By Peter Cameron for Wausau Pilot & Review
More than once, the members of the Crisis Assessment Response Team in Marathon County have received calls from concerned family members saying their loved ones, paranoid and struggling with mental illness, are messing with the phone lines in their home.
When members of the team pay a visit, they often find that “yup, they’re really tearing the wires out of the wall,” said Stacey Rozelle, a crisis counselor on the team. This may sound extreme, but people experiencing paranoia and delusions can act this way because they’re so consumed with their irrational thoughts and beliefs, they’ll do anything to make it all stop.
Before the 2018 launch of the CART team, police officers would have responded on their own to calls like these, as police do in cities across the country, with people in crisis acting out in a myriad of ways. Frequently, that contact would result in handcuffs and a transport to a medical facility or jail, an event that comes at potentially great emotional cost to a person struggling with a mental crisis, and a great financial cost to taxpayers in Marathon County.
Today, those calls are handled very differently. The Marathon County Crisis Assessment Response Team, or CART, pairs a mental health counselor with a plain-clothes law enforcement officer, a solutions-based approach to a problem faced by law enforcement officials nationwide. The initiative, embraced by members of the health care community and local police departments alike, aims to answer these types of calls in a more therapeutic, problem-solving way, keeping more people in their homes and out of a facility. That can result in a better outcome for everyone.
“You’re saving money. A lot of money,” said David Bertram, a Wausau police officer and former Marine who serves on the team. “And at the same time, you’re building community trust and getting people the help they need.”
THE WAY IT WAS
In the first half of this decade, the city of Wausau had a problem.
The city, and to a lesser extent Marathon County, was receiving about 1,200 emergency calls annually directly related to mental health issues.
Police were the ones answering those calls, and officers were detaining nearly half of all people for treatment, said Wausau Police Lt. Nathan Cihlar, who oversees CART. When someone is in crisis – acting erratically with the potential to harm themself or others – police were often forced to transport that person to the North Central Health Care Crisis Center in Wausau. Sometimes in handcuffs.
Then, they may end up spending nights at the Marathon County Jail, which has resources for mental illness. Chief Deputy Chad Billeb Marathon County Sheriff’s Department calls the situation “harsh, but it is a reality.”
That high percentage of detentions led to “astronomical” costs for the county and the city of Wausau, Cihlar said. More than $3 million per year, estimated Jessica Meadows, a spokeswoman for North Central Health Care, a nonprofit partnership between Marathon, Lincoln and Langlade counties that provides a variety of health services.
“We know that’s not the best option,” Cihlar said regarding police taking people struggling with mental illness to a facility, “and it’s just a revolving door, so we have to find a better way.”
The municipalities started hacking away at the high rate of emergency mental health detentions in 2015, three years before the CART team was born. That’s when Wausau Police started taking crisis intervention training, classes which help officers do things like recognize specific mental illnesses and how strategies for de escalating crisis situations.
As more officers received that training, the rate of hospitalizing or jailing people in crisis fell to about 35% in 2016, Cihlar said. By 2017, most officers at the Wausau Police Department had been trained, as had many deputies in the Marathon County Sheriff’s Department, and the number fell again to about 25%, Cihlar said.
THE LAUNCH OF THE CRISIS TEAM
Around the same time, municipalities in the Wausau area began investigating further ways to help people and reduce mental health detentions.
They noticed the city of Madison was pairing mental health clinicians with police officers in the field, and decided to try that back in Marathon County.
In 2018, Marathon County officially launched CART. The team consists of a partnership between the Marathon County Sheriff’s Department, the Wausau Police Department and North Central Health Care.
A police officer – Bertram from Wausau Police and Deputy Jacqueline White from the Marathon County Sheriff’s Department – partners with a crisis counselor from North Central Health Care. Alvin, a shaggy white therapy dog, is also part of the team.
Currently, the two pairs roughly cover the first and second shifts of the day, Monday through Friday, with help from Alvin. Members of the team respond to calls throughout the city of Wausau, and the parts of Marathon County, mostly rural, that don’t have their own police department.
Those areas account for about half the population of the county, Cihlar estimated.
Bertram has been deputized by the Marathon County Sheriff’s Department, allowing him to operate anywhere in the county.
This specific model – a team that partners a crisis professional full-time with a law enforcement officer and covers an entire county – was the first in the U.S., Cihlar said.
Each organization pays for its employee on the team, and management of the team has required significant coordination from all three. That’s not an easy task.
“Healthcare and law enforcement don’t always get along,” Cihlar said. “It’s getting everyone at the table and agreeing how it can be mutually beneficial.”
LOW KEY COPS AND PREVENTATIVE POLICING
When a person is suffering a mental health crisis, a squad car rolling up to their house – for all the neighbors to see – can immediately make the situation worse.
“They’re already having a bad day,” Bertram said. “No one wants to see the cops on a bad day.”
To “soften the presence,” as Cihlar puts it, the crisis teams drive unmarked cars and the officers dress in plainclothes.
Bertram said he wears cargo khaki pants and a polo with a badge and his name embroidered on the shirt. He wears his bullet-proof vest under his shirt, and he doesn’t carry his baton or taser on his belt. Just his firearm, handcuffs and radio.
People with mental health issues “can be very fearful or paranoid right off the bat,” Cihlar said. “We don’t want to trigger anything at the get go.”
Bertram can relate to some of his team’s clients, with deeply personal and difficult experiences of his own.
After high school, he served with the Marines in Iraq, participating in the intense fighting to take back the city of Fallujah in 2004. He did a second tour in 2008. Returning to civilian life was a difficult adjustment.
“I went through my struggles,” he said. “Drinking, being angry, depression, not wanting to be around crowds.”
After he started seeing a counselor and picked up meditation, Bertram said he has been able to better manage his anxiety.
His own issues and triumphs have helped him connect with clients.
“Hey,” he tells them. “I’ve been there.”
Counselors say leaving the crisis center and meeting people in the field also has distinct advantages.
“We don’t just deal with what’s going on right now,” said Chuck Kerstell, one of the two CART counselors, who has been working in crisis response for the past 25 years. “We see people in their homes. Sometimes you’re able to recognize barriers or needs that people have other than mental health.”
For example, if a struggling person has little to no food, the team will drive that client to the food pantry.
Also, having a team that goes into the field ensures ‘there’s no lag in response,” Kerstell said. Previously, counselors would have to wait for police to bring a client to the crisis center.
And members of the team try to get ahead of potential problems, checking in by phone with clients, building relationships, and “talking through their demons for an hour, and getting them through their day,” Cihlar said.
The goal is to take some stress from an already stressed person, and it seems to be working.
The number of calls coming into Marathon County 911 and CART for mental health issues have actually increased in recent years, but in the first six months of 2020, mental health detentions are now down to about 17% of these calls, Meadows said.
That decrease – since local law enforcement started receiving crisis intervention training combined with the launch of CART – will save the county and the city a total of more than $2 million per year, Meadows estimated.
“I’m optimistic that we’re seeing a downswing,” Cihlar said. “It’s working.”
CART has been so successful, “we have dreams of adding more crisis staff,” Cihlar said.
Discussions within the county are ongoing, he noted. And other municipalities in the county may join the CART jurisdiction. The ideal, Cihlar said, would be to add another team, a police officer and crisis counselor who would staff the third – and potentially busiest – night shift.
For other municipalities considering their own crisis team, the various players in Marathon County stress the importance of teamwork between the healthcare and law enforcement organizations, as well as the relationship building with those in the community who may be at greatest risk for mental health emergencies.
“I believe that every community should look at a CART model,” Kerstell said. “It really does lessen the person’s anxiety and stress, meeting them where they are.”
This story has been supported by the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems.