Avel eCare, provider of clinician-to-clinician telemedicine services, has rolled out its Crisis Care program in central North Dakota to support law enforcement agencies.
The program, officially launched in 2023, is a co-responder model that supports law enforcement with 24/7 behavioral health services via cellular-enabled tablets. Participating police departments and sheriff's offices can leverage the program to assist with de-escalation, stabilization and real-time safety assessment of individuals in crisis.
The program originally began as a pilot in South Dakota in 2020. Today, in addition to South and North Dakota, it is also available in parts of Michigan, Montana and Nevada. The American Psychological Association estimates that at least 20% of police calls for service involve a mental health or substance use crisis and for many departments, that demand is growing.
A study of the first nine months of the crisis care program pilot found that individuals were allowed to remain in place in three-quarters of all encounters. It works like this: on-site law enforcement calls the crisis response team at Avel eCare to request a safety assessment. From there, law enforcement gives the individual in crisis a tablet for a video session with a psychiatric nurse, after which a recommendation on next steps is made to law enforcement. If needed, the clinical team can also connect the person with community mental health resources. The crisis care team can also provide language interpreters around the clock.
“You’re normalizing behavioral health issues, so that they can get it addressed appropriately," the company's CEO Doug Duskin told Fierce Healthcare.
The pilot was inspired by a desire to keep people in crisis from entering the legal system, Brian Erickson, vice president and general manager of behavioral health and specialty clinic services, said. Without the program in place, individuals would be handcuffed and taken to the nearest emergency department, he explained—or even possibly arrested.
“Just think about that when you’re at your probably lowest point in your life and now you’re being handcuffed and criminalized for something you have no control over,” Erickson told Fierce Healthcare.
At the hospital, they might face a several-hour long wait and the law enforcement official must wait alongside them. And, a mental health board must ultimately evaluate them before they can be released, Erickson said.
In South Dakota, the Clay County Sheriff Department was among the first to adopt Avel eCare's program in 2020. Prior to the program, a deputy who encountered a person in crisis would have had to call the county mental health board chairman to order a detention for evaluation. They would then have to transport a patient to the county jail to be held until an evaluation could be completed. The involuntary holds were time- and cost-intensive for the sheriff department and stressful for the person in crisis. Now, they can interface with someone who can help them, according to a case study posted on Avel eCare's website.
“We don’t want to criminalize it," Duskin said. "The worst thing I think you can do is handcuff someone suffering from behavioral health issues."
Where exactly they get referred ultimately depends on the state that Avel is partnering with, per Erickson. The determination of next steps is based on the recommendation from the nurse to law enforcement, which makes the final call.
Avel eCare's crisis care program has 19 licensed staff who also support some of its other programs. It continuously monitors volumes to ensure adequate coverage, per Erickson. It also has surge plans in place that trigger off-shift staff to respond if needed. While it guarantees a response within 30 minutes, the program has been able to respond in under five minutes, Erickson said.
The crisis program is also available to officers themselves on-demand, for free. “In listening to our partners over the last months, it became very clear that agencies were interested in providing confidential, medically competent tools for law enforcement for themselves,” Erickson said.
One of the benefits of telehealth in emergency response is ensuring the safety of behavioral health professionals, Erickson said. The other is bypassing potential traffic delays and staffing shortages.
“We can be a force multiplier using telemedicine, where we can be in many places at the same time,” Erickson noted.
New York City was among the first cities to pilot a behavioral health emergency response program, dubbed B-HEARD. Emergency calls that do not have violence or weapons as the primary concern get routed to the B-HEARD team, made up of social workers and emergency medical technicians. They then respond to eligible, low-acuity incidents in-person “in minutes,” a spokesperson for NYC Health + Hospitals told Fierce Healthcare. They confirmed B-HEARD does not use telehealth.
As of January 2024, B-HEARD was operating in 31 of 77 police precincts across four of the five city’s boroughs. However, according to the city’s own data, B-HEARD was able to respond to just over half of eligible calls in the first half of 2023. This is reportedly in part due to limited working hours (16 hours a day) and challenges around hiring social workers.
“Telemedicine could be used in conjunction with a program like this to scale and force-multiply resources,” Erickson said. “There is a significant shortage of behavioral health professionals. In NYC, equipping the FDNY response vehicles with telemedicine support would allow fewer behavioral health professionals to cover several districts at once by removing the geographical barriers of travel."
Editor's Note: After receiving an additional response from NYC Health + Hospitals, this story was updated to include more details on New York City's B-HEARD program.