The young man who lived with autism often let out a spontaneous howl, an unsettling outburst that alarmed people around him. They frequently called 911.
The outcry was something the young man did to soothe himself after he became overstimulated. It made him feel better and was not a show of pain or distress.
Nevertheless, again and again, deputies with the El Paso County Sheriff’s Office and local EMS responded, conducted an evaluation and took the young man to the hospital or a mental health facility to make sure he was OK.
Then, thanks to a co-responder program in El Paso County, the pattern changed, and the man’s life took a dramatic turn for the good. Known as the Behavioral Health Connect Unit, or BHCON (pronounced beacon), the co-responder program pairs an El Paso County Sheriff’s deputy with a licensed professional counselor. Launched in July 2018, the partnership is with the sheriff’s office, UCHealth, the state’s Behavioral Health Administration and the National Alliance for the Mentally Ill.
Mental health services and crisis response
Katie Gassett, a licensed clinical social worker with UCHealth, prepared small little cards for the young man that explained his disability – that he was having a panic attack and overstimulated.
Gassett and El Paso County Sheriff’s Deputy MacKenzie Boyne, a 15-year veteran of the department, began to see the young man more frequently, providing him with food and water, and transporting him to places he needed to be.
“It really helped us build that rapport with him,’’ Gassett said. Over time, as trust between them grew, the young man confided to them that his mother lived out of state. The team reached out to his mother, and the young man returned to her a few weeks later.
Since the program started, BHCON has expanded to Fountain. UCHealth will soon be partnering with Manitou Springs to start a similar program. The team of law enforcement officer and clinician respond to 911 calls for people who are suicidal, having a mental health crisis or behavioral issues. UCHealth also has behavioral health professionals working in co-responder programs in Aurora and Fort Collins.
When someone is experiencing a behavioral health crisis
BHCON has had enormous success, allowing people in crisis to talk about what’s bothering them from the comfort of their La-Z-Boy, sitting at their kitchen table or in their homeless camp. The unit has helped divert people from the criminal justice system and kept them out of busy hospital emergency departments. Since the program started, 90% of people in crisis have been able to receive care and resources and have avoided transport to another location.
Deputy Boyne said the work is most gratifying.
“I enjoy it, and I find it much more rewarding than what you would call traditional cop work. It’s been a huge success and it seems like we have a greater impact on the lives of the people,’’ Boyne said.
Andrea Wood, a licensed counselor and manager of behavioral health at UCHealth, is among the UCHealth clinicians who ride with deputies to mental health-related calls.
“If you take the hundreds of calls for service that the unit sees a month, that means we get to leave many people in the comfort of their home and give them the help that they need, the resources, and they never have to come to the hospital. I just think that is fantastic,’’ Wood said.
How the co-responder program in El Paso County works
The BHCON unit does not respond to calls with lights and siren blaring. The deputy drives an unmarked Chevrolet Tahoe. The car has a screen in the back seat and clinicians can sit in the back of the Tahoe and evaluate the individual. Clinicians carry a radio and wear bullet-proof vests, though they don’t approach an individual until a deputy has deemed a situation safe. Evaluations are often done on the side of a road, in a truck stop or homeless camp. BHCON responds to calls 7 days a week.
“We go mostly to calls where we are checking on the welfare of somebody who is potentially suicidal or severely mentally ill,’’ said Carey Boelter, a licensed professional counselor who is the program manager of behavioral health programs for the El Paso County Sheriff’s Office. “We will go to those calls and try to deflect from the criminal justice system if we can. For example, we may respond to an individual who is wandering on someone’s property, and it might appear that they are casing the house. But they’re really in psychosis; their intent is not malicious, they just don’t know where they are, and they’re delusional.’’
Such an individual, if deemed to be a danger to themselves or others, could be placed on an M-1 hold for 72 hours by a deputy or a licensed clinician. Clinicians are either independently licensed professional counselors or licensed clinical social workers, which means each has a master’s degree, has 3,000 supervised clinical hours and has passed a state competency test.
Most of the calls come in through 911, either from a concerned loved one or the individual in crisis. When Wood arrives on a scene, she approaches with a gentle kindness: “Hi, I’m Andrea and I’m a behavioral health clinician. Someone has made some statements about you, or you called 911, and we’re here to address that for you and to talk to you about it.”
Boelter, who also responds to calls, said “it is incredibly rewarding to be able to be by someone’s side when they really are having one of the worst days of their life.’’
Intervening when someone is contemplating suicide, and making a difference, is especially rewarding, Boelter said.
“Even if we are just providing support, and we are there to say, ‘We’re here. We’re here to help.’ Maybe we can make things look better, so they’re here for another day. A lot of times we go on calls and people don’t feel like they have any reason to go on, and it hurts too bad to stay where they are,’’ Boelter said.
In those moments, BHCON can immediately connect individuals to resources and determine whether to transport to a psychiatric facility. Caring for people in their own comfort zone, whether that’s at home, work, or elsewhere, adds a dimension of comfort and immediate care, something a local emergency room may not provide.
“In the emergency department, they’re working on medical clearance and other things, while we are seeing them immediately. We can do direct admits to psych facilities or detox facilities, so if we decide to put them on a hold or take them voluntarily, we can put them in the car with us and deliver them to a psychiatric facility or a crisis walk-in center.
“And usually, it is not a difficult process,’’ Wood said. “You would think that if you’re putting someone on a hold that they might not want to get in the car, but we usually just negotiate with them and walk them through that process and they kind of feel a little empowered, especially if they determined to go voluntarily on their own.’’
In some cases, the deputy builds rapport with an individual, and works through the mental health evaluation process.
“They ask all of the right questions, they know how to do the suicide screening, so they know what to ask and say. There are times when I’m writing things down and the officer is actually doing the interview because the individual has respect for the deputy at that point, and we kind of go with whatever they’re most comfortable with, and feel safe with.’’
The deputy and the clinician often collaborate on whether an M-1 hold is necessary. In the four years since BHCON was established, individuals of all ages have been cared for. BHCON also conducts follow-up calls to check on individuals and continue to build rapport.
“We do geriatric adults, and people as young as 5 who have behavioral issues, and people with developmental disabilities. We see a lot of geriatric dementia, where you have someone who has been doing really well, and then all of a sudden, they feel like someone is in their house or they start having hallucinations from dementia.’’
With multiple calls from such individuals, the team has a front-row seat to an individual’s decline from dementia. BHCON provides resources for the family, walking them through next steps and setting up services. In children, the unit sees behavioral health issues and children acting out in their homes. Some individuals with developmental or intellectual disabilities have aggression and anger issues.
More people experiencing mental health issues
Since the COVID-19 pandemic began in 2020, BHCON has seen an increase in anxiety and depression.
“We saw a significant escalation in psychosis,’’ Wood said, adding that during the early days of the pandemic, individuals who struggle with schizophrenia or bipolar disorder were unable to see their psychotherapist, case worker, nurse practitioner or psychiatrist on a regular basis. Many of those individuals were asked to do video visits.
“What we saw is that people who have chronic mental illness couldn’t figure out how to connect into the tele-psych world. So we saw a significant escalation in people who couldn’t get their medications, couldn’t stay on their medications, so we did a lot of follow-up calls and a lot of connecting with services,’’ Wood said.
Wood believes the BHCON unit benefits the community in multiple ways, and she believes that it will become more common to have co-responder units in cities and counties across America.
“The community benefits in many ways. They are getting faster responses, and they’re getting responses from people who are well trained in mental health,’’ Wood said. “You get professionals trained in crisis prevention intervention. All of our clinicians are trained in how to de-escalate situations and walk people through their suicidal or mental health crisis.’’
The program benefits the sheriff’s department by de-escalating crisis situations and averting violent encounters. Hospitals benefit because they are less busy and able to focus on medical needs. Most of all, the program benefits a person in crisis like the young, autistic man who has now been reunited with family.