It can be easy to have a poor perception of law enforcement.

Every day, police officers are tasked with responding to complicated calls related to individuals in the midst of mental health crises, and community members are inundated with horror stories in the news and on social media of those interactions going wrong.

We have stories like that in Summit County, too.

When it comes to the intersection between law enforcement and mental health, few have a better understanding of what’s at stake than Breckenridge resident Travis Bickford. His wife, Jacqueline, was arrested in April 2016 on charges of child neglect. He said she was suffering from a severe bout of postpartum depression, and he’d taken her in for mental health evaluations several times in the final months of her life.

In jail, Jacqueline was evaluated by a counselor and cleared for placement in the general inmate population. Bickford said he knew his wife was suicidal, so he decided to let her stay in jail, thinking it would be the safest place for her while he and her family worked to get her into a mental health facility.

Five days after her arrest, she attempted suicide in her cell and later died from her injuries.

“The entire system failed my wife, myself included,” Bickford said. “… The police failed her by arresting her instead of bringing her to a mental health institution, the hospital failed her by not recognizing that she had a problem … and I failed her, too, because I didn’t do enough.”

Longtime Summit County residents have likely heard Bickford’s story before. This is the next chapter: A community, and the law enforcement agencies that serve it, coming together to try to make sure the tragedy is never repeated.

With the emergence of the Systemwide Mental Assessment Response Team and the Strategies to Avoid Relapse and Recidivism program, Summit County is at the forefront of a growing nationwide shift to change the way law enforcement handles mental health related calls.

A broken system

At the center of the shift is Summit County Sheriff Jaime FitzSimons.

FitzSimons began his career with the Los Angeles Police Department in 1990, during a time in which the systematic deinstitutionalization of individuals with mental health conditions was creating a robust homeless population with untreated illnesses.

“Back then, there was none of that awareness,” FitzSimons said. “People were on drugs and alcohol, it was the crack heyday, there were mental health issues, but there was no real separation of what’s what. … It was more about crime fighting than trying to find the root of the problem.”

It’s an experience he held closely in his eventual move to Summit County and ascent up the law enforcement ranks, when the county’s limited mental health services began to unravel: The provider contracted for crisis services wasn’t living up to the agreement, the emergency room was overburdened with patients in crisis and the month before he was named sheriff, Jacqueline Bickford died by suicide while in custody.

“I started to realize how broken this system really was,” FitzSimons said. “At the same time, there was this great interest in Building Hope to change things on a community level, and I saw it as an opportunity to change the way law enforcement responded to crisis in our community. … Law enforcement will never get away from these mental health calls. So if we just understand that, then how do we then build the best law enforcement response?”

In comes the Systemwide Mental Assessment Response Team, or SMART, a group of clinicians, case managers and specially trained deputies called technicians who are among the driving forces behind the county’s efforts to improve crisis response. The team’s philosophy is simple: Having mental illness isn’t a crime and shouldn’t be treated as one.

The program launched in January 2020 under the umbrella of the Summit County Sheriff’s Office and today is in the process of launching its third and fourth teams. By October, the teams should be conducting crisis response 20 hours a day, seven days a week, according to Lt. Daric Gutzwiller, who oversees the program.

Teams include a plain-clothed technician and clinician, who roam the county in an unmarked vehicle listening to a police radio. They’ll frequently respond to calls that sound like there could be a mental health issue involved as well as at the request of dispatch or another police jurisdiction. The inconspicuous response is meant to help de-escalate the situation and ensure patients aren’t left embarrassed by a visit from police in front of their neighbors.

The new breed

Summit County deputies have taken mandatory crisis intervention training since 2014, but SMART technicians are required to go through an additional seven-week course, which includes training on the legality of mental health holds, nonverbal communication, behavioral health assessments and more. They’re considered significantly more equipped to handle a crisis response than an average police officer, and their training in law enforcement helps to ensure a safe environment for the patient and clinician.

“For about five years before working here, I did mobile crisis by myself, so responding without police,” clinician Andrew Brottman said. “But … if anyone had a weapon, I couldn’t go. But now, for example, (technician Micole Kotz) and I had a call a couple months ago where a juvenile had a knife to their neck. … That would have been a call where I would have had to leave before. But thankfully, having Micole there, we were able to make sure the scene was safe, deescalate, get her to put the knife down and get her to treatment.”

SMART’s goal is to stabilize someone in place, not incarcerate them. Gutzwiller said there’s been only one arrest since the program’s implementation, which involved an individual with an active warrant. Through June this year, in nearly 200 SMART responses, fewer than 15 individuals have been placed on any type of mental health hold.

There’s value in helping someone stay in the community. According to data provided by SMART, the typical cost of a mental health call can be upward of $15,000 for ambulance transport, hospital bills and more. That doesn’t take into account the potential of a lost job or other life-altering impacts while incarcerated. The cost of a SMART stabilization is usually around $1,100, which includes six outpatient treatment sessions and continued case management.

“I’ve put people in cages for 20 years,” Gutzwiller said. “I’ve seen that it doesn’t always work. It’s not at all what we’re trying to accomplish here. There are other avenues besides traditional law enforcement showing up to investigate a crime and put someone in jail. I think the more that people see that, the more they do have interactions with us, the more trust there is in our community.”

Avoiding the next mistake

Of course, people sometimes do get arrested.

That’s where the Strategies to Avoid Relapse and Recidivism program comes in. It was established in 2019 and was brought into the Sheriff’s Office operations in 2020. It serves as a counterpart to SMART, with a lieutenant, clinician, psychiatric nurse practitioner and case manager providing mental health services to anyone in the jail who requests it.

Employees say treatment offerings go above and beyond what an inmate in other county jails would typically see, including group and individual therapy in English and Spanish, medication assisted treatment, eye-movement desensitization and reprocessing, long-acting injections of anti-psychotic medication and more — all for free.

The goal is to ensure that individuals can get adequate treatment in jail and after their release so they won’t reoffend.

“By providing all the services that we do, we are hoping that these people will actually stop coming to jail, that they’re able to find a job, find housing, get therapy outside or food assistance with human services,” Lt. Sylvia Simms said. “… We want to make sure that even though this time they made a mistake, even if it’s their 10th mistake, that there won’t be a next mistake.”

Simms said about 60% of inmates take part in the program, whether that’s case management, mental health care or some combination of the two. In jail, the normal barriers to treatment like cost and time are eliminated, meaning clinicians can provide therapy sessions of up to two or three hours without worrying about patients’ schedules or insurance.

“This is an environment that paradoxically can be a great fit for starting therapy,” clinician Gabe Lynch said. “A lot of our clients are typically not in a stable housing situation. They typically don’t have a stable food situation. Many of the realms of their life that feed into a quality therapeutic experience don’t exist. While they’re here, not only do they have some free time where they don’t have to go to work or take care of kids … but they’re also in a relatively safe, stable place where they can really focus on their treatment.”

Continuing care

The job isn’t done after a client is stabilized or released from jail. Both programs have case managers whose job is to ensure individuals who come into contact with law enforcement have the resources necessary to access continued treatment.

The work goes beyond therapy, as the case managers take a holistic approach in helping patients make plans to deal with stress on their own, direct them to community partners and more. They’ll often keep in touch with clients well after the initial contact, whether it takes months or even a year to make sure they’re staying on track.

The jail’s program will also release inmates with food and hygiene items, bus tickets, clothes and even things like cellphones and bicycles when available.

“If somebody doesn’t have enough food or doesn’t have shelter, therapy is not their first priority,” SMART case manager Scott Bradley said. “We try to present them with a package of solutions. We’ll walk through a process with them and say, ‘First we’re going to do this, then this, then this.’ Just setting forth a plan can help reduce an individual’s stress tremendously. Therapy is part of that, but it’s not all of it.”

Case managers also work with clients to ensure they have the know-how to take full advantage of available resources.

“For some of them, it’s the hardest thing to do in the world,” Strategies to Avoid Relapse and Recidivism case manager Mili Arana said. “I educate them how to be in contact with FIRC or how to make an appointment with a mental health provider in the community. … When they’re released, sometimes they’re on their own, so we want to make sure they learn those skills.”

The improvements that local law enforcement have made within the realm of mental and behavioral health response don’t exist in a vacuum. FitzSimons and his teams agree that the work they do would be impossible without Building Hope Summit County, the Family & Intercultural Resource Center, the Summit Community Care Clinic, local faith organizations and countless others that have dedicated themselves to improving the county’s mental health infrastructure.

A community of support

In order for things to get better, it takes the entire community willing to buy in: compassionate law enforcement officers who genuinely want to help people, support staff who understand the difficulties of mental health navigation, widespread efforts to improve access to treatment and human services, and a community willing to educate themselves on when crisis intervention is needed and how to get help.

“I built this from the community up, not from the sheriff down,” FitzSimons said. “… Without community support, this wouldn’t be successful. It’s those stakeholders and our team’s ability to reach out across the county to different organizations and say, ‘This person needs a pair of boots and a jacket.’ And someone goes, ‘I have the jacket,’ and someone else goes, ‘I have the boots. What size?'”

Officials hope programs like these could serve as models to help other agencies establish or improve their own programs built to suit their community needs.

“I personally see this type of program catching on like wildfire across the nation and becoming a part of police departments everywhere,” SMART technician Brian Lemick said.

There’s always room for improvement, and officials said they’ll continue to refine these programs as community needs evolve.

But things are getting better, Bickford said.

“A couple months ago, I finally broke down,” Bickford said. “I felt like the weight of the world was on me. I was thinking about the loss of my wife, the lockdown from the pandemic. … I called 911 and said I didn’t feel OK. And it was game on. I was immediately taken to the hospital, and I was evaluated. I was sent to a facility, and the crisis team contacted me immediately and Building Hope took over — everything I wish was in place when Jackie passed.

“I’m going to therapy and getting help and doing tremendously better. … My experience just tells me that a lot has changed for the better.”