For police officers in New Hampshire, having a mobile crisis team of trained clinicians and social workers respond alongside them to calls involving mental health crises can be an invaluable resource. But the lengthy response times — sometimes stretching into hours — remain a significant hurdle.

In January 2022, New Hampshire launched the Rapid Response Access Point, a helpline designed to support residents during times of grief, fear and urgent suicidal crises. This initiative was rolled out six months before the national 988 hotline, aiming to provide around-the-clock support and connect residents with local community behavioral centers.

Apart from helping New Hampshire residents, the helpline has also become a crucial resource for police officers responding to 911 calls involving potential mental health issues. Like police intervention, the presence of mental health professionals at the scene as quickly as possible is seen as essential for reducing negative outcomes.

But Deputy Chief John Thomas of the Concord Police Department noted that officers sometimes have to wait 30 minutes to two hours for the mobile crisis teams to respond.

“At that point, the officers, we can’t stand by for an hour waiting for somebody to respond,” Thomas explained. “So what ends up happening is they end up transporting them to the hospital for help.”

Often, individuals only need to be connected to community mental health resources like a therapist, rather than being involuntarily admitted to emergency rooms, which can exacerbate the situation by occupying beds needed for in-patient care.

This issue isn’t unique to Concord.

Hopkinton Police Chief Thomas Hennessey, echoing these sentiments, said that while the mobile crisis team has helped officers make informed decisions and get people the help they need, response times can be problematic.

“If it’s somebody who is on the fence about whether they want to get help or not, the more time that goes on, they decide not to,” said Hennessey. “Typically, they’re decent, they understand, and again, they want to get the help so they’re willing to wait.”

Challenges in statewide implementation

Before the helpline expanded statewide, Riverbend Community Mental Health Center in Concord was the first to respond to the state’s request for mobile crisis teams.

Starting in 2015, the initiative focused on how the center could collaborate with local police to provide support.

Until then, New Hampshire had relied heavily on the 911 system, police, fire departments, and emergency services for crisis support.

Heather Gaylord, director of psychiatric emergency services at Riverbend, said that to ensure the success of the mobile crisis initiative, it was essential to collaborate with these traditional responders.

The goal was to meet people where they were in the community, “especially the police, who often were left with either trying to dissolve or take care of the crisis independently, without sometimes the necessary skill set or resources,” said Gaylord.

In the years leading up to the launch of the statewide helpline, Riverbend mainly worked with the Concord Police Department.

Like any system, Thomas remembers there were hiccups, but monthly meetings to address what went wrong and what worked right led to significant improvements.

Within a little over a year, the system was functioning smoothly, with the longest wait time for Riverbend’s response being just 30 minutes.

“I couldn’t tell you how great it was. It was working great,” said Thomas. “The officers were all brought into it”

Since the helpline went statewide with Carelon Behavioral Services managing it, law enforcement made 1,133 calls, accounting for 1.5% of the total calls, from its launch until this April.

Rockingham County law enforcement made the most calls with 244, followed by Merrimack County with 204 calls. The lowest number of calls from law enforcement came from Cheshire County.

With the statewide helpline, it isn’t guaranteed that Riverbend will be the only responding mental health center for Concord police officers.

It could be any community mental health center with available resources at the time.

Thomas noted that he has sometimes heard negative feedback from officers when the responding team isn’t from Riverbend because they know the officers and are already used to working together, allowing them to operate as a team.

He also finds that response teams from other areas aren’t as aware of the resources available in Concord and are unfamiliar with the city.

“The more local you get, the better it is,” said Thomas. “I don’t just talk for the city but I think this would go for every jurisdiction.”

With the statewide helpline, major delays are caused by staffing issues and the inability to use vehicles equipped with lights or systems that allow staff to bypass standard traffic regulations.

But Gaylord said they are working on the issues and something is better than nothing.

“They might not be getting a response as timely as it might have seemed previously, but they’re getting a response where they might not have had the ability to have a team come out if it was only Riverbend responding, or only Nashua or only Manchester to their very specific region,” Gaylord explained how the lack of a statewide system could exacerbate the situation. “So I certainly think it’s a point where we’re still trying to refine.”

Balancing intervention with public safety

Recent incidents involving mental health crises and police shootings, like those of Mischa Fay in Gilford and Alex Naone in Manchester, have raised questions about why mobile crisis units aren’t called more often and whether their involvement could have led to better outcomes.

But police officers explain that even when a 911 call is identified as a mental health issue, they are the first to arrive on the scene to assess the situation. A mobile crisis team is only called if the situation is considered safe for civilians.

If officers suspect the person has a weapon or they exhibit violent tendencies, the mobile crisis unit is not involved.

“They’re not going to request civilians to come into that scene. That’s our standard practice,” said Thomas.

“If it’s going to become violent, we’ll try to handle and mitigate it ourselves. We don’t want to put anybody else in danger,” Hennessey added.

As police officers and mental health centers work with the helpline to expand the model and smooth out the issues, one area being explored is broadening the types of professionals who can work on crisis teams.

The idea is to not just rely on a master’s level clinician and a peer, but to consider what other roles or positions could be included to reach more people effectively, explained Gaylord.

There’s also potential in adopting a telehealth model where peers meet with individuals in crisis while a clinician provides support remotely. This approach would allow for quicker response times, even when a clinician isn’t physically present.

The number of mobile crisis teams available varies by mental health center and shifts, but Gaylord noted that Riverbend typically has an office-based team and one mobile deployment community team available for every shift.

Statewide, the number of mobile crisis teams is insufficient to respond to all calls from law enforcement. While officers receive crisis intervention training at the academy to handle mental health issues, Thomas acknowledges that they don’t have the expertise of clinicians or social workers and are not well-suited to manage individuals in mental health crises.

“I think a mobile crisis unit is obviously a plus all around but it has to work without any issues, because if you have these issues, it just creates more frustration,” said Thomas. “And who’s that helping right? We’re not helping the folks we’re trying to help, and it’s just frustration.”