The RIGHT Care project seeks to improve collaboration among police, paramedics and social workers in responding to emergency calls related to mental health. Parkland’s social workers help defuse crises and thereby help avoid unnecessary ER visits or incarceration, and help ensure that patients with mental illness can receive clinical care. How does this build trustworthiness? Through its collaborative effort, the project has enhanced the trust of community members that mental health concerns can be addressed effectively and safely.
How It Works
RIGHT Care is a multi-disciplinary, first-responder program for 911 mental health calls which involves a police officer, paramedic and social worker. RIGHT Care is building trust on many different levels.
First we are building trust among agencies and professions. When the program first started, police officers told us: “This is ridiculous and a waste of time!” Over time, however, those same officers have seen that social workers talk and interact with clients very differently than the police – often times achieving different results. Police officers now see the benefit of the RIGHT Care team and call the team for assistance with challenging mental health calls. Police are now more trusting of the clinical judgment of Parkland’s social workers. This speaks to a trust of competence among professionals involved. Dallas Police officers used to automatically take all patients to an ER when they said they were suicidal. Now social workers have been able to teach officers that some citizens are conditionally suicidal and if we can resolve that condition in the field, then the patient is no longer suicidal. That builds trust between the officers and social workers but also the clients and RIGHT Care. Parkland, Dallas Police Department, and Dallas Fire-Rescue are more trusting of the responsibilities of each agency and services provided by each large entity.
Second, RIGHT Care is building trust in the community and among citizens. RIGHT Care currently operates in South-Central Dallas, an area which is a food desert, economically depressed, and has a life expectancy 23 years shorter than residents in the northern part of the city. Police are often not trusted in this area of the city because of how they have historically responded to mental health 911 calls. RIGHT Care is working to rebuild the trust of residents who have mental health conditions. They do this in a variety of way. They work to resolve crises in the community – avoiding unnecessary ER visits or jail incarcerations. They are able to get clients connected to mental health services through same-day appointments, filling medications when needed, resolving conflict in the home, finding new housing, activating a client’s support network, etc. These are all new services in the community and since 2018, we have responded to 6,000 calls. Over that two year period, clients now call 911 requesting assistance from the RIGHT Care team directly.
Skills and Competencies
RIGHT Care relies on the skills of each of the three professionals to make the team work: police, paramedic, and mental health clinician. Every RIGHT Care team member attends a tailored 2-day training, which includes a review of the policy and procedures, team building, and scenarios the team might encounter. The training also includes an 8-hour course called Mental Health First Aid.
The mental health clinicians for our team are licensed social workers. We prefer Licensed Clinical Social Workers (LCSW) with at least two years of experience in an acute clinical mental health setting, but we also accept Licensed Masters of Social Work (LMSW). The social workers all attend an annual 8-hour Satori Alternatives to Managing Aggression program through Parkland Health & Hospital System. It is important that social workers on these teams have a commanding knowledge of mental health diagnoses (including substance use disorders), appropriate levels of care, treatment options, and local resources to utilize. They also must be able to use a computer and our electronic medical record system.
RIGHT Care’s creation was the outcome of many large entities coming together with strong buy-in to change how we manage crisis response and change how we interact with people who are in a mental health crisis. All of the agencies involved had strong buy-in largely because there were significant trust issues. The Dallas Police Department had several bad outcomes (in the most severe cases, a client was killed while police were responding to a mother’s 911 call) related to how they managed mental health crises. Dallas Fire-Rescue was overburdened by the number of 911 mental health calls. Parkland was under a Corporate Integrity Agreement and trying to rebuild trust with the community. Meadows Mental Health & Policy Institute applied for a grant from the W. Caruth Institute that provided the money necessary to pilot the program for three years. Meadows wanted to show that a program such as this could change how all three agencies interact with each other, resulting in a different outcome for clients with a mental health condition.
Citizens call 911 and ask specifically for RIGHT Care. Dallas City Council is unanimously supportive of RIGHT Care and the proposed expansion from one team in South-Central Dallas to three teams serving the entire city.
Data shows that RIGHT Care is diverting 32 percent of all encounters away from busy ERs and jails. Police officers now call social workers at Parkland requesting advice on how to handle challenging situations. Other mental health agencies and programs are eager to partner with RIGHT Care and expand with the team to a city wide model.
One example is MetroCare. They are currently writing policies for how they operate their same-day clinic for RIGHT Care, so that other MetroCare clinics in other parts of the city can serve in a similar manner. The North Texas Behavioral Health Authority is willing to fund the next 1-2 years of the program and supplement the program with an additional follow-up team, clinicians in the 911 call center, and a complex care team.
The collaboration among some of Dallas’ most important institutions is also evidence of trust in the program and the program’s effectiveness. These institutions include the Dallas Police Department, Dallas Fire-Rescue, City of Dallas, Parkland, MetroCare Services, North Texas Behavioral Health Authority, and Parkland Foundation.
We believe this is a model that is scalable. Between February-April 2021, the RIGHT Care team expanded to five teams that now operate citywide. We have added additional clinicians in the 911 call center. We are about to add a non-law enforcement follow-up team as well. We believe that this model will work in different areas of the city as well as in different cities throughout the country. We initially wondered if different areas of the city with higher socioeconomic status or in our predominantly Spanish speaking areas of the city would respond differently to the RIGHT Care Team. So far, our data is mostly anecdotal but it has been a positive response. The fact is that mental illness transcends racial diversity, socioeconomic status, and language barriers. As long as we have access to translators, the team has been successful in these areas so far.
I also believe other smaller communities can modify this model for a more affordable option. Operating a team only during peak hours is one example.