How St. Louis is changing what it means to be a first responder

The banging woke Kim from a deep, alcohol-steeped sleep.

The last few months had been rough. An ex-boyfriend had reappeared, wreaking havoc in her marriage. She turned to alcohol more frequently, stopping by the liquor store the moment it opened at 6 a.m., and continued drinking throughout the day at work. She lost her job in October. She racked up a DUI in November. And on December 30, she texted her psychiatrist, saying she was thinking of ending her life. 

That night, Kim stood shivering on her doorstep in her nightgown and socks and tried to tell St. Louis police officers, apparently alerted by the psychiatrist, that she was fine. They had already called an ambulance, and EMS workers took her to a local hospital where she was put on a suicide watch. “I couldn’t stop crying,” recalls Kim, who asked that her last name not be used. “I must have cried for 24 hours straight.” She spent five days in the psychiatric ward, detoxing.

As soon as she came home, she started drinking again. And then she called 911.

This time, dispatchers sent out a mental health specialist paired with a police officer as part of the city’s year-old Crisis Response Unit initiative, an effort to defuse situations that can escalate and become dangerous for police officers, the people in crisis and anyone else involved.

The intersection of mental health and law enforcement has always been complex, but several high-profile police shootings of people in the throes of a mental crisis, have led American cities like St. Louis to find new ways to deliver help. The urgency to address this problem peaked in 2020, following the deaths of unarmed Black people, including George Floyd and Daniel Prude, while they were in police custody.

The St. Louis initiative is designed to connect people with the resources they need, keep  them out of jail or emergency rooms when possible, and rebuild a sense of trust between law enforcement officers and those they serve.

Clinician Randall Richardson, third from left, and  peer counselor Patricia Johnson, second from right, helped a St. Louis family in crisis through the city's new initiative that pairs police officers with counselors. (Photo courtesy of Behavioral Health Response) 

"Connecting the right professional to the right call is a key facet of reimagining public safety,” says Mayor Tishaura O. Jones. “Not every call requires a police response, and diversion programs help our officers focus on their main job — preventing violent crime.”

With the St. Louis program, some 911 calls are routed to crisis counselors with Behavioral Health Response, the city’s nonprofit mental health care contractor, which works to deescalate situations and identify services and follow-up care. In other cases, clinicians ride to calls with police officers, taking the lead and providing a compassionate ear.

The clinician called out to help Kim put her in touch with Patricia Johnson, a certified peer specialist with BHR whose own history of addiction – she has been in recovery for 32 years – gave her special insight into Kim’s challenges. “I listened,” Johnson says, “and I pulled out the main thing she was dealing with, which was hopelessness.” She helped Kim identify her strengths and think about ways to stay well, such as adopting a pet.

Since their conversation, Kim has found more peace in her marriage, a new job that pays well and a rescue dog named Riley. She still checks in with Johnson occasionally, whom she calls “my angel from God.” 

Coordinated efforts

The St. Louis program is led by Wilford Pinkney Jr., a 20-year veteran of the New York City Police Department who came to St. Louis in 2018 to work on bail reform. Central to his work is building what he calls “off-ramps” — ways to divert people from the criminal justice system, starting with their very first contact with police.

“If people can get their needs met before they get arrested,” says Pinkney, who now heads the Office of Children, Youth and Families for St. Louis, “that is an important step in addressing the level of crime and violence and the history of institutional racism in the city.”

Pinkney’s work in bringing people together across law enforcement, the courts and substance abuse and mental health agencies led to the pilot of the Crisis Response Unit, which includes a partnership with Mastercard to use its Test & Learn platform. People running the program use this software to analyze data from BHR and police on incidents they’ve responded to so they can see if the pilot is working.

So far, these insights are showing elected officials who fund the program that it’s delivering on its promise to help people in crisis while reducing the need — and the cost — of police and EMS response. A 2019 study by the nonprofit Treatment Advocacy Center showed that an average of 10% of law enforcement agencies’ total budgets was spent responding to and transporting people with mental illness.

In the first year of the program, the Crisis Response Unit has responded to nearly 5,000 cases. For the vast majority of calls, the clinician is able to resolve the case on-scene, saving the police department and EMS well over 2,000 work hours so they can respond to other priorities, saving the city an estimated $2.2 million in 2021.

Through the 911 diversion program — in which calls determined to be mental health in nature are routed to crisis counselors — 4 out of 5 cases are resolved on the line without requiring police or EMS, saving 900 police and ambulance dispatches and $400,000 in 2021.

“Most of what you know or believe is anecdotal,” says Pinkney. “Now we have the data that tells us about the engagement, the outcomes and our ability to handle it. … It lets us know what we learned about the follow-up and how we’re able to prevent repeat engagements. We know there are more calls that we could divert.”

The city is already planning to expand the hours of the Cops and Clinicians program — currently 7 a.m. to 11 p.m. — to 24/7, says Pinkney.

Working with the Mastercard team to develop insights has also helped Pinkney understand how to access, track and coordinate the appropriate data to deliver a true picture of impact. This exercise in developing a more efficient and better-connected data ecosystem could help the city find new ways to identify improvements to its other services.

Mastercard typically uses Test & Learn to help businesses make smarter decisions – from pricing and markdown tactics to capital investments to recruitment strategies. But as part of its $500 million In Solidarity commitment to help solve the challenges faced by communities of color, it is increasingly using the analytics platform to help cities spend their money in smarter ways to improve the lives of more people.

“A lot of analyses that come out, they’re looking at one metric,” says John Fimbel, a senior vice president in the company’s Data & Services business. “We try to look at all the metrics to understand the positives and negatives. It allows us to see all dimensions to find out what the true benefit actually is, and to do it in real time.”

Ending repeat calls for help

Perhaps the best proof the program is working will be a lack of data. Randall Richardson, a BHR clinician with the Crisis Response Unit, says the initiative can particularly benefit the more chronic cases – a family calling 911 again and again to respond to a family member who is a threat to himself or other relatives, for example. A mental health expert may be able to identify needs or triggers better than a police officer trained to handle immediate threats.

“This crisis happens and the automatic reflex is to call 911, and they’ll be resistant to the response once the first responders get there,” Richardson says. “But there might be some things building the volcano up before it erupts, and after a couple of meetings like that, you can diagnose what’s going on.

“I can’t say it was overnight, I showed up and — voilà — the situation is handled and solved, but when we solved the first tumultuous encounter, the second encounter got better,” he says. “The follow-up is very, very critical. They didn’t get issues in a day, so they won’t go away in a day.”

Johnson says she didn’t realize the impact she had on Kim until she got a call from her a few days later. “Sometimes you don’t get anything back from the people. They’re not calling you back, and you just think, Did it work? When people call you back and it did work, you feel like magic has happened.”

Kim started her new job on January 31. “The feeling I have, it’s like I’m supposed to be here. I have somewhere that I need to be,” she says. “God has opened up a door and I am not going screw this door up because I love this door.”