BJ Wagner, vice president of public health and safety at the Meadows Mental Health Policy Institute, has been instrumental in bringing a new way of responding to behavioral health emergencies in his state of Texas. With decades of experience in health and public safety, he specializes in the intersection of behavioral health and justice systems, with a particular focus on emergency response models.
One of the models that Wagner helped create is the Multidisciplinary Response Team, which was first tested in 2018 in Dallas. This community paramedic model takes the first approach to emergencies with mental health or substance use disorders, with licensed mental health professionals. paramedics, and specialized law enforcement officers who often respond to the health care or social needs that often prevail in these situations.
This interview has been edited for clarity and length.
Q: Can you tell us how you and your team created the Multidisciplinary Response Team model?
A: We started talking to over 500 police officers and started organizing discussion groups in Dallas County. We asked these officers what they were up to when they were responding to a mental health emergency, and we heard over and over again that they had no medical help.
Paramedics, meanwhile, say the situation is sometimes unsafe and therefore they cannot provide medical care. Law enforcement agents and paramedics also stress that they cannot provide immediate access to mental health care. And that’s why it was important to include a behavioral health doctor in the solution.
So we started thinking about mental health emergencies and started looking at how they develop in their most critical phases. We have combined these three professions (law enforcement officer, paramedic, and behavioral health physician) to provide access to treatment and services for people who may be at risk for public safety or who may be unpredictable while having a mental health emergency. As people with mental health emergencies do without creating public safety hazards.
We tested the program in Dallas and saw immediate success. That’s when we started spreading that program to other areas of the state.
Q: What were some of the initial reactions from stakeholders, such as law enforcement, paramedics and community behavioral health experts, and community leaders?
A: There were some setbacks. We heard a couple of things. One, it may appear to be a very expensive program, especially for smaller communities, as this approach includes a specialized three-unit team, which includes licensed behavioral health professionals and paramedics along with mental health emergency police. So cost will be a challenge when we look at it from an employee perspective. And then we also hear the opinion of these three professions: “Why do we all have to be together?” You personally have three people I call the alpha of their professions (usually highly qualified and accustomed to being in charge) in one patrol unit at a time.
So the setback was internal to the area, not necessarily to the community. Paramedics were not very accustomed to responding to mental health emergencies, and law enforcement was not really accustomed to being assisted by civilians, such as behavioral health specialists, who responded to high-risk volatility calls. A lot of people’s buying was done by a traditional crisis response team or by law enforcement and doctors responding to an emergency together to do something different.
Q: How did you change your culture to get that purchase?
A: A change of culture does not happen overnight. We had about a year of planning in Dallas, including talking to outside law enforcement professions. We had to work with paramedics to help see mental health as an immediate medical need. We also had to make sure that there were security measures in place so that these groups could respond to calls that posed a high risk to public safety.
Then we moved the model to other areas of the state, which in itself was a cultural change. We had to reduce the Dallas identity of the program to be able to move to more rural areas, such as Abilen.
Q: What role do you think the state and local governments can play in ensuring the continued care of people suffering from mental health emergencies?
A: I believe that local government is primarily concerned with analyzing the needs of their individual communities and ensuring that there is ongoing attention. It is also important that local hospitals, community behavioral health experts and the police are deeply involved in these conversations and that these stakeholders are talking to each other.
And I believe that our state needs to make resources available not only for staff, but also for vehicles and other equipment for this health-based approach to really work. The state should ensure that people suffering from a mental health emergency can receive care in hospitals or treatment centers, and can also connect to the needs of other social services such as housing, substance use care and care based on trauma information. I don’t think state governments in general can order a uniform service design across the state that might be useful in a large metropolitan area because it is not useful in a small rural area. But the state must ensure that resources are available for people living in its state.
Q: In recent years we have seen a change in the way we talk about mental health crises in this country. What do you think we are achieving, and what do we still need to work on?
A: One thing we are doing well is we are talking about mental health in the health field. It is part of the regular health insurance services in most cases; when you go to your first doctor’s office, you know they’re going to ask you some health questions. It’s not something we whisper anymore, and it’s not something we’re talking about in conversations. Mental health is becoming part of a person-centered approach to providing health services.
We still have to debate — whether we have had it for a long time, or in the last year or a half, or what has increased — whether we need a law enforcement response, on the one hand, or a civil response. on the other hand, to a mental health emergency. And it encourages me to see some communities discussing “and” about “or” about a law enforcement response. and a civilian response that includes paramedics and behavioral health experts, so we have a whole mental health emergency ecosystem that fits the direction of care. But we have a long way to go to bring “and” everyone into the conversation, so we don’t rule out a section of the population in response to law enforcement because we don’t understand what their mental health emergency looks like. The question “Why did we send law enforcement to this mental health emergency?” “Why did we send law enforcement to that mental health emergency?”