Sheriff Fred Lamphere of Butte County, South Dakota, was blunt: “This is our future. We can’t fight it. My initial impression was ‘no one is going to talk to a box’, but, we all talk to boxes, don’t we?”
He was talking about his department’s successful experiment using tablet technology to bring mental health practitioners to people in crisis, no matter how small the town or remote the setting.
“Honestly, I can’t say enough about it,” he said, and I was surprised, in a good way. Technology is often proposed to fill gaps in rural policing; then it runs into reality in the form of long distances, rough geography, sad budgets and bad internet service. Skepticism has become my default. Virtual Crisis Care as provided by Avel eCare seems to be a welcome exception.
Overcoming obstacles in rural mental healthcare
Brian Erickson, vice president and general manager for Avel eCare’s Behavioral Health and Specialty Clinic, explained the program’s roots and how it works.
It was first tried in 2019 in Brookings County, South Dakota. The proof of concept established expansion into a pilot program with an additional 17 sites including probation. The idea was to overcome the obstacles to mental healthcare in rural communities, from a dire shortage of mental health practitioners to the strain on local law enforcement created by long travel times.
The program supplies iPads with cellular data packages to law enforcement agencies for a flat monthly fee. The tablets are used for video calls between mental health practitioners and people in crisis, providing real-time access to counseling, often without even leaving the caller’s home. The responding officer initiates the call between practitioner and citizen, for an assessment that takes about 25 minutes. According to Erickson, eight out of ten subjects work out a safety plan with the remote counselor with follow-up in their own community. This avoids trips to the hospital emergency department, or worse, to jail.
Avel eCare is a virtual hospital, with behavioral health just one of its service lines. Therefore, practitioners are available to law enforcement personnel and potential patients, 24/7. Before a county implements the program, Avel eCare works with them to root out potential problems with cell coverage and dead spots, and find solutions.
Funding for rural teleheath care
Funding has been provided by several sources, easing the demands on law enforcement budgets. South Dakota calculated grant funding contributions based on cost avoidance and downstream savings. Further funding from the CARES Act and the Helmsley Charitable Trust covered most of the initial costs, and some of the grants are renewable.
Besides South Dakota, Oklahoma has embarked on a similar program and Nevada is researching one. Erickson expects remote mental healthcare to expand beyond use by patrol officers to SROs and campus police and in jails.
For Sheriff Lamphere, remote crisis care in the jail won’t be a concern. Butte County, which covers more than 2,000 square miles bordering Montana and Wyoming, doesn’t have one. The county’s inmates are transported to Sturgis in the next county over, but an already-tight budget isn’t spared by not having a jail. Instead, the costs go to paying Meade County to house Butte’s inmates, and to transport costs every time his deputies have to take a new arrestee for processing or bring one back for court.
Tech offers substantial savings
The last, worst option for a detainee in a mental health crisis is isolation in a jail cell, presuming one is available; the virtual crisis care system has reduced the number of in-custodies Butte County maintains, for substantial savings. Where he used to have 20-30 inmates housed in Sturgis, there are now perhaps 10. Lamphere says the system has reduced committals to out-of-area mental health beds by 30% to 40%, also notable savings since the nearest mental health beds are in Rapid City, 65 miles away and they have only 12 beds. When those are full, the next best bet is in Yankton, a 400-mile round trip.
“Each county has its own mental health board in South Dakota,” Lamphere explains. “It takes hours for the review and approval just to order an evaluation. That’s after the contact with the person in crisis. So a deputy’s been dealing with a contact for what, maybe seven or eight hours, then waits for a review and referral for a bed, and then gets in a vehicle at three in the morning for a transport? From a management perspective, there’s no way that’s safe.”
Not to mention, expensive.
There’s no handing off a difficult case to the next shift in a small, rural agency either. Lamphere has only five deputies when fully staffed; right now he has four, and none who have been there for more than two years.
“Two are laterals, and two are super fresh,” he said. While that made acceptance of the remote crisis care system “a done deal” since it was in place before any of the current deputies, it means both people and time are always in short supply. In the case of an aggressive subject in need of a mental health bed, a transport to far-away Yankton could require two deputies – half his patrol staff – taking them out of the field for hours, entire shifts if they hit a blizzard on the way. If a trained professional can instead meet that person in crisis where they are, and figure out a safety and treatment plan right then, where could the downside be?
“Mental health calls are going up, as more people are trained to recognize symptoms,” Lamphere said. “It’s a sad aspect that some suspects are breaking the law because of addiction and mental health issues, but we must safeguard victims as well. This tool is a positive change; jail numbers are going down and victimization is going down. When I talk to our taxpayers, they ask, ‘Why didn’t we do this sooner?’”
Few of the obstacles that were originally expected have materialized. The deputies needed no specific training to use the system. It’s been mostly well-received by citizens in crisis who want help, and don’t want to leave their homes for distant hospitalization, or jail. Cell service has been adequate, sometimes aided by cell boosters in patrol cars. In some cases, the tablets have simply connected to the subject’s home wifi.
And the costs, when grant funding expires? “I can accept the cost because it’s saving money on committals, on transportation, and in the jail population, “ Lamphere said. “This is a great program. I see it continuing to grow in the future.”
