CESSA - Region 4 Committee Meeting Approved Minutes 02/21/2023

Community Emergency Services and Support Act (CESSA) Region 4 Advisory Committee

Meeting Minutes- Tuesday, February 21, 2023 - 10:00-11:30 via Zoom

Meeting Minutes - Approved by Members 04/18/2023

  • Call to Order/Introductions
    • Meeting called to order at 10:001am by Co-Chair Julie Brugger.
  • Members Present: Jeff Schafer MD, Dana Rosenzweig, Dave Fellows, Kelly Ann Jefferson, Steven Johnson, Brittany Pinnon-Becker, Joseph Harper, Cindy Wagner, James Hengehold; all members attended via Zoom and approved minutes.
  • Absentees: Deborah Humphrey, Amy Foster, Megan Black, Andrew Stein, Layla Simons, Timothy McClain, Dennis Perez and Randy Randolph.
  • Julie Brugger went over slides of The Continuum of Law Enforcement/Behavioral Health Responses and CIT
    • Questions or comments:
      • Joe Harper- Our local site for CIT Program Training for Illinois Criminal Justice Information Authority is not currently reporting E. ST. Louis PD as being listed, is this training an option of the department or is it required?
      • Police Chief Steven Johnson- The goal of every professional police department in this area is to have every officer CIT trained for all 40 hours of that training. There have been discussions that the Illinois Police Academies have increased the amount of time that officers go through training including that training within. CIT has put in all different aspects already in the training that they do, but it would be beneficial to have a certification. There are several departments in the area that have no officers trained in CIT, this is always funding. There are so many mandates for law enforcement officers for training that many departments struggle with the problem of how to keep officers on the street. The training is free through SILEC, however, the issue is when people are away at training, what staff is there to answer calls on the street? Bottom line, every professional department is working on getting every officer CIT certified.
      • Dana Rosenzweig- I think locally we need to take inventory of where our deficiencies are and how we can target departments. To assume that we have a fully functional CIT presence in the County is rather misleading.
      • Steven Johnson- This information can be obtained through SILEC, which is the Southwestern Illinois Law Enforcement Commission. They cover eight or nine counties in this area, and we would have a better number and would be able to gather all the numbers of certified officers. SILEC.org does offer the 40 hour class.
  • Julie Brugger covering slides of Co-Responder Teams.
    • Does anyone have any experience with Co-Responder Teams?
      • Steven Johnson- We have researched this for quite some time. We had San Antonio Police Department come give a demonstration a couple years ago. They did two different things, they had officers who were specially trained, dressed in plain clothes and were in an unmarked car that didn't look as if it were a police-type vehicle, and they went on all the mental health calls. Their findings were absolutely amazing. They had significant reduction in use of force, reductions in suicides, as well as reduction in repeated calls from the same person. It worked really well. Also on their free time, they would follow-up/check up on those individual to see how they were doing. We spoke with these 12 officers and they felt it really went well. However, with time and budgets, the unit was cut. It works but how do we get the funding?
      • Brittany Pinon-Becker- We had a short-term grant, EDA, where we partnered with Alton Police Department soon before Covid started. Unfortunately, right as we were getting to the point where we were doing ride-a-long's, we found some logistical challenges, as if a responder was at the police department and someone got a mental health call, logistically how would she get there without delaying the officers response or do the responders ride along for everything? With Covid happening, in the end, the responder started following up with the mental health related calls that were received and try to engage them after the fact. This wasn't what we were hoping to accomplish and unfortunately the grant ended, but we did see some good data come out of that in terms of reduced interaction with law enforcement and getting people engaged with services. We were able to give the police department resources in situations of this nature that we felt was beneficial.
  • Julie Brugger covering slides of the Alternative Response model.
    • There are five - 590 Response Teams in our region; Chestnut, Centerstone, Comprehensive, Hoyleton and Comwell. Each of these Mobile Response Teams has its own phone number where they can reached.
    • Chuck Kelley- from an EMS prospective we have very limited training in de-escalation and techniques to get people to go the hospital willingly. We can have a law enforcement officer there but when there isn't proper paper work, we can't take them against their will. There are many small volume departments that don't have a lot of staff. I do have Supervisors that are not on the ambulance full time that could respond to these incidents, to help aid the EMS crew in de-escalation if we were able to get the CIT training. This would help us release the officers sooner to get back to their jobs duties and let us handle the mental health care part of it. Mental health is a healthcare crisis in this nation. Some education from the EMS perspective, we might be able to add a level of response to it; bring in other individuals in the training other than just law enforcement. Can EMS get the CIT training from SILAC?
    • Cindy Wagner- I think one of the most critical pieces is where the will be housed. Is this as being one of the top issues being worked on right now?
    • Julie Brugger- the state has done a lot of work on someone to call, someone to respond. However, the somewhere to go piece of this is the piece that will require the ongoing and additional work to be done. Currently Chestnut has a Crisis Unit but access is limited by the number of beds. Call for Help has a living room model in the day. Centerstone is opening March 1st for internal referrals and April 1st external referrals in Carterville, IL. A place to house is absolutely critical. Some of these entities exist but they are not statewide and there just aren't enough of them.
    • Dana Rosenzweig- with the inadequacy of what we currently have, nothing is going to be developed in the near future to aid our efforts here. I think we need to proceed from a networking and co-ordination perspective, to think that we can impact resource development is probably very unrealistic.
    • Joe Harper- one of the things that needs to be looked at seriously, with the CESSA Act being passed, there has been very little communication of how this act is going to be dealt with. It states in the act that mobile crisis responders cannot prepare petitions. In the crisis business, roughly 80% of the calls received are not from the people voluntarily asking for services. Many of these people are very ill and they need to be treated immediately. Now the responsibility has been placed on first responders to do that. I don't know that there has been a process to train first responders about doing petition. I wonder if it has not put people at risk because there is not a mechanism to do that. Also, for training for our mobile crisis responders in terms of dealing with sometimes dangerous situations, we've asked about that and I've not gotten any response in that. DMH has looked at it and I think they referred it to UIC, as far as I know there has not been anything put together. This is a critical part of this. Some of the situations in which we are sending people, are dangerous. You can ask all of the questions you want, but sometimes you get a different picture when you get on the scene, then how do we get law enforcement and others to respond? There is a systemic breakdown in these systems interacting together. If we go to a scene as mobile crisis responders and there is no other resolution to that person going to a hospital and they don't want to go, if first responders don't know how to that, what are we going to do?
    • Chuck Kelley- That is the reason we are happy to transport to Missouri, once we are on the other side, I can sign that petition, in Illinois I cannot.
    • Joe Harper- Any citizen can sign a petition under the mental health code, you can't sign a certificate. I believe since they have passed this act that is something that is going to have to happen, there will have to be training of first responders how to appropriately do that.
    • Julie Brugger- it is a difficult process and our team has faced these issues in not being able to sign petition and not being able to achieve transport for clients that we truly believe require hospitalization in order to create safety.
    • Joe Harper- it is difficult to talk about how we are doing these things, these changes. It appears that it was just thrown out there for the people that do this work or it's their background, and having them deal with it. It is important that this is looked at.
    • Peter Eckart- the issues that you raise, are being raised across all of our regions. I would encourage you and the RAC leadership to continue documenting this as an issue that we can aggregate that issue so we can bring it back to leadership around CESSA.
    • Joe Harper- it seems that a lot the information and work that we are hearing about is crisis services and is geared more towards this being a person who is calling and asking for assistance. This is largely not the type of call we get. We get a call from the neighbor, the family member, the friend calling about someone who is acutely psychotic and doing behaviors that are threating to themselves or others. I think we need to look at this. We are talking about two separate services. The service where a client calls and wants to come and talk to someone in their office is a lot different than someone who is calling the crisis line. These are distinctly two different populations and it seems that hasn't been well addressed in the planning.
    • John Nowack- pulling the data to separate and analyze to see what type of calls we are getting is critical. The data is needed to find if it is truly a huge crisis or is it someone seeking to talk with someone? I think this is critical and will give us some ideas of what our region is up against. Our call volume with the assistance of behavioral issues has grown extremely.
    • Julie Brugger- collecting that data has begun. We have been discussing what we are experiencing in our area from the 590 standpoint. James Hengehold from PSAP is gathering information as well. Joe Harper has shared data for his area, there have been 485 referrals between 8/17-2/17. They have joined with the CERT Team in East St Louis which has special involvement with the Illinois State Police embedded at the E St Louis PD.
    • Joe Harper- The numbers speak for themselves. A large percentage of the calls we receive are children who are already in the ER, they've possibly been at home and the parent has called EMS or the parents have taken them to one of the St Louis based hospitals. No matter where they live in this area, if they are in one of the St Louis hospitals, we are the agency that is going to see that child for that initial assessment to decide whether or not hospitalization or other outcome is appropriate. Our concern is that we have had instances where the situation was deemed as being safe but upon arrival it was not, getting a response from law enforcement in these cases was difficult. We have also had other problems in other situations where a licensed clinician was on site, knew the history of the client and that they needed to go to the hospital, and being licensed, was ready to complete a petition certificate and was told that this would be kidnapping if they were transported. The CERT Teams do primarily major crimes, such as homicides. The CERT Team does assist the E St Louis PD, which is seriously understaffed. We have done quite a few things to try to assist but I feel there are some real deficits.
    • Steve Johnson- That is correct, E St Louis is always significantly understaffed and probably have only two officers per shift, with the highest amount of violence crime per capita in the entire nation. Just to note, EMS personnel, specifically ambulance personnel are able to attend the CIT training program through SILEC.
    • Chuck Kelley- We have a growing number of pediatrics to adolescents that is an underserved population for hospitalization in Illinois especially down state Illinois. I think it's important for the state, IDHS to know, we get requests from the family to transport their children over to the children's hospitals, as they are specialist for children. Once they find out that the child may be covered by some form of state managed Medicaid/Medicare, only to find out they have to find a transferring facility to send them back into Illinois and then they can only treat their medical needs and not their psychiatric needs because of some type of rule that they have. This needs addressed. This is an untapped resource here in southern Illinois. We have two wonderful children's hospital and they can't do anything to help even if they have beds because they cannot treat them because of their insurance coverage.
    • Brittany Pinnon-Becker Centerstone is currently providing a mobile crisis response team as we are available to. We had a difficult time in recruiting for that position and last month were at about 30% mobile crisis response team. We are onboarding a couple more.
    • Julie Brugger- Chestnut Health Systems has responded to 724 requests for face to face crisis assessments in the past six months. 384 have been in Madison County, 340 in St. Clair County. In looking at these numbers, as Joe stated, many of these calls were concerned individuals calling for others experiencing symptoms of psychosis. In some of these cases it was the client but many times it was not. We too have had the experience of not being able to secure transport to hospitalization. Now we are in the situation where anyone in the state of Illinois over the age of 18 can write a petition unless you are the crisis responder, this is difficult to work through as well. Comwell reported 70 crisis responses, Hoyleton reported 77 in the past six months.
    • James Hengehhold- Police departments are required to report to the UCR for mental health situations responded to. In reaching out to the state to get that data, the numbers are not going to be 100% accurate to what we respond to. I am still waiting for the state to give me that information. I believe they are waiting for the law makers to see them first. As the Edwardsville PD last year, we responded to 104 CIT cases. These calls would be from self-reporting, from Centerstone or the VA. What was aptly pointed out was, the hidden mental health issues, the domestic issues, the things that have an underlying tone of mental health that may not be titled as such, are going to be the fall in the cracks. This makes a real issue with getting the real numbers. It will be difficult to reach out to every PSAP's or law enforcement agency in Region 4 to get accurate numbers probably in a timely manner.
    • Julie Brugger- Dave Fellows was able to share that 43 of our 79 law enforcement agencies in our district have CIT Officers and there are 296 of them trained.
    • Chuck Kelley- MedStar in 2022 responded to 2235, 911 emergency calls. Our average is 211 per month of behavioral health calls.
    • Peter Eckart- Cindy Barbella-Brelle will be contacting the PSAPs to reach out to the law enforcement agencies to gather data and then pass on to RAC's. The tool kit and process for the regions to collect the needed data was discussed. Agenda discussion for the next meeting will include the Risk Assessment Matrix.
    • Dana Rosenzweig- The slide presentation from DHS is fine, but doesn't reflect that we are dealing with a broken system. Not only to we have to know who we send, we have to get together with logistics in terms of how do we complete the paperwork, how do we facilitate involuntary admissions, this is a real problem currently. We can map all of this out but we can't be delusional in believing we have alternative resources that we are not currently using; we can plan this out, but if we don't have a system and assistance from the state in addressing us with our problems such as passing legislation that doesn't allow crisis responders to fill out petitions, this is a real issue. I think our agenda needs to be modified to address our local issues and concerns and work on that, not just following the DHS presentation with no staffing support.
    • Julie Brugger- it is very important, we have to address who is going to complete the paperwork. Hospitalization is absolutely necessary in the acute cases, where safety cannot be provided in any other way.
    • Steve Johnson- When CIT training came about it was very beneficial, the police officers were trained and they did the best job that they could. However, when the officers would arrive at the hospitals, the hospital staff would state that they were not familiar with the CIT paperwork and would suggest that the officer stay there the whole time with the patient; this is an issue. Law enforcement need to return to their rolls on the street.
    • John Nowack- This issue is still being dealt with today.
  • State Updates: Currently at the state level, they are working on preparing the process of who to send when these crisis calls comes in.
  • Next Meeting Date: March 21, 2023; 10:00-11:30 am. Subsequent meetings will be held at 10:00 am on the third Tuesday of each month and are scheduled through June 2023.
  • Public Comment
    • The floor was opened for public comment and there were none brought forth.
  • Julie Brugger made motion to adjourn, Dana Rosenzweig made first motion, James Hengehold seconded. Meeting dismissed at 11:30 am