By Anna Kaminski and Winter Wagner
A scorching afternoon in Tucson in August 2020 had all the makings of a tragedy.
A local judge had ordered Tucson police to pick up a man for a mental health evaluation. The man, an Army veteran in his 30s, had been diagnosed with post-traumatic stress disorder and paranoia and had locked himself in his home. Police knew the man was, as one police officer put it, “actively losing touch with reality,” and he could have a weapon.
In other cities, this scenario would have resulted in a SWAT team surrounding the house in armored vehicles. Officers wearing tactical gear and snipers with high-powered rifles would target the house. In many cases, the person in a mental health crisis would have been taken against their will. Or worse, shot dead.
But not in Tucson, where the Mental Health Support Team comprises plainclothes officers and behavioral health clinicians specializing in mental health calls. The team uses its specialty training through careful planning and tested protocols to help such situations end peacefully.
On this day, the team workshopped a strategy specific to this situation — including having an officer who was also a veteran speak to the man.
The officers patiently negotiated with the man for seven hours.
He told officers he wasn’t going anywhere without his pit bull. The officers agreed, but the man didn’t believe them. Not long after, the man’s cell phone rang. On the other end was Dr. Margie Balfour, the chief of Quality and Clinical Innovation for Connections Health Solutions, which operates the Crisis Response Center in Tucson.
“I’m the boss of this hospital,” Balfour told him, “and I’ve told these officers that it’s OK if you bring your dog.”
The man went with the officers without a fight. The dog went, too.
What is remarkable about this scene is that it is unremarkable in Tucson, a city of 545,000 that has created a national model for helping people experiencing a mental crisis.
It’s a result of almost 20 years of work to train officers and provide a seamless path to care and counseling to people in crisis, rather than sending them to jail. The success lies in a well-operating mental health crisis center and full cooperation from law enforcement.
That’s far from the case in Lane County. Documents obtained by Eugene Weekly from the Lane County Department of Health and Human Services describe a “system gaps analysis” that spells out the county’s deficits: The Lane County Jail has become a default psych ward.
One document obtained by EW under the Oregon public records law details a lack of follow-up with people who enter the criminal justice system or receive only cursory treatment in jail. There is a missing connection between providing mental health services and addressing the root causes of homelessness.
Lane County is not alone. The Washington, D.C.-based Treatment Advocacy Center reports that “people with untreated mental illness are 16 times more likely to be killed during a police encounter than other civilians approached or stopped by law enforcement.”
The U.S. Substance Abuse and Mental Health Administration points to the Tucson system as ideal, and other U.S. cities have followed its lead. Lane County might be next.
Lane County officials have called for a cohesive, collaborative mental health system for nearly a decade, and they are looking closely at the Tucson model. Officials hope to build a $19 million 24/7 facility within three years on the Lane County Behavioral Health campus near Martin Luther King Jr. Boulevard. Of the 42 beds in the proposed crisis center, at least 12 will be set aside for youths aged 16 and under. Stays can last up to 30 days.
Officials are now debating who will run the center and how they will pay for it. With the goal of a stabilization center being operational in 2025, around half of the estimated $19 million construction cost has been secured thanks to federal dollars. Most, $7 million, is from American Rescue Plan Act funds, and $1.5 million comes from the recently-approved federal omnibus bill. The $19 million estimate was made in 2021 and is likely to increase due to recent inflation.
Lane County officials claim a crisis center would save the community $77 million a year. Early estimates say $15.1 million is needed to run the center in its first year. In that same time, it could bring in $16.7 million in revenue assuming the center takes in 14-18 people per day and the majority of those people are covered by Medicaid, according to records from the county’s Health and Human Services department. To date, the county has around half the funds it needs to build the center. It’s unclear where the remaining building and operational funds will come from.
The majority of commissioners are in favor of a crisis stabilization center even after a shift in leadership from the most recent election.
Lane County Commissioner Heather Buch says such a center is central to creating a workable system. “We know it’s a grave need,” Buch says. “And, really, we have an obligation as a public health department to do something.”
EW and the Catalyst Journalism Project discovered officials’ interest in Tucson after reporters examined hundreds of pages of public records, listened to hours of public meetings, and interviewed key officials who are working behind the scenes on the mental crisis plan.
But constructing a new building will accomplish little without an effective strategy to provide police with real alternatives to arresting and jailing people who may be experiencing a mental health crisis.
That requires cooperation across law enforcement agencies and mental health services providers unlike anything Lane County has ever attempted before.
Tucson shows how it can be done.
The Path to Tucson’s Success
The Crisis Response Center (CRC) serves all of Pima County, Arizona, which includes 1 million people in the greater Tucson area. The CRC sees about 12,000 adults and 2,400 youths annually, directing people away from jail and toward the care they need.
Pima County took initial steps toward building its mental health crisis system when voters in 2004 and 2006 approved bonds to build a facility. The resulting CRC opened in 2011, but the system struggled in its first three years.
The center had recliners for 34 adults and 10 youth for stays lasting under 24 hours. Officials built the initial system assuming that the typical client would be someone who might need counseling or a place to have a cup of coffee and peer support.
But the center’s officials soon realized this help, while needed, didn’t get to the heart of the region’s challenges.
Months prior to the CRC’s grand opening in 2011, a gunman shot U.S. Rep. Gabby Gifford, D-Arizona, at a Tucson event. The shooting killed six people and injured 13, including Gifford. The shooter had a history of mental illness, and Tucson law enforcement and health officials wondered if their system could do more to prevent crises, not just respond to them.
Within three years, county officials switched to another approach, called the crisis observation model. Developed by psychiatrists Dr. Chris Carson and Dr. Robert Williamson in 1993, the model had already proven effective in Texas and Phoenix. The options for care include short-term visits, urgent care, daylong observation and longer stays. The programs include medical professionals as well as peer counseling — assistance from others who have faced similar experiences. The crisis center is part of a larger medical center but also works closely with community-based programs and a mental health court.
Sgt. Jason Winsky of the Tucson Police Department says the TPD does not see mental health services as just another stop along the way to jail.
“There’s not a paper ticket in the person’s pocket as they go into the CRC and they have court later,” Winsky says. “There’s not a warrant that gets issued. It’s a pure deflection.”
One feature of Tucson has particular relevance to Lane County’s challenges: Police can bring a person in crisis to the CRC knowing the patient won’t be turned away. The CRC calls this a “no wrong door” policy.
In its earlier incarnation, the CRC lacked clear protocols when it came to assessing who might be a low-risk client and those who posed a serious risk to themselves or others. This lack of coordination meant long waits for services — something that frustrated law enforcement officers and patients alike. It took away their incentive to bring people to the CRC when they could save time by just dropping them off in jail.
Balfour, who was brought in to manage the transformation of the CRC’s operations, quickly discovered patients were waiting up to eight hours to be checked into the crisis center to receive mental health services.
Now, that average wait time has been cut to 90 minutes, and the average drop-off takes only five minutes.
“The sooner you start treatment,” Balfour says, “the better it is for everyone.”
Crisis intervention training and mental health response teams within law enforcement have aided the CRC in its success by prioritizing bringing people in crisis to the center. Because of their training, conflict between police and people in crisis has decreased significantly.
The CRC system in Pima County has its limitations.
Like many Western U.S. cities, Tucson is facing a homelessness crisis. While it was designed to divert people from the criminal justice system, the Tucson system is still struggling to help people with mental health issues who are unhoused. The Tucson police have created a homeless outreach team designed to connect people with services.
“When you think of your hierarchy of needs,” Balfour says, “that’s at the base of it: food and shelter. And, I mean, how can you expect someone to be taking care of their mental health, if they don’t even know where they’re going to lay their head that night?”
Criminalizing crisis
Lane County faces numerous challenges in building a comprehensive strategy to align with a new mental health facility. Tackling those challenges begins with the need for law enforcement to shift its mindset, as police in Tucson and other cities have done.
Eugene and Lane County have taken steps to find alternatives to arresting people. The best and most widely-known is CAHOOTS, the mobile crisis intervention service provided by White Bird Clinic and paid for through the city’s budget. Founded in 1989, CAHOOTS has received national attention for its innovative program. But CAHOOTS teams, who say they are overworked and underpaid, still rely on the police to dispatch them.
As a result, mental health intervention is an option for police, not an automatic first step.
Cpt. Doug Mozan of the Eugene Police Department says a crisis center would enable officers to direct people with mental health symptoms to more qualified professionals.
“We might be able to off-ramp them to a crisis center and get them stable,” Mozan says. “Our officers didn’t sign up to be mental health providers.”
In 2015, Eugene resident Brian Babb was shot and killed by an EPD officer as he stood in the doorway of his home. Babb, an Army National Guard veteran with severe PTSD, had called his therapist when he began to experience an episode while armed with a gun. The therapist called 911, and within the hour EPD descended upon Babb’s home with an armored vehicle, guns and tactical gear. An EPD sniper shot Babb in the head. Five years later, a federal jury denied Babb’s family $9.3 million claim in a wrongful-death lawsuit, ruling that the EPD officer who shot and killed Babb “did not violate the Fourth Amendment in using excessive force.”
Eugene police now require officers to have Crisis Intervention Training (CIT), which has existed in its current form since 2015 — months after Babb’s death. But the mandatory training doesn’t help if officers fail to complete it.
Two of the three EPD officers who interacted with Landon Payne in March 2020 had not completed the required training. Payne, 37, who had a history of mental health and substance use, was experiencing psychosis when officers arrived at his home. Payne asked the officers for help, and they arrested him. Payne died after seven Lane County deputies restrained him face down on a concrete floor outside the Lane County jail. Police later misled Payne’s widow about the circumstances of his death. She has since brought a wrongful death lawsuit against the city of Eugene.
Whatever the outcome of the lawsuit, records from the case make clear police didn’t think they had anywhere they could take Payne except to jail. In 2021, Lane County District Attorney Patty Perlow said she believed Payne should have gone to the hospital. “This is another tragic event triggered by mental illness and drug use where the seemingly only viable option was to transport this individual to the jail,” Perlow wrote in response to EW‘s questions about the Payne case.
“The conclusion that Mr. Payne should have gone to the hospital isn’t a legal conclusion, it is a factual conclusion with the benefit of hindsight,” Perlow continued. “The county is working very hard to get a crisis center opened so that there is a place other than the jail to take people in the throes of a mental health crisis.”
The Lane County Jail is the number one provider of mental health care in the county, according to Lane County Behavioral Health (LCBH), indicating a pattern of criminalizing crisis behavior.
“Law enforcement just gave up trying to get people to the hospital,” said Pauline Gichohi, the division manager for LCBH. “So the jail has become the default for anyone that is causing some disruption to the community.”
Cpt. Clint Riley of the Lane County Sheriff’s Office oversees the jail. He estimates that around 80 percent of people come in with a mental health disorder, an addiction disorder or a combination of both. Riley says the jail isn’t set up to provide the mental-health treatment most of those inmates need. When inmates are released, he says, they’re on their own.
“We should only be jailing people that are a danger to the community, and that need to be held in this kind of manner,” Riley says. “If we realize somebody’s addictions and mental health issues are really what’s causing their criminality, we should really take a hard look at that.”
Breaking a cycle
Dan Isaacson, board president of National Alliance for Mental Illness Lane County, describes the problem of people cycling in and out of jail as an “invisible asylum.”
Many people living unhoused experience constant trauma and crisis. Some are brought into the county jail on a regular basis, remaining long enough to be stabilized only to be released back onto the streets, at which point “the fog returns,” Isaacson says.
Lane County has options for providing temporary respite care to people experiencing a mental health crisis. In 2016, Hourglass Community Crisis Center, operated by the nonprofit Columbia Care Services, opened its doors to provide a safe respite for roughly eight people at a time to stay up to 23 hours with the option for further services.
Ami Jerome, Hourglass’s program administrator, recognizes those services aren’t enough. Jerome emphasizes the need for what she calls “recovery all the way,” which includes housing and post-care support and resources to ensure actual, long-term stabilization for crisis-affected individuals. A major gap in the system exists in Lane County, Jerome says.
“The services just aren’t there,” she says.
In June, Lane County officials started to lift the veil around their planning for the center. Officials hosted a public discussion via Zoom. Eighty-nine people attended, ranging from health care professionals to activists to people working with Lane County’s unhoused population as well as law enforcement and community members who wanted to learn more about the county’s plans for the center.
One attendee, David W. Oaks, a consultant and a disability rights activist and psychiatric survivor, cautioned that pursuing a stabilization center without the inclusion of a diverse set of voices with lived mental health experiences can lead to disempowerment.
“Lane County really needs to support the organized voice of mental health consumers and psychiatric survivors with lived experience,” Oaks says. “We really need our folks at the table.”
Oaks, who founded an international coalition that advocates against forced or coerced medication and treatment, has repeatedly requested that crisis center project heads include peers’ input at every level of the process. He submitted a resolution to the county in December demanding their commitment.
According to county documents, those piloting the stabilization center project are doing so with a trauma-informed approach. But some within Lane County’s existing crisis response system today say they have been left out of the conversation.
Marc Douthit, program director for Buckley House, the sobering and detox center in Eugene, says he hasn’t been asked to weigh in on what the local crisis system needs. Douthit is a recovering alcoholic who in 1989 was dropped off to sober up at the Buckley House. He says he understands well the connection between substance abuse, addiction and mental health.
“It’s a balance of what’s going to happen next with what we know is going to happen next every single day here,” Douthit says. “No one really takes a day off.”
Douthit brings specific expertise that comes from knowing the system inside and out and operating long-term and short-term programs. He has seen the cycle of entry and re-entry into treatment firsthand, and he’s seen it from people in counties all across Oregon.
“We get people from everywhere. We get people from eastern Oregon sometimes. They come from Bend. They come from La Grande. I have sent my people to the airport to pick people up that were coming from Alaska. And you just never know what you’re going to get,” Douthit says.
The county intends to continue engaging public interest groups, especially people and families with lived experience, says Jason Davis, the county’s Health and Human Services public information officer.
The most recent effort was a question and answer panel in early December when some technological issues caused barriers for participation for some virtual attendees, Davis says. The next will begin in February when the county will host, but not lead, four topical listening sessions to garner public input. Topics include design, lived experience and equity and access.
As in Tucson, any efforts for a crisis stabilization center in Lane County will have limitations, especially without a comprehensive philosophical shift in the way law enforcement, government and even alternative forms of crisis response, such as CAHOOTS, treat mental health crises. A coordinated effort is required to build community trust, says Gichohi with Lane County Behavioral Health.
People who experience mental health crises are often distrustful of law enforcement and the behavioral health system — much like the Army veteran from Tucson.
“We need to change that,” Gichohi says.
“With the crisis center,” Gichohi adds, “what I keep reminding people is that it’s not going to solve all of our problems. It’s not the cure all.”