A treatment room at the Mental Health Cooperative’s Crisis Treatment Center, bare of decorations that could be used in a suicide attempt. (Photo: John Partipilo)
The disheveled, middle-aged man struggled against the Metro Nashville Police officer hauling him into the Crisis Treatment Center for a psychiatric evaluation, his loud mumbling muffled by the glass in the treatment room.
From an enclosed glass room in the center of the facility, mental healthcare workers watched calmly as the man was processed and analyzed. With one turn of a chair, other workers could peer into additional treatment rooms designed specifically to create a calming and safe environment.
The state-of-the-art facility, operated by the Mental Health Cooperative (MHC), provides immediate access to specialized care for both adults and children needing psychiatric treatment. Weighted chairs are both comfortable and impossible to lift, preventing them from being thrown by agitated patients. Rooms lack any decorations that could be used in suicide attempts.
In the wake of several fatal police-involved shootings, civil-rights advocates have called for more prevention tactics and emphasis on mental healthcare across Nashville. In April, Chief John Drake announced that the Metro Nashville Police Department would be teaming up with the MHC and using the treatment center for support.
As first responders, police officers have had limited options in handling those experiencing mental health issues. They could drop off individuals at emergency rooms, where emotional or psychiatric crises could become exacerbated while awaiting treatment.
Now, police officers are able to take individuals to the Crisis Treatment Center for immediate and specialized care. Police officers will pair up with mental health specialists in an effort to de-escalate situations and ensure those in crisis get appropriate care.
“We are branding the co-response pilot “partners in care” because that’s really what it is. It’s how multiple departments and mental health co-ops work together to get people to the right care, at the right time and at the right place,” said Dia Cirillo, senior policy advisor with Mayor John Cooper.
The program will launch on June 28 , but police officers are already seeing the results of working alongside mental healthcare professionals. In one week, six situations were resolved, with one incident being an armed individual experiencing a mental breakdown.
“Police were called and immediately recognized that there was a mental health issue. They called our crisis team that were able to respond, and through a combination of officers and mental health workers talking to the individual, we were able to de-escalate and get them into psychiatric hospitals without further incident,” said Amanda Bracht, MHC’s senior vice-president.
Cooper funded the Co-Response Model Crisis Intervention Pilot Program for the upcoming year, with Crisis Treatment Center receiving $1.25 million and the co-response pilot receiving an additional $560,000 from the America Rescue Plan.
Still, mental healthcare advocates wonder if the money is too little and too late.
MHC opened in 1993 and focused on serving low-income Nashvillians with mental health issues, and since the crisis treatment center opened in 2019, it’s been operating on a deficit.
Although the program has received funding from the mayor, mental healthcare experts worry the co-response model will identify more individuals in need of treatment. Over the past two years, MHC experienced an 18% increase in admissions for treatment due to renewed interest in mental health.
Since 62% of walk-ins are uninsured, the facility was unable to recoup the financial loss.
Regardless, “we don’t turn away people because of insurance,” said Bracht.
The problem is national. A year of pandemic-related stress resulted in increasing reports of negative mental health. During the pandemic, about four in 10 adults reported having symptoms of depressive disorder, a drastic increase from one in 10 adults the previous year, according to the Kaiser Family Foundation. Racial riots, job loss, pandemic deaths and environmental disasters are just some of the underlying factors affecting mental health.
In Tennessee, healthcare has not been a priority for legislators, and many Tennesseans needing critical services are falling through the cracks. Tennessee is one of 12 states that refused to expand its Medicaid program under the Affordable Care Act, which uses federal funds to match and expand state programs to include low-income uninsured adults. The expanded Medicaid programs were meant to cover the gap that’s left adults living below the poverty line who can neither qualify for healthcare market subsidies nor their state’s Medicaid program.
Since private insurance is unlikely to pay for mental healthcare, individuals are left with few public service options. Tennessee has four mental hospitals throughout the state. The Middle Tennessee Mental Health Institute serves 18 counties and has a total of 207 beds, but high demand means there’s about a four-day delay, according to Bracht.
A shortage of staff is causing additional issues.
The average wage for a mental health worker across Tennessee is lower than the national average. According to Elliot Pinsly, executive officer at the Behavioral Health Foundation, workers have very little incentive to enter a field dealing with mental health patients while getting paid low wages.
Using clinical social workers as an example, said Pinsly, 72% hold a graduate degree but get paid less than the median wages for all Tennessee occupations combined. Treatment centers across the state have had difficulty finding staff despite funding and demand for care. Recent reports showed that in Tennessee, only 3% of available jobs pay more than $20,000 a year, despite the poverty level line being under $22,000.
“We’re not paying people enough for retainment,” he said.
Nashville’s co-response model plans on making up the deficit by training police officers to respond to mental health crises. Initially, about 16 officers will receive additional training, but officials are pushing to have each new graduated officer trained.
“I think when it comes to mental health crisis response and mental health in general, to me there’s no one solution because the mental health care system has been neglected for many years,” said Michael Randolph, MHC’s emergency psychiatric services program manager.
These services are just a drop in the bucket, said advocates, and while state services have improved, all aspects of society are in need of restructuring to improve mental health, especially as the population enters a post-COVID-19 world.
“We need better access to mental healthcare and addiction treatment, but how,” said Pinsly. “We’re literally approaching the tipping point.”
Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our web site.