Someone you love is having a breakdown. They could hurt themselves. Who do you call?
If 911 leaps to mind, you’ll likely get a visit in a few minutes — from police, whose training includes behavioral health but is focused more on addressing criminality.
If you can remember 1-888-796-8226 (or 1-888-7-YOU-CAN), you’ll get a mental health professional from resolve Crisis Services, a 13-year-old unit of UPMC hired by Allegheny County to handle behavioral incidents. Help might arrive in half an hour.
Those different digits — the phone numbers and the response times — may be two reasons why social services have taken a back seat to public safety in handling mental health crises, occasionally with tragic and expensive results. Though resolve stands ready for telephone consults, walk-in visits, overnight treatment and mobile teams, its phone number just isn’t as memorable, and its staff doesn’t always zip to the scene.
As local leaders have joined a national search for alternatives to the police-dominated handling of behavioral crises, resolve’s leaders press the case that their 150-clinician team can be part, though not all, of the solution. A two-month PublicSource exploration of resolve — including conversations with clients, analysis of quarterly reports and interviews with officials — revealed strengths and shortcomings at the agency, and showed why shifting duties from police to social services won’t be easy.
- People who have interacted with both resolve and police said that in a behavioral health crisis, they prefer the mental health pros, not armed officers.
- 911 and police don’t regularly refer behavioral health calls to resolve.
- The gap between police response time and resolve’s response time complicates efforts to increase the social service’s role in handling crises.
- With a thrifty mission statement that limits its budget, resolve may struggle to improve response times which occasionally range up to several hours.
"We provide quality services in some of the most bizarre and extraordinary situations,” said Liz Sysak, resolve’s senior director of clinical services. Saying she’s “incredibly proud” of resolve, she added that, “when we show up, we do great work. But yes, there's some limitations to us showing up."
‘They didn’t mention resolve’
When Amanda Papa was grappling with post-miscarriage depression and anxiety in early 2018, neither she, nor her family, knew about resolve.
On May 30, 2018, her father, Michael Papa, called 911 to seek emergency help for Papa, who said in a recent interview that she had been cutting herself and expressing suicidal thoughts.
Coraopolis police officers arrived at her home.
Though Papa’s parents and her husband Garret Wassermann had expected an ambulance and asked the officers to help them to involuntarily commit Papa to a hospital, the officers instead placed her under arrest.
“Then the police took me, and that was it,” Papa said. “They didn’t mention resolve.”
Following Papa’s arrest, she said she was unable to use the station restroom and urinated in a holding cell. (Police, in an internal report, wrote that she was “trying to flood [the] joint,” and “acting like a fool” and “pissed on [the] floor.”)
Papa was charged with resisting arrest and institutional vandalism, held in the Allegheny County Jail for eight days, found guilty and sentenced to a year of probation with mental health treatment. She has appealed the conviction. She has also sued the borough and the officers, claiming false arrest, negligence and malicious prosecution.
Coraopolis’s police chief did not respond to requests for comment. On Nov. 13, an attorney representing the borough filed an answer to Papa’s lawsuit, including a blanket denial of all of her accusations, and adding that the officers “conformed to all applicable laws and regulations” and are entitled to immunity because they acted in good faith.
Not until after the 2018 incident did Papa learn of, and connect with, resolve. Papa found their staff to be friendly. “I think it helped me,” she said. “And I stopped going because I was feeling a lot better.”
But given the efficacy of resolve’s services, Papa questioned why her crisis — one that she said resolve could have readily handled — instead resulted in a years-long saga involving cops, courts, probation officers, and an ankle bracelet.
“Police came in my case, but they didn’t really need to,” Papa said. “It would’ve been a fine case where they could’ve just sent a mobile crisis unit.”
“The whole thing could’ve just been stopped, and we [would] probably pay the therapist way less than these officers, these courts, all the staff, all the records — everything,” she added.
Resolving the ‘flow chart’
Resolve was created, at county government’s behest, to make it easy to get professional help in a behavioral crisis.
Prior to the unit’s inception, a confusing network of around a dozen separate teams offered behavioral crisis services in the county, according to resolve’s Medical Director Dr. Jack Rozel.
“The joke was that by the time you worked your way through this flow chart, the kid had aged into the next bracket,” he said.
In 2007, the county Department of Human Services contracted with UPMC’s Western Psychiatric Institute and Clinic [WPIC] to provide behavioral health crisis services to residents, and WPIC established resolve.
Resolve’s mission is to respond to mental health disasters and traumas, divert unnecessary emergency and inpatient care, reduce incarceration and assist those seeking to involuntarily commit another person. It also explicitly requires “being cognizant of the stewardship of public funds.”
Resolve currently operates a 24-hour telephone hotline, a walk-in center, residential services, and a mobile unit that addresses crises throughout the county, face-to-face. Its clients pay nothing.
DHS pays UPMC around $1.6 million a year for resolve’s mobile, residential and walk-in crisis services. Resolve also bills the state and private insurers for services. From mid-2018 through mid-2020, county dollars covered between 18% to 28% of resolve’s quarterly costs, with state programs covering most of the rest.
While no one interviewed for this story argued that mental health crises are declining, over the past two years, demand for resolve’s services has dipped.
Sysak attributed the decline in the number of mobile service dispatches to the natural “ebb and flow” of community need. “I'll just add that this is also, I think, a marketing shortcoming for us that a lot of people simply don't know about what we offer, and the extent that we offer it.”
“Everyone knows 911,” Rozel said. “Resolve, people know, but maybe not quite as well.”
Rozel added that the social service approach to behavioral health crises may get a boost in July 2022, when, under the National Hotline Improvement Act, the number 988 becomes the national suicide prevention and mental health crisis hotline.
In the meantime, the COVID-19 pandemic has posed additional challenges for those seeking face-to-face behavioral health services. As people avoided in-person interactions, resolve’s mobile team dispatches plunged in the spring.
resolve in the post-Floyd world
While resolve’s mobile team dispatches dove, George Floyd died, in May, under a Minneapolis officer’s knee. His death followed a nonviolent incident that may have been related to drug use, and energized interest in behavioral crisis management.
While Floyd’s death occurred five states away, Allegheny County has also seen behavioral crises turn tragic. Over the past decade, police were involved in the deaths of at least three county residents — Jennifer Piccini, Gary Beto, Bruce Kelley Jr. — who were in the throes of apparent behavioral crises, according to lawsuits filed by their estates. The first two cases settled, for $1 million and $500,000, respectively, while the third case is ongoing.
Speaking at a Dec. 1 virtual meeting of Mental Health America’s [MHA] Regional Policy Council, Rozel said he sees the current “crisis” as an opportunity to address behavioral health incidents more effectively.
“This is where we actually have the political will, and maybe the resources” to make big changes, he said. “Now we’ve got an opportunity to make a leap to be where our communities need us to be.”
Resolve, though, hasn’t been at the center of the discussion in its community.
The county in September held the initial meeting of its Crisis Response Stakeholder Group, which featured a national expert in the justice system's interactions with people who have mental health, substance use or homelessness problems. Group members came from the county Department of Human Services, police departments, foundations, community organizations, the city, academia and various agencies — but none from resolve.
It’s not clear why resolve wasn’t initially invited. County officials have, since September, repeatedly declined or ignored PublicSource’s requests to discuss the stakeholder group.
Sysak said in a November interview that resolve is now “actively participating in the stakeholder meetings and stakeholder work groups.” She said she’s “optimistic that we'll hopefully come up with some ideas that may work, or at least that we can pilot and sort of tweak as we go forward.”
The City of Pittsburgh, meanwhile is creating a new Office of Community Health and Safety [OCHS]. Its proposed budget of $5.3 million includes money for a contract with Allegheny Health Network’s Homelessness Outreach Program, aimed at shifting some of the work of helping the displaced from the police to social services.
“We do absolutely see interactions” with resolve, said Laura Drogowski, the city’s critical communities manager, who is leading OCHS. “At this point, we’re trying to figure out how to continue to improve the communication and relationship.”
No guns needed
When one of Cori Frazer’s roommates had a mental health crisis last year, and ended up playing in puddles, in a nightgown, in an alley behind their home, someone apparently called 911.
“I look out the back, and there are a bunch of police in the back,” said Frazer, the executive director of the Pittsburgh Center for Autistic Advocacy, and a member of the City-County Task Force on Disabilities. “The police did not call resolve.” They were instead “just shouting a bunch of things,” until Frazer calmed the suburban officers and coaxed the roommate back inside.
Frazer imagined a more proportionate response. “Someone could’ve asked her, with a calm voice, quietly, ‘Are you OK? Are you safe? Do you live around here?’”
“If we had a competent trained mental health response ... the police never needed to show up,” Frazer added. “Nobody with guns needed to show up.”
As someone who is often engaged with people who have mental or behavioral health diagnoses, Frazer has crisis management experience. In another case, Frazer called in resolve to address a dispute between a homeless couple and people who had taken them in.
Arriving at a scene in which one of the homeless people was “laying in the street screaming,” the resolve team “was able to really assess risk in a way that was very impressive to me,” and deescalated the situation, said Frazer.
The downside: It took resolve close to an hour to show up, Frazer recounted, calling that “terrible."
"An hour? Somebody can OD or load a gun in an hour.”
Fast times, odd hours?
Resolve’s quarterly reports, which it submits to the county Department of Human Services, indicate that in more than two out of three cases, its teams are dispatched to the scene of a crisis within half an hour of the end of the initial phone call to resolve. The same reports show that the wait can be much longer.
For instance, resolve’s reports show a May 2020 call from a mother, concerned because her 14-year-old son ran away from home and had “plans to cut himself.” Because resolve’s mobile teams were busy that day, the team was still en route five and a half hours later, when the mother called and advised that police had found the boy and were taking him to WPIC.
Resolve reports to the county on its longest wait time for each month. Most months include at least one incident in which resolve arrived more than four hours after the call came in.
In 2019, a caregiver called resolve to report that a person “doesn’t want to live anymore and does have one prior suicide attempt,” and was refusing food and some medicines, according to one of the quarterly reports. resolve took four hours and 19 minutes to dispatch a team, per the report, which did not detail the outcome.
Rozel and Sysak noted that while police have sirens and lights, resolve teams are at the mercy of traffic. They said they are constantly trying to find ways to improve response times, like assigning mobile teams to geographic zones. In the end, though, it comes down to staffing.
“Let’s say we could get a mobile team to every request in 15 minutes,” Rozel said. “Well, we could do it, but it means adding a lot of teams,” some of which might have “more slack time” when calls are slow.
More teams means more costs. During an interview conducted via Microsoft Teams, Rozel noted that “as I'm looking at you, right above the camera is the crisis mission and vision statement that was written for us at creation by the county. And the final line of the mission statement is, ‘being cognizant of the stewardship of public funds,’ which I get, right?”
“The needs are so great,” he said. “The resources are quite finite. But the reality is that if you want to have more teams available to respond more quickly, you've got to have more well-trained staff available.”
He and Sysak acknowledged that, given resolve’s response times, it’s hard to see how its mobile teams could replace police as the first responders to most mental health events. “When a family or person is in crisis, and you need somebody there right away,” Rozel said at the MHA meeting, “it’s almost certainly going to be law enforcement.”
Police like resolve, but …
Ross Township Police Department Detective Sergeant Brian Kohlhepp said resolve has been a “great addition” to the department’s existing services and has had a “tremendous impact” by reducing repeat calls to the same crisis-prone people. Rather than convince the person to come with police to the hospital, he said, “All we have to do is convince them to have a conversation with people from resolve.”
There’s no evidence, though, that law enforcement is frequently handing the baton to resolve. Resolve has no data on the number of calls it received via 911 or from police, according to Rozel and Sysak. “I don’t think [the number of such calls is] substantial,” said Sysak, though some do occur.
The county also had no information on law enforcement’s interactions with resolve.
Pittsburgh Bureau of Police spokesperson Cara Cruz wrote, in response to PublicSource's questions, that resolve is a “critical partner” to the bureau. The city has no data on the number of times police worked with resolve teams, but "is currently working on a project to gather more comprehensive data in this area."
Pittsburgh police Officer Robert Swartzwelder, speaking in his role as president of Fraternal Order of Police [FOP] Lodge 1, said his interactions with resolve have been “pretty positive. … My only concern is response times, and whether they’re going to be there odd hours.”
Swartzwelder said that if society wants an agency like resolve to be the first responder when someone is standing on the edge of a bridge, it will need to consider the response times. “Police response time is 2-7 minutes,” he said.
He added that police get much more mental health training than they used to. “We have a lot of training in all of these areas,” he said, “but it seems, because of recent events, society does not believe that we do.”
Penn Hills Police Chief Howard Burton said that while officers "are not against working with social service agencies,” it’s often essential that the police be the first point of contact for individuals experiencing a behavioral health crisis.
“Even though these folks may be mentally challenged or may be in crisis, you just don't know how violent they are,” Burton said. “If they’re going to have weapons or what the case may be, you really can't just arbitrarily pick social workers.”
Not a hospital, not a jail
Davina Groover spent seven months in the Allegheny County Jail, in 2015, for disorderly conduct, because she could not post bail while awaiting hearings. In a November interview, she said that some of that time she was housed in the mental health unit.
The Perry South resident and restaurant server said she has since found better ways to address her bipolar disorder. She has had several stays at resolve’s inpatient clinic, and at one point this year was “using resolve services all the time. I was calling them on the phone, talking to them about my anxieties, I was calling them to my girlfriend’s house because we were having difficulties.”
Groover added: “They’re always really calm and responsive, and serious, but not alarming.” Best of all, resolve is “not a hospital, and it’s not jail.”
Her calls for mobile crisis support, though, revealed the service’s limitations, she said.
Once resolve sent a team to Groover’s girlfriend’s house. Since the girlfriend did not want to let them inside, the team talked with Groover for a few minutes, advised her to find another place to stay for the night, and left.
Another time, she called resolve about a dispute with a roommate, and the team arrived quickly. “And what I needed at the time was for someone to sit down with my roommate and I and hash some shit out, and devise a plan on how to live better,” said Groover. “But resolve doesn’t do that, really, unless all parties are on board.” They weren’t, so resolve’s team left.
Resolve’s limitations became factors in lawsuits stemming from a 2012 fatal shooting, by schizophrenic 30-year-old graduate student John Shick, at WPIC. The mobile crisis team had visited Shick’s apartment multiple times to commit him but he repeatedly refused to let them into the building. Survivors alleged that resolve was negligent for repeatedly failing to complete the process of having Shick involuntarily treated, arguing that if they had done so, the shooting would not have occurred.
Several of the cases were settled.
“Obviously, any traumatic event certainly propels change," Sysak said. “Ultimately, we take those incidents, we look at what happened, we look at what might have triggered that, we look at our day-to-day interactions and we are always teaching on how we may respond to discord, and how we also may contribute to it."
As society wrestles, again, with behavioral crisis management, discussion of expanding resolve’s mandate and powers would be “something we would love,” she said. “I think that is part of these dialogues with the mayor's office, with the stakeholder groups. That has to be part of this.”
Rich Lord is PublicSource’s economic development reporter. He can be reached at email@example.com or on Twitter @richelord.
Amanda Su is an editorial intern for PublicSource. She can be reached at firstname.lastname@example.org.
This story was fact-checked by Matt Maielli.
Mental health reporting has been made possible with funding by the Staunton Farm Foundation, but news decisions are made independently by PublicSource and not on the basis of donor support.