Judges, attorneys, and law enforcement endorse a bill in South Dakota’s Statehouse that aims to ease mental health problems for people entering the justice system. House Bill 1183 is a measure that changes competency assessments, creates training for people who work in criminal justice, and encourages works that helps people avoid unnecessary arrests or extended time in jail.
Leaders in the Unified Judicial System are finding money for various programs within the UJS budget, and the bill funnels some of that to a grant program for mobile crisis teams. Pennington County has established a crisis care center. Hughes County and Minnehaha County have mobile crisis teams. The mission is to get mental health professionals to people experiencing episodes so they can coordinate resources, assess problems, and eliminate unnecessary psychiatric placements.
Sioux Falls Police Sergeant David Osterquist says he remembers responding to a call several years ago. An older woman was drinking and threatening to hurt herself. Osterquist is a member of the Crisis Intervention Team, so he's specifically trained to work with people struggling in mental emergency. He says he spent time with the woman, kept her calm, and made her comfortable.
“I reached out to a friend of hers to come spend time with her so she wasn’t alone," Osterquist says. "And several months later we received a letter in the mail from her saying, ‘I know I treated all of you badly, but the help you provided me that night lead me to get treatment, and now I am leading a productive life.’"
Osterquist says that’s the goal of the Mobile Crisis Team. It’s a group of mental health professionals on-call 24 hours a day. They meet people in their moments of need instead of handcuffing and hospitalizing them.
"With 70 to 75 percent of the people not needing follow-up work, it was clear that something different needed to be done, because we were wasting resources putting people on mental illness holds, locking them up in a locked facility, when it wasn’t really what they needed to be successful," Osterquist says.
Osterquist says a taskforce laid the foundation for the work, but no one knew exactly how to develop it. He says he and Southeastern Directions for Life’s Kris Graham just started one. He says they scoured versions of mobile crisis work from around the country and plucked the pieces that best fit Minnehaha and Lincoln counties. Graham says they launched the joint mental health effort in 2010.
"One of the reasons that Southeastern got involved too is because we do do calls as part of our community mental health work, and so it helped us to learn more techniques about de-escalation and how to work with people in a crisis situation, so it was really a good fit for us in that way," Graham says.
Graham says the operation in Sioux Falls emphasizes the “mobile” in Mobile Crisis Team.
Sioux Falls Police Sergeant Tarah Walton explains how it works. She says it may start because a person is threatening self-harm, and a friend or family member is worried.
“Obviously the person’s scared," Walton says. "Who do we call when we’re scared or afraid? 911. We’re raised to do that from the very beginning.”
Once those numbers ring through, Walton says police evaluate the call.
"The officers would be asked to respond. They’d make contact with the person, make sure the environment’s safe, and then assess the situation at that point. ‘Does this fit the need for the mobile crisis team?’" Walton says.
Specific parameters exist to answer that question. Walton says officers can’t call in the Mobile Crisis Team if a person has taken action to harm himself or herself. The person can’t be too inebriated with drugs or alcohol to function and work with officers, and he or she can’t be violent. In those cases, law enforcement prioritize safety.
Megan Wexler is a therapist who coordinates the Mobile Crisis Team.
"Say we get called and they’re not taking their meds. Every person does have the right to refuse their own medication, so as we can go we can definitely strongly encourage them. We’ll assess their symptoms that are going on," Wexler says. "Sometimes there’s medical meds that is life and death if they don’t take it. If they refuse it, okay, we’re going to intervene by making you go to the hospital."
Wexler says even people who do need mental health treatment don’t automatically require a placement from law enforcement.
"We’ll encourage them to go to the hospital voluntarily rather than putting them on the hold, because that still gives them more of a right than putting them on the hold. It pretty much takes away all their rights," Wexler says.
Sioux Falls Police Sergeant David Osterquist says law enforcement and the Mobile Crisis Team operate in serious situations.
"That officer has to have, by statute, probable cause to place that person on a mental illness hold before the Mobile Crisis Team can be activated. Once the officer determines that probable cause exists, they can then contact a mental health professional and have them respond to the scene and deal with it. They are statutorily protected. The handoff is spelled out in state law about how that is supposed to work," Osterquist says. "The mental health professional then makes a determination whether or not they want the officer to stick around or whether they want to release the officer to go back to work, and then that mental health worker – that mobile crisis team member – deals with the situation and then makes recommendations and determinations for that person."
The purpose is to respond and develop a safety plan. If that person can stay in the home, that means no unnecessary medical bills from a hospital. It means the person doesn’t miss work the next day, and any children involved don’t have to go into government placement.
In January 2017, Minnehaha County’s Mobile Crisis Team handled a record 47 calls – and not one of those required hospitalization.
Southeastern Directions for Life CEO Kris Graham says leaders are constantly asking questions to ensure the program’s efficacy.
"Are they repeat users of mobile crisis, or were they one-time situations?" Graham says.
Graham says three out of four people who need mental health help in the community don’t call again in the same year.
Police officers, though, do encounter people repeatedly outside of crises. Sioux Falls police sergeant Tarah Walton says the Mobile Crisis Team fosters relationships.
“Someone that we took the time to help and not just take to a mental health facility or take to jail, but we showed empathy and we showed some understanding and wanted to get them help rather than just find a quick solution, those people are more responsive to us in future contacts," Walton says. "There’s some mutual respect that takes place and some understanding, and I’ve definitely seen an appreciation in the community that we’ve been able to touch or those family members as well."
The Mobile Crisis Team that covers Minnehaha and Lincoln counties responds to about 400 calls on average per year. They can respond to houses and apartments but also city parks and other public spaces where people need help.
House Bill 1183 requires reports on the mobile crisis grant program twice a year. Those include numbers for applications, money awarded, the purposes, and populations served. The legislation also creates an oversight council through the Unified Judicial System. The bill mandates courts provide data on mental health court referrals and outcomes, including the number of people convicted of a new crime in one to three years of completing that court’s requirements.
The bill limits the amount of time a person can wait in custody before receiving a mental health assessment to 21 days. Right now South Dakota has no cap on the number of days a person waits. State Court Administrator Greg Sattizahn says that means some people wait months.
“Once they’re in the criminal justice system, they’re much more likely to stay longer than people who do not suffer from mental illness," Sattizahn says. "There are significant delays in competency evaluations, and this all leads to greater costs for the counties.”
Sattizahn says is costs about $90 per day per person to keep someone in jail, and people deserve treatment for their mental health needs. HB1183 allows 21 days for a person to receive an assessment.
The measure also expands the kind of mental health professionals allowed to perform evaluations. Right now only psychiatrists and psychologists can assess patients. UJS leaders say that creates a backlog, so the bill includes certified nurse practitioners, counselors, and social workers who have the right training and practical experience.
The bill includes mental health training for people in law enforcement and in the judicial system - including judges and lawyers. South Dakota Supreme Court Chief Justice David Gilbertson testified on this point in a legislative committee on Monday.
"Tomorrow will be my 32nd anniversary of being a judge, and I don't think I've ever had mental health training," Gilbertson says. "We would propose it for judges, prosecutors, defense attorneys, law enforcement people, really important group - intake officers at jails, who usually have that initial contact, and probation officers, also."
House Bill 1183 is 17 pages long. It includes an emergency clause. That means the bill – if passed by the full State Senate and signed by Governor Dennis Daugaard – can take effect immediately.