Ambulances to Replace Police Cars in Ore. Mental Heath Crises

Portland, Ore. — Police throughout the metro area expect this fall to start routinely calling for an ambulance to carry people suffering a mental health crisis to the hospital instead of handcuffing them in the back of a patrol car for the ride.

The state has adopted new rules that allow for ambulance services to apply to provide secure transport for people suffering behavioral health problems.

"This really is not criminal behavior. So why do you put someone who needs help frankly in a caged police car? It's not the appropriate response for somebody who really needs medical help,'' said Portland police Capt. Mike Marshman. "These folks being handcuffed in a car can traumatize them even more."

A group of hospital officials and emergency department doctors, police and ambulance company executives have met once a month for more than a year to develop the new approach.

The police are at the table, Marshman said, because of a 2012 federal investigation that found Portland police engaged in a pattern of excessive force against people with mental illness.

The new plan is  modeled after a system in Alameda, California, where state law allows police to transfer custody of people on mental health holds to an ambulance service. The medical crew then screens the people at the scene to determine if they need care at a regular hospital or a psychiatric emergency unit.

Here, people would either be taken to an ER or the new Unity Center for Behavioral Health in Northeast Portland, a psychiatric emergency department scheduled to open in January.

Portland police alone estimate they typically drive about 1,000 people to hospitals on involuntary mental health holds throughout the year. That compares to about 2,000 general mental health transfers to hospitals that ambulances in Multnomah County already do.

Officers usually must wait at hospital emergency rooms, sometimes for hours, until a doctor can do an evaluation and decide whether to maintain the mental health hold or release the patient.

Under the new approach, ambulances not only would take people to the hospital, but police wouldn't have to follow along as they do now on the occasions when both officers and ambulances are called to a mental health emergency.

American Medical Response Inc. would transport people in Multnomah and Clackamas counties; Metro West would cover such transports in Washington County. Overall, 132 licensed ambulance services in Oregon would be eligible to apply.

"It's what everybody wants. We don't want to handcuff a behavioral health patient on what could be the worst day of their life,'' said Rick Ralson, Legacy Health's project manager for Behavioral Health Services.

Police are working out some of the logistical issues, such as sending officers' reports electronically to an ambulance company to submit to a hospital.

AMR and MetroWest ambulance companies are training their paramedics and emergency medical technicians to handle the decisions in the field.

"It's kind of a natural shift,'' said Randy Lauer, AMR's general manager. "Paramedics look at people as someone either suffering from a traumatic crisis or medical problem that they need help with. It's just a different approach.''

The company's paramedics and emergency medical technicians now are trained to deal with "combative, out of control'' patients using cloth Velcro to tie their arms and legs to a stretcher, in addition to a shoulder harness, he said.

The National Alliance on Mental Illness, along with Disability Rights Oregon, welcome the change, but pushed for clear standards for ambulance providers, enhanced crisis intervention training for ambulance workers and annual training on when to use restraints.

Kevin Fitts, executive director of the Oregon Mental Health Consumers Association, said he's

"generally in favor of less police contact for folks in crisis and less coercion and force in providing services.''

"I am hopeful this is a better solution, but I am mildly fearful of the old cliche of the men in the white van with butterfly nets chasing down the individual in an extreme state," he said.

Under the new practice, Marshman envisions police showing up to a mental health call to provide safety at the scene. If no crime has been committed, officers would step out of the way and allow medics to step in instead.

It's similar to how police respond to heroin overdose calls, he said.

"A high percentage of the time, we stand around and do nothing. We watch AMR and fire do medical treatment and then transport. That's how I envision a majority of these mental health calls resolving themselves,'' Marshman said. "We'd be there solely for scene safety. It just makes sense.''

Police and ambulances should be the last resort, said Jason Renaud, a volunteer with the Mental Health Association of Portland.

He suggested less expensive alternatives, perhaps a mental health consumer in recovery could provide a transport service or even Uber.

Portland Fire & Rescue Bureau's Interim Chief Ken Burns, previously its deputy chief of emergency medical services, said he'd be open to such changes down the road.

"People are starting to ask more questions. Let's try to get people to the right place for the right reason in the right way,'' Burns said.

If people aren't a danger to themselves, ambulances might not be the most appropriate way to drive them to a hospital, Burns acknowledged. "Maybe we need to arrange for alternative transportation, a friend or perhaps a taxi,'' he said.

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