Telehealth a better tool for law enforcement

As Texas continues to fight the COVID-19 virus, cities and counties must confront the critical need to reduce “jail churn” — the routine cycling of people through local lockups. All it takes is for one carrier of the virus to move through a jail to expose hundreds — if not thousands — of defendants, convicted people and employees of the criminal justice system to the potentially deadly disease.

As of this week, 4,276 people detained at the county jail have been tested for COVID-19 — with 1,115 positive results. So far, two deaths behind bars have been attributed to the coronavirus. Among staff, 443 jail employees have tested positive. Two have died.

To avoid further spread, Harris County tried to take steps to release from jail or not arrest people charged with non-violent, low-level offenses, but sometimes the best option is to simply not charge people with a crime in the first place. While communities across the country are implementing innovative strategies to divert people away from jails and prevent this churn, Harris County is ahead of the curve thanks to a cutting-edge telehealth program — one that could serve as a model for the country.

The program presents an inventive new approach for law enforcement officers to respond to individuals in mental health crisis by virtually bringing a mental health clinician to the scene of a call using an iPad. At a time when the nation’s students and office workers have grown accustomed to Zoom meetings at home, the Harris County Sherriff ’s Office is using teleconferencing to connect people in crisis with mental health professionals.

By virtually transporting a mental health practitioner to the scene, the program is able to better equip officers with the resources needed to efficiently triage calls. In many cases this prevents unnecessary transports to hospitals or having to wait for a clinician to arrive. Overall it maximizes precious resources necessary to keep people out of overtaxed emergency rooms and jails.

While the nation debates the fundamental nature of law enforcement, this program also presents a new vision of what community safety can look like. Funding for police and social services does not need to be a zero-sum game. Officers and mental health experts can work hand-in-hand toward the same goals.

Arnold Ventures is funding an evaluation of the program, and early results are a promising indication that it is helping officers keep everyone at the scene of a mental health crisis safe and divert people away from jails. During its first six months, 40 percent of the telehealth calls made were resolved on site. Findings also showed that for the majority of calls, the clinician helped officers safely deescalate the situation, identify resources they would not otherwise have accessed and decide what course of action to take. In fact, the National Association of Counties gave the program an achievement award for innovative, effective county government.

The coronavirus and criminal justice debate have each emphasized the importance of this kind of telehealth program, but the sad fact is that Texas has a mental health care problem that’s been decades in the making.

More than 60 years ago, people with mental illness were warehoused in oftenabusive asylums against their will. But when asylums were rightly shut down, promised community-based services were never adequately funded, leading to today’s shocking gap in mental health resources.

From 1964 to 2016, Texas’ population nearly tripled, but its number of state psychiatric hospital beds dropped 80 percent. And a national shortage of mental health care workers is only getting worse, with demand exceeding supply by a projected 250,000 workers by 2025. In Texas, the shortfall is especially troubling: A recent survey showed that we have the fourth-lowest number of per-capita psychiatrists — nearly three-fourths of Texas counties are without one.

Absent better options, the criminal justice system has effectively become the de facto response to people with mental illness. In Texas, people with severe mental illness are 7.8 times more likely to be incarcerated than they are to be in a psychiatric hospital. As funding for community services continues to dwindle, police are increasingly called to respond to people experiencing mental health crises: In 2017, the Houston Police Department responded to more than twice as many mental-health-related calls than it did in 2007.

While we still need more information, Harris County’s telehealth program appears to be providing much-needed support to law enforcement facing difficult and sometimes dangerous situations. Clinicians are able to virtually make more calls in a day, law enforcement officials are better able to keep themselves and individuals in mental health crisis safe, and jails are better able to avoid the dangerous churn that can spread the COVID-19 virus.

Meanwhile, more people experiencing mental health crisis get faster access to health care — ultimately reducing their likelihood of future arrest and criminal justice system involvement. As the largest jurisdiction to implement this approach to date, Harris County stands to be a pioneer in crisis response innovation at a time when we need it the most. And importantly, bringing telehealth to mental health crisis response teams is easily replicable in urban and rural communities alike.

Half a century after we shut down asylums, the COVID-19 virus is testing the limits of our health care and criminal justice systems. It’s time to use all the tools we have — including technology — to help keep everyone safe.