Who can you expect to show up when you call for help in Madison?
Illustration: A yellow phone is shown against a red background. A thought bubble emerges from the phone, with a medical cross symbol inside it. Illustration by American Trash.
In the wake of the historic Black Lives Matter protests of 2020, plenty of ink was spilled about ways to decrease contacts between police and marginalized people. As we’ve seen clearly, even here in Madison, mental health crises can escalate into violence and death when armed police get involved. One of the models that addresses this problem is the CAHOOTS-style pre-hospital mental health crisis intervention model, with teams that have been active in Eugene, Oregon since 1989. Now, both the City of Madison and UW-Madison have begun experimenting with pilots of these so-called “co-responder” programs.
The City of Madison’s Community Alternative Response Emergency Services (CARES) program started taking calls in September 2021. Ché Stedman, the assistant chief of medical affairs for the Madison Fire Department, told Tone Madison that the goal of the program is to “provide more appropriate intervention for our citizens that are having behavioral health crises.” CARES staff have worked with the Dane County 911 dispatch system to send non-violent mental health crisis calls to two-person teams composed of mental health experts and EMTs, who are currently based out of the Williamson Street fire station. Stedman said planning for the pilot program was a wide-ranging collaboration between the Fire Department, Public Health Madison & Dane County, the Dane County 911 dispatch, the Mayor’s office, the Madison Police Department mental health team, Journey Mental Health Center, and other providers. Consulting with co-responder teams in other places, like CAHOOTS in Eugene and STAR in Denver also helped CARES get rolling quickly—although emergency services are governed by fairly specific rules in Wisconsin administrative code.
The University Health Services (UHS)/UW-Madison Police Department (UWPD) co-responder program started in October 2021. UHS Mental Health Services director Sarah Nolan said via email to Tone Madison that the program’s goal is “to ensure that students dealing with a mental health crisis that would historically be responded to by police is responded to by mental health clinicians.” However, these co-responder teams are still sending out a UWPD police officer along with the UHS mental health expert. Some calls to UWPD dispatch get “qualified” for this co-responder program; Nolan told Tone Madison, “That determination is made by UWPD using a protocol developed by UHS and UWPD that is based on similar programs elsewhere.” UWPD did not respond to requests for comment.
Models with and without cops
One major difference between these two programs is obvious. UHS arrives with a mental health worker and an armed police officer in uniform, while CARES arrives with two people in plain clothes.
The schedule and scope of these programs vary as well, though they cover some of the same ground. Josie Montañez-Tyler, a crisis specialist with UHS, told Tone Madison via email that UHS/UWPD teams are currently staffed on Monday, Wednesday, and Friday, from 10 a.m. to 6 p.m. around the campus area. CARES teams are active Monday through Friday from 11 a.m. to 7 p.m., and have recently expanded coverage city-wide—but with teams coming from Fire Station 3 on Williamson Street, it takes travel time to get places around town.
Stedman showed Tone Madison some dashboards and visualizations of CARES’ service and its effects so far—though of course this information is quite preliminary. He said that after expanding to city-wide coverage around Christmas, CARES responds to an average of four to five calls a day. (It is unclear if this data will be public at some point, or if data from the UHS/UWPD pilot will be available on UWPD’s “Equity Dashboard.”)
“No matter how many public service announcements we do around this, and what we spread around on social media, a lot of folks don’t know about the existence of our team,” Stedman says. “So they may call  and see our community paramedic and [Journey Mental Health Center] crisis workers show up to their door, maybe expecting the police, because they’ve seen the police at one of these calls before… and maybe that’s a good surprise for them.”
Some folks might see an instance of police officers responding to a 911 call near them and think, “great, our public safety is in good hands.” Others, as activists and communities most impacted by police violence and mass incarceration have made quite clear, can easily see police as representing an entry point from everyday life into the cages and control of our carceral machine—or worse. Adrian Lampron, chair of Associated Students of Madison, told Tone Madison: “The co-responder program is a result of student advocacy for safer and more appropriate emergency response.”
Neither co-responder program has any option for a caller to explicitly request an unarmed response without police. Dispatchers make that decision based on their estimate of whether the situation is non-violent. However, Stedman did say that while CARES is strictly a 911 service right now, “that may change in the future; there might be room to have a direct number [to call.]” For the university population, UHS has a 24-Hour Mental Health Crisis Line (608-265-5600 option 9) that provides aid. The UHS/UWPD co-responder teams only respond when UWPD dispatch is called.
Can we build on these pilot programs?
Very rarely do privileged people suffering a mental health crisis get confronted by police, arrested, and carted off to jail. Rich people can already access mental health care that is customized to their particular needs. We need to consider these co-responder programs (and other options) as ways to beef up our social response systems for mental health crises of all kinds, for all people. Diverting non-violent emergencies to be triaged by mental-health-specific experts should create more pathways into real care for people who badly need it, and fewer pathways into police contacts that could escalate into worse situations.
One bright spot in the timing of these co-responder programs is that they may complement proposed additional services, such as the crisis and triage center currently being planned by Dane County. It’s a confusing time: Dane County is simultaneously spending $11 million on building and staffing the triage center, but also trying to spend $175 million on a new jail. (The jail plans do not include any of the possible positive effects, including reduced incarceration, from these pilots.) These programs are just some of the ways we can funnel people away from our carceral punishment systems and into real care. These co-responder services will not solve everything, but by linking together more kinds of social services and supports, the greater Madison area can really help more people suffering mental health crises.
Other open questions revolve around how these programs will be evaluated and possibly expanded in the future. While it’s great to see CARES already covering all of Madison instead of just the central district, people don’t schedule their mental health crises, so expanding the days and times available would be an improvement we can push to fund.
Concerning the UHS/UWPD pilot, Josie Montañez-Tyler told Tone Madison via email that “The plan at the end of the pilot is to cooperatively evaluate the program with UWPD. This would include but is not limited to reviewing the stats and well as anecdotal evidence. Our hope is to expand the program to five days per week and to continue to develop whatever programming is needed to ensure that our students experiencing a mental health crisis are receiving the appropriate response and treatment.” Sarah Nolan said, “The main ongoing cost is staffing. We’re in discussion with the city’s CARES program about potential collaboration, which will determine the level of staffing needed going forward.”
Both of these programs are improvements on the past. Police are not trained mental health experts, and we should not expect them to be. But these pilots are currently limited in scope, and the power to decide who the co-responder team responds to and who the police respond to is somewhat hidden away, at the Dane County 911 dispatch and UWPD dispatch respectively. We need transparency in the future to ensure bias isn’t creeping in. Who, exactly, gets the privilege of this response style? Plus, there’s a big difference between these two “co-responder” pilots in terms of who shows up to your door, and that could have a profound impact on people in mental health crises. Whether the situation escalates, or an expert defuses it and makes actual assistance possible, can lead to very different outcomes.