In 2020, the Denver Police Department (DPD) was confronting a challenge. As Chief Paul Pazen noted, DPD had experienced dramatic increases in its workload. Yet the organization had barely grown. This meant that DPD needed to increase efficiency and impact, particularly when it came to responding to mental health-related service calls, which were up 17 percent. Fortunately, the department had a model for success. In 2016, it had introduced a co-responder program that paired mental health workers with police officers to respond to people in crisis. Now, DPD and its partners planned to create the Support Team Assisted Response (STAR), a program that would be integrated into the 911 dispatch system and deploy a mental health worker and a paramedic to respond to a citizen in distress. This would enable DPD to focus on law enforcement and help citizens in need get support. While the approach was logical, implementing the program required addressing difficult questions. How would DPD foster collaborative relationships with mental health providers? How could they leverage data to design and evaluate the program? How would they communicate with diverse stakeholders about the program’s objectives? Most fundamentally, in an environment characterized by enormous stress and increasing pressure on law enforcement, how could DPD and its partners scale the program and achieve better outcomes?
In 2016, DPD partnered with the Mental Health Center of Denver, a non-profit mental health provider, to pilot the co-responder program through which mental health clinicians would be deployed with police officers in response to high acuity, emergency behavioral health calls. The goal was to help residents in distress get mental health and/or substance abuse support, improve information sharing and coordination, and reduce costs by helping people in crisis avoid jail and emergency medical services. The risk was that the mental health clinicians and police officers would view each other warily. To mitigate against this, leaders from both groups emphasized the importance of collaboration. Chris Richardson, a program manager for the Mental Health Center of Denver, recalled that he and his colleagues “did not force an agenda. … We started out talking with officers about, ‘How do we help improve what it is that you’re doing already? How do we become a force multiplier?” DPD leaders similarly emphasized the importance of a cooperative mindset, which helped to set the tone for the partnership. “It was that relationship,” Pazen said, “that was built with the co-responders that helped with any kind of problems that you would’ve normally anticipated with somebody that in some areas would be perceived as taking your job away.”
This synergistic approach fueled the program’s growth and success. The pilot involved four clinicians, but the co-responder program expanded to 37 clinicians who were working in all six DPD districts as well as partnering with the intelligence and special victims units, the fire and sheriff departments, and a local university. Of 13,836 total encounters involving co-responders, only two percent resulted in an arrest or citation, 35 percent of individuals accessed services through the Mental Health Center of Denver, and approximately 20 percent received treatment from other community organizations. Richardson attributed this success in part to DPD’s support. “I will always praise Chief Pazen for this,” Richardson said. “I have never seen someone back the idea of having an alternative response and an assisted response in the way that he has.” Richardson also pointed to the importance of a shared sense of mission. He emphasized, “This isn’t just a police problem. Mental health problems need to be addressed by mental health providers. I work for a big, huge mental health provider agency, and we need to hold ourselves accountable. What are we doing in the community to prevent this from hitting 911?”
While the co-responder program was making an extraordinary impact, there was still significant need for more services, so DPD and the Mental Health Center of Denver began discussing how they might be able to build on the momentum from this initiative. They focused on how to send the best response when someone experiencing a mental health emergency calls 911. Historically, there had been three options (police, fire, or ambulance), but when a team of mental health clinicians and social workers listened to 911 dispatch calls, they identified an opportunity to fill a gap with a response structured around mental health needs. Carleigh Sailon, the STAR Operations Manager with Denver 9-1-1, recalled:
It was really kind of eye opening for me to see what different situations people call 911 for…because they need a ride, because they don’t have access to food, because they took the bus from Philadelphia to Denver and ran out of money and don’t know where they’re going next. And it was really shocking for me to see, ‘Wow, these are calls that police have historically been tasked with because of a lack of a better option.’
This led to the creation of STAR, a program in which a 911 dispatcher deploys a mental health clinician and paramedic to help a person in distress and connect the customer to ongoing supports and resources. As Sailon recalled, DPD and the Mental Health Center of Denver did extensive whiteboarding to identify the scenarios in which this kind of response was likely to be most effective (e.g., an intoxicated person, an indecent exposure case, or a welfare check) and studied best practices across the country (including visiting the CAHOOTS program in Eugene, Oregon). This enabled Denver to launch a pilot for STAR on June 1, 2020 with teams operating in eight police precincts on weekdays from 10 a.m. to 6 p.m.
One early challenge was building support for and communicating the purpose of STAR to different stakeholders. Some organizations were enthusiastic about and wanted to control the initiative, which, Pazen recognized, could lead to a “turf war.” Others saw STAR as an avenue to further their objective of defunding or abolishing the police. It was imperative for DPD and its partners to emphasize that they were creating a broad, partner-driven ecosystem that complemented DPD. “STAR doesn’t have to exist because DPD is doing a bad job,” Sailon said. “They do the best that they can with limited resources. We said, ‘Let’s allow DPD to focus on the safety of our city and let us take these calls and route them to people where this is their area of expertise.” Or, as Pazen said, “This is not a ‘replace the police.’ This is an enhanced response.” Pazen added, “This is an ‘and,’ and we want more ‘ands’ and no ‘ors.’”
In addition to shaping an external narrative, DPD and its partners invested heavily in internal structures, systems, and processes. This included introducing a training system and building processing guides for 911 operators to determine how and when to route calls to STAR. The program’s leaders also established a strong data collection and evaluation system, which was important in part because the pilot was operating on a one-year grant that was contingent on success in the first six months. Finally, DPD created a team of case managers who were assigned to each district and helped people transition to other services after they interacted with STAR and the co-responders. This resulted in a “hub and spoke” system through which customers were connected to human services providers, helping to prevent scenarios where STAR deescalated a situation and temporarily addressed someone’s needs, only to have them cycle back into the emergency response system soon thereafter. “What about tomorrow? What about next week? What about next month?” Pazen wondered. “That’s where our case managers don’t get the credit they deserve.”
The careful planning surrounding training, evaluation, and staffing reinforced the collaborative dynamic between different service providers that had begun to take shape through the co-responder program. For instance, rather than have STAR and the co-responders be seen as competitors, DPD and the Mental Health Center of Denver depicted them as strategic complements, with the co-responders being more likely to be deployed to a situation with a safety concern and STAR focusing on a mental health crisis where the risk to first responders seemed lower. “It’s all about the spectrum of services that can be provided,” Richardson explained. “It’s not one over the other.” Similarly, DPD recognized STAR as a valuable part of an emergency response system that helped police, as Sailon noted, “offload [certain] types of calls to a more appropriate team so that they can deal with their very, very busy call queue and make sure that members of our community are safe.” This has contributed to the sense that the different stakeholders are working together seamlessly. “Over time, the Denver Police Department stopped being our partner,” Richardson said. “We’re just part of their culture, the same way they’re part of ours.”
In part thanks to the strength of this partnership, STAR has been extremely effective. Since June 1, 2020, when the pilot was initiated, 3,843 calls for service have been diverted to STAR that would have otherwise been dispatched to police, fire, or ambulance. What’s more, not one STAR deployment has required a call for police backup because of safety concerns; the pilot alone helped to prevent approximately 1,400 crimes across six months, and the program has had “zero budget impact.” The initiative has also produced unexpected benefits. As Pazen noted, in recent years, many police officers have been exposed to significant trauma, and some personnel ask if Sailon, Richardson, or a member of the STAR or co-responder teams can be deployed with them so that they have an opportunity to discuss these challenges. “We get those hidden benefits that we certainly had no idea were possible,” Pazen said. “And they’re invaluable in the grand scheme of things.”
The program’s impact comes through with not only statistics but also stories of how STAR helped someone in need. STAR recently responded to a call about a woman who was naked in an alley. When the STAR team arrived, they spoke to the woman, who was a member of Denver’s unhoused community. The woman explained that she was trying to put on clean clothes and that the alley was the most private place she could find. The STAR team told her about The Gathering Place, a day shelter for women who are unhoused in Denver where they can change, nap, eat, and do laundry. The woman thanked them, and they helped to transport her to the facility. This embodies how STAR can not only deescalate situations but also mitigate future challenges. As Sailon said, “we were not only able to provide her with a more appropriate response, but then also connect her to that ongoing support and services that she needed….”
STAR and the co-responder programs still face significant questions, including how they will collaborate with the 988 Suicide Prevention hotline that will launch this summer. STAR leaders are also developing a strategy to scale the program. To that end, they developed a heat map that shows where and when the demand for its services are highest. This helped them to realize that, instead of deploying STAR vans evenly across different parts of the Denver area, as they had originally anticipated, it will likely be more effective to concentrate services in locations and periods when demand is highest. Yet even as DPD and its partners explore how to grow, these initiatives have already made an extraordinary impact, both because of the support they have given to thousands of people in crisis as well as the insight they provide on how to design and scale collaborative services. DPD, the Mental Health Center of Denver, and their partners have succeeded because they embraced teamwork, communicated carefully with key stakeholders, developed strong evaluation systems, and strategically leveraged financial opportunities. This should serve as a model for other communities nationwide that want to create systems like Denver’s where STAR and the co-responders are seen as significant contributors to a strategy that promotes wellness and safety. Pazen concluded, “These are better outcomes for individuals in crisis, period.”
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