REGIONAL—Mental health-related incidents continue to rise in Sioux County, and the first to respond often are law enforcement officers.
“It’s falling into law enforcement’s laps more because the funds aren’t available,” said deputy Jessica Dorhout of the Sioux County Sheriff’s Office based in Orange City. “We’re closing facilities in our area, and we don’t have the resources that maybe we used to.”
Rural communities in Iowa face a critical shortage of mental health-care providers. Since 2007, eight nonprofit Iowa hospitals have permanently closed their inpatient psychiatric units and in 2015, former Gov. Terry Branstad closed two of the state’s four mental health institutes. Of the beds that remain open, only a portion are staffed, a product of personnel shortages and financial challenges.
As mental health-related calls continue to rise in Sioux County, the sheriff’s office has responded by mobilizing a Mental Health Unit. The team of five officers will receive ongoing specialized training in crisis intervention, suicide prevention and strategies for identifying and responding to individuals with psychiatric disorders.
“Law enforcement isn’t a mental health service, but we’re the first ones who are called a lot of times to respond to it,” said sheriff Jamie Van Voorst. “We’re kind of quasi-mental health professionals without the master’s degree, and so we have to kind of figure things out on the street level.”
The unit is part of Van Voorst’s vision for increasing his department’s ability to respond to situations that involve mental illness and other mental health-related issues, a growing concern for law enforcement officials who increasingly are called upon to address situations that exceed their official training and expertise.
“Mental health in general is becoming more and more of an issue in society,” Dorhout said. “I don’t know if it’s due to social media or what it’s due to, but as officers, we’re most definitely more aware — it’s here. And it’s affecting our job.”
Orange City Christian School sixth-grade students Rebecca Oordt and Adaley Foreman pet McGrath, a therapy K-9, next to his handler, Sioux County deputy Jessica Dorhout. The duo is part of the Sioux County Sheriff’s Office’s newly formed Mental Health Unit, a team of five officers who are receiving specialized training.
Aleisa Schat
[email protected]
Van Voorst said the trend may partly be due to growing awareness and acceptance of mental health as a category of concern.
The sheriff initially planned to designate a single mental health officer, and at the time, Dorhout was the clear choice for the role.
“The original vision was one very well-trained deputy to do the work,” said Sgt. Brad De Kam.
Dorhout is one of the county’s two school resource officers, and she had completed extensive mental health training to equip her to respond to calls involving sexual assault.
Furthermore, in August she became the handler of the department’s first certified professional therapy K-9, McGrath. The yellow Labrador is one part of Van Voorst’s vision for increasing his department’s ability to respond to situations that involve mental illness and other mental health-related issues.
“There’s not a lot of law enforcement agencies using therapy canines yet, but they are popping up all over the state,” Dorhout said. “With the data and everything out there, we’re seeing them as a good resource.”
Evidence suggests therapy canines can be effective in de-escalating potentially violent situations, including situations that involve mental illness or other mental health concerns. Animal-assisted interventions are becoming increasingly popular in policing, and they are sometimes used in courtrooms or witness interrogation rooms, where they can provide comfort, increase memory recall and relieve stress in the wake of a traumatic event.
McGrath provides a calming presence that can help de-escalate potentially volatile situations involving threats of self-harm or other mental health-related issues.
“There are studies about therapy canines and how they bring people down from an escalated state of mind,” Van Voorst said. “When they’re agitated, it could calm them down.”
‘It’s not a job for one’
Before McGrath joined the force, Van Voorst had already publicly stated his goal of designating one mental health officer to serve the county six months earlier. Over the course of the year, however, his vision for the unit grew to include a more robust group of specially-trained officers, increasing the odds more than one member of the unit would be on duty or on call when specialized skills and training would be beneficial.
“We realized it was kind of a bigger task than one person would be able to probably handle,” Van Voorst said.
“Knowing how our mental health calls have grown in the last even five years, I would say that it’s not a job for one person,” Dorhout said. “To best serve would be if we had a unit itself, where we had multiple people that could respond and or have multiple people available if one person wasn’t available.”
The members of Sioux County’s new Mental Health Unit receive special mental-health training to help respond to the rise in calls related to mental health in the region.
Photo submitted
Van Voorst said mental health-related calls have increased dramatically over the years, although pinning down accurate numbers is difficult given inconsistencies in the way data has been tracked by the agency over time.
“Back in the early ’90s, we logged maybe 10 to 15 mental health-related calls a year — 15 is probably a safe number,” he said.
As of late last year, that number was more like 125.
In September, the vision for the new unit grew to include three or four officers, but this year, a team of five is in place and beginning to undergo extensive and ongoing training.
“All of our deputies have mental health training, we just have happened to have additional training,” Dorhout said.
Along with De Kam and Dorhout, the unit includes deputies Seth Maitlen, Zach McKee and Jose Mora, a 16-year veteran of the sheriff’s office who is bilingual, fluent in English and Spanish.
“We definitely thought we needed that component,” De Kam said. “We’re negating an entire community without it.”
‘To help these people’
The five members of Sioux County’s Mental Health Unit recently completed suicide-prevention training offered by Spencer-based Seasons Behavioral Health. However, they attended their first training together last July, when the group spent a week completing a 40-hour crisis intervention program tailored specifically to the needs of law enforcement officers.
“Most mental health training that we go to is just a general mental health thing that can encompass lots of different groups,” Dorhout said. “But this was specific toward law enforcement and what we can do in our capacity as law enforcement to help these people in a mental health crisis.”
De Kam went into the training session eager to learn, but he had misgivings.
“Being told to go to five days of mental health training — I knew I wanted to be a part of this group, but it did seem daunting,” he said. “A lot of times cops get more excited for, ‘OK, how many bullets do I need to take to train?’ But really, I think it had us interested and excited the whole time.”
Developed by SolutionPoint+, the crisis intervention training program for law enforcement officers emphasizes treatment rather than incarceration, a constructive approach that reflects the inadequacy of a crime-and-punishment approach when mental health-related concerns are a factor.
“The program originated down in Texas,” Maitlen said. “They were seeing an overwhelming number of critical incidents — people needing help that really weren’t getting the help that they needed.”
He said one of the program’s most effective activities were role play scenarios, which took up a significant portion of each of the five days. The scenarios included trained role players, and they were designed to give participating first responders experience in employing strategies they were learning in a simulated crisis situation.
“You would get feedback on what you did well, and things that could be worked on or tweaked a little bit to better connect with the person in crisis,” Maitlen said.
Sgt. Brad De Kam talks with deputies Jessica Dorhout and Seth Maitlen, members of the Mental Health Unit for the Sioux County Sheriff’s Office as therapy K-9 Mc-
Grath performs a stretch in Orange City.
Aleisa Schat
[email protected]
Each law enforcement officer was assigned another trainee as a partner and the team collaborated to mount an effective response, responding to new developments in real time.
“With the practicals, where you ran the scenarios, it was like, ‘All right, this is what we taught you — do it now in a stressful live-scene scenario,’” De Kam said.
He said mental health awareness and training has changed policing for the better, equipping officers to respond with a variety of interpersonal strategies that in some crisis situations may lead to better outcomes than the use of force.
“We typically get trained to command a presence — be strong, be loud, you know, basically take over what’s going on here. Whereas in a critical incident, where there’s an individual in crisis because of a mental health issue, that might do the exact opposite of what you’re hoping to accomplish,” De Kam said. “It’s still using a safe approach, but at the same time, maybe lowering your presence a little bit, looking less becoming and trying to gain cooperation that way, versus, ‘I’m here. I’m a law enforcement officer. I need you to do what I’m telling you to do.”
Maitlen said he has begun to employ some of the softer skills he has learned through crisis intervention training in other policing situations, too, including routine traffic stops and witness interviews.
“Active listening is probably the biggest take-away that I apply to every conversation I have,” Maitlen said. “Just repeating phrases that they’ve said, paraphrasing, summarizing — to just make sure they feel like they’re actually being heard. That you care about what they’re saying. Which is huge in critical incident — but everyone likes to know that they’re being heard.”
‘Take one step at a time’
In some cases, a softer approach to policing is more effective, but part of discerning which approach is appropriate is being able to distinguish between the behavior effects of illegal drugs and the symptoms of severe psychiatric disorders. During the Mental Health Unit’s weeklong crisis intervention training program, they learned to identify symptoms and behavioral patterns that are consistent with a variety of psychiatric diagnoses.
“They went over like a series of different types of mental health disorders, and being able to recognize the signs and then being able to maybe address those mental health disorders according to what we think we’re seeing,” Dorhout said. “Obviously, we’re not mental health therapists — we’re not at that level. So, we can’t diagnose, but we might recognize some signs of, ‘Hey, this might actually be a mental health issue, versus somebody is high on something.”
De Kam said he has become more likely to consider whether mental illness is the cause of an individual’s erratic or abnormal behavior and less likely to jump to the conclusion that the person in question is under the influence of drugs.
“It used to be that the go-to: ‘Oh, they’re on meth. That’s why they’re acting this way.’ And that’s not always the case,” De Kam said.
Responding to someone with schizophrenia, for example, requires a different protocol than responding to someone who is experiencing hallucinations related to cocaine use.
“It’s trying to approach it as a mental health issue, and then being able to point it in the right direction,” Dorhout said. “Sometimes that’s just about getting them to take one step at a time with you.”
Another tool in the unit’s tool belt is McGrath. The unit is still in its infancy, but Dorhout said the Sioux County K-9 has already been used effectively during critical incidents.
“We have used him in crisis situations,” Dorhout said. “Some of the ones I’m thinking of, it’s like a family crisis situation. I can’t say that it’s been at suicidal person call.”
“We’ve even wondered whether that would be appropriate — it’s such a hot scene,” De Kam said. “We’re still kind of even figuring out when it’s best.”
‘Educating our officers’
Once peace officers leave the scene of a critical incident, there are others who step in to provide follow-up care. Sioux County’s new Mental Health Unit will strengthen the agency’s already existing partnership with Seasons Behavioral Health, which offers mobile crisis services in all four counties in N’West Iowa.
The Seasons crisis team arrives on the scene when officers determine expertise in mental health care might lead to a better outcome for everyone involved.
“They can kind of make a determination of, ‘Hey, this person needs follow-up treatment or follow-up appointments,’ or, ‘Hey, this person maybe needs to be committed,’” Van Voorst said. “That’s been really, really helpful to us and that frees up a lot of the patrol deputies. If the Seasons person feels safe, then we can leave them at that call.”
The sheriff’s office relies on follow-up services from other county and state providers, but De Kam said he and his fellow officers have begun to prioritize making more follow-up calls of their own, too, including after traumatic incidents like a car crash, which often involve not just first responders, but other witnesses.
“We have a lot of people that witness traumatic incidents — cops do, EMTs do. We have a debrief with these people, and we talk it over together. And typically, I think that helps most people work themselves through it — and maybe you can identify those that are still struggling afterward,” De Kam said. “But one thing that we never thought about was, ‘What about the first person that comes up to a car wreck and sees the worst thing they’ve ever seen in their life?’”
Whether it is a debriefing after a traumatic event or a suicide-risk intervention, Dorhout hopes her team of law enforcement officers will help address the gap created by a critical shortage of mental health care providers in the state.
“That’s what we’re hoping for — we’re hoping to address the gap. Law enforcement is changing in some of its capacity, and we’re educating our officers more so that we can better serve our communities,” Dorhout said.
De Kam said the new strategies he is learning along with the members of his unit are not foolproof, but he believes they have improved his effectiveness as an officer of the peace.
“When there’s success, it feels great. One time, we were able to talk somebody out of the house that was adamant about harming anybody that came toward the house,” De Kam said. “When you do something like that, it’s an awesome feeling. Because we know which way that could have gone.”
