street.”

The deputy said he is better able to recognize signs of mental illness now and is better able to de-escalate the situation when someone is upset.

“The more I learn, the easier it gets,” Jerome Stewart said.