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Posted on: June 2, 2022

Galveston Island introduces an innovative health-first, paramedicine model to navigate behavioral 91

City of Galveston officials announced plans for a multi-disciplinary response team approach involving its city police, fire, and local mental health authorities, an innovative health-first model to respond to 911 emergency calls involving people with mental health or substance use needs.  

The model, known as a Multi-Disciplinary Response Team (MDRT), will be rolled out in October 2022 in Galveston to transform mental health emergency response and bring that transformation to scale in communities across Texas.  

The announcement was part of a roundtable discussion at Galveston City Hall moderated by Tony Fabelo, Ph.D., senior fellow of justice policy, Meadows Mental Health Policy Institute (Meadows Institute), and included  

The Hon. Craig Brown, Galveston’s mayor, offered opening remarks, and Dr. Marina Walne, the Cynthia and George Mitchell Foundation’s Galveston program consultant, introduced the participants. 

This community paramedicine approach brings together licensed mental health professionals, paramedics, and specialized law enforcement officers to better address the health care or social needs that are often front and center in these emergencies. At the same time, they can ensure the safety of the person in crisis, others involved, and the responders themselves. 

The innovative model is based on a compelling proof of concept developed by the Meadows Institute through a generous grant from the W.W. Caruth, Jr. Fund at Communities Foundation of Texas. The initial implementation launched in early 2018 in Dallas and is now part of a nationwide collaboration with The Pew Charitable Trusts (Pew).

“We are delighted to be working with The Pew Charitable Trusts, the Meadows Mental Health Policy Institute, and several local foundations focused on the best interest of the residents of Galveston,” Mayor Brown said. “I am confident that this health-first policing model will exemplify how public-private partnerships can make a dramatic difference in the community of Galveston.” 

The MDRT model integrates both law enforcement and civilian response in ways that respond to the multiple issues often raised in a single 911 call that may involve mental illness. In addition, MDRT teams must be nested within a set of essential services that permit access to care beyond the immediate crisis, including 24-hour care and responsive community services related to urgent psychiatric care, housing, and other needs. 

Through its work with the Meadows Institute, Pew allocated $325,000 as a “challenge grant” to foundations to raise the same amount to fund the MDRT pilot in the City of Galveston.   

“Galveston’s health-first response to behavioral health emergencies will provide more options to care for people in crisis while keeping them and first responders safe,” Pew’s Tiffany Russell said. “Galveston mirrors emerging efforts by state and local governments in creating more compassionate and effective responses to behavioral health emergencies.”

Six local Galveston foundations partnered with Pew and Meadows and donated private funds to incentivize and support the city of Galveston in implementing this initiative.  The Moody Foundation, Mary Moody Northen Endowment, The Permanent Endowment Fund of Moody Methodist Church, Ippolito Charitable Foundation, Harris & Eliza Kempner Fund, and the Cynthia and George Mitchell Foundation collectively allocated $422,500 for the initiative.   

"Today's announcement reflects a shared commitment made by philanthropists and community leaders to find and implement a better way to respond to a mental health emergency," said Dr. Andy Keller, president and CEO of the Meadows Institute. "By working together, they have made this important, positive change in how, when, and where mental illness is treated in Galveston."

The Meadows Institute will administer the fund to finance vital elements of the MDRT implementation during the first year and supplement in-kind or financial resources committed by the city of Galveston through its Police and Fire/EMS departments. 

The Meadows Institute’s B.J. Wagner manages the planning and technical assistance process with Galveston officials.  

The debate regarding response to mental health emergencies typically envisions two lanes, one civilian only, the other focused on law enforcement. The MDRT approach integrates both law enforcement and civilian response in ways that respond to the multiple issues often raised in a single 911 call that may involve mental illness.

Establishing MDRT capacity cannot occur as a single, isolated intervention. Instead, MDRT teams must be nested within essential services that permit access to care beyond the immediate crisis. 

ADDITIONAL BACKGROUND

Galveston County has funded the Meadows Institute since 2017 to provide technical assistance to the county to improve pretrial, judicial, and mental health policies.  

The technical assistance team works with the Coordinating Council created for this purpose in 2018. Galveston County Commissioner Holmes chairs the council, which includes elected officials such as the county judge, the county’s sheriff and district attorney, the Gulf Coast Center’s chief executive, and other agency representatives such as court administrators and the Galveston County mental health public defender.

County Judge Mark Henry has led the Galveston County Commissioners Court’s effort to provide financial support. 

In May 2021, the Meadows Institute, with support from Pew, issued a report that provided a systemwide assessment of Galveston County’s mental health system.   

One key finding showed that law enforcement needed increased capacity to use a more effective model to address the needs of those with a mental health emergency.   

That same month, Meadows Institute released a second report, with support from Pew, presenting the framework for implementing the MDRT.

Galveston County leaders are committed to exploring how county resources can be allocated to support this effort on a parallel track.

For example, discussions will soon be underway to explore the feasibility of creating a crisis assessment and stabilization center as an integral part of this effort. This would provide a location to stabilize and connect persons with mental illnesses to care who require more detailed observation and stabilization than an emergency room can provide. 

The Dallas experience with MDRT, documented in the May report noted above, shows that many mental health emergencies can be handled at the community level instead of through arrest. The goal is to replicate those results for the MDRT in the City of Galveston. 

Galveston City Manager Brian Maxwell stated that “On behalf of Mayor Craig Brown, Police Chief Doug Balli, Fire Chief Charlie Olsen, and the city of Galveston, we are ready to improve how we address the needs of the mentally ill in our community—those who are not a threat to public safety and can be better served with community services than with a trip to jail.”

Felicia Jeffery, the CEO of the Gulf Coast Center, Galveston’s mental health authority, is also part of the planning process and has stated her support.  

The Coordinating Council, as stated by Chairman Holmes, “is committed, along with Commissioners’ Court, to exploring how the county can assist in supporting the initiative.”

THE CITY OF DALLAS MDRT PILOT

Dallas began piloting the MDRT approach in 2018 Dallas with its Rapid Integrated Group Healthcare Team, or RIGHT Care. Teams—made up of three units, each consisting of a paramedic, a mental health clinician, and a trained police officer—were first assigned to the district that had generated the most 911 mental health calls in Dallas.  

According to the Meadows Institute study, the RIGHT Care teams responded to 6,679 calls from Jan. 29, 2018, to June 7, 2020. The analysis found that: 

  • 40% of calls resulted in a connection to community services, such as a referral to health or housing services;
  • 29% of calls were resolved on the scene with no further assistance needed;
  • Only 14% of calls resulted in emergency detention; and
  • 8% of calls resulted in a person being taken to a hospital or psychiatric facility.

The data demonstrated RIGHT Care’s ability to connect people in behavioral health crises with needed care and services. Moreover, doing so helped minimize the number of arrests and transports to jails or emergency departments. For instance, the report notes that 130 of the team’s responses—only 2%—resulted in arrests for new offenses. 

And although all mental health visits to the emergency department at Dallas Parkland Hospital increased by 30% from 2017 to 2019, areas served by RIGHT Care saw a 20% decrease in mental health-related admissions. 

“When a person is in a mental health or substance use crisis, most communities dispatch law enforcement officers, who often lack the training or resources needed to manage the situation effectively,” B.J. Wagner said. “Too often, this action results in jail time or a trip to an overburdened emergency room—and a missed opportunity to deliver needed care.”  

Some communities do not send police officers to calls deemed to be low safety risks. However, that approach does not address instances in which public safety concerns are immediately evident or are raised unexpectedly.

Ultimately, neither scenario is sufficient. Therefore, in addition to the on-patrol three-member units, Dallas Parkland Hospital provides the RIGHT Care team with licensed mental health professionals to assist with navigating 911 calls involving behavioral health crises.

That is important because recent research by Pew suggests that few 911 call centers have staff with the training or resources needed to manage these calls and dispatch appropriate responses. Dallas’ initial success shows how an adequately resourced call center can improve outcomes. 

Based on the positive data from Meadows, Dallas officials earlier this year (2022) expanded RIGHT Care throughout the city. They added two new teams, increasing active units from nine three-person units to 15 and moving closer to the goal of RIGHT Care, responding to 40% of mental health-related calls in the city.  

Meanwhile, Pew and Meadows are partnering to identify other locations to launch an MDRT approach throughout Texas. Although each community presents unique challenges and opportunities, Dallas’s experience can help policymakers in other locations.    

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