Some are homeless veterans arrested for disturbing the peace every few weeks, or the addicts brought back from the brink of repeated overdoses. They have an untreated mental illness or substance abuse issues – sometimes both.
The goal is to get them the help they need rather than put them in jail.
"We kept arresting the same people over and over again. People with mental illness who were committing minor, low-level, nuisance-related offenses," Ashland Police Chief Craig Davis said. "They were entering the criminal justice system over and over again, and they were spinning back out without any kind of treatment or any kind of proactive plan."
The number of people with these problems – "frequent utiliziers" – is small in each community, but the problem is nationwide, and a national organization, the Laura and John Arnold Foundation, is trying to fix it.
"It's not a new problem," said Lynn Overmann, vice president of Data-Driven Justice at the Foundation.
The nonprofit is providing money to the Middlesex Sheriff's Department to help collect and analyze the data gathered by first responders, hospitals, social service organizations and other participating groups to study the response, treatment and results of encounters with frequent utilizers. Overmann said the long-term goal of the project is to reduce the number of frequent utilizers, and, secondarily, save money.
Middlesex County is one of three communities across the country chosen to pilot the foundation's Data-Driven Justice Project.
"If you can make it work in Middlesex County, I think you can make it work in almost any setting across the country," Koutoujian said, citing the county's mix of urban, suburban and rural communities.
So far, more than 20 of the county's 54 cities and towns are working with the sheriff's department on this project. He expects more the join with the launch of the pilot program.
The initiative, which is also piloting in Johnson County, Iowa, and the city of Long Beach, Calif., is focused on data collection and collaboration.
"They tend to have multiple complex needs," Overmann said, of frequent utilizers. "These are folks who really were cycling through these multiple different systems."
A frequent utilizer could make contact with several different organizations, for example an emergency room, a homeless shelter and a police department. But there is no tracking system to ensure the person is getting the help they need.
"This is really probably the most expensive and ineffective way of providing treatment," Overmann said, "and (results in) terrible outcomes for the human beings involved."
For many first responders – generally the people who meet frequent utilizers first – options are limited. Police can arrest someone or send them to the hospital. Many hospitals don't have psychiatrists available all the time to help people having a mental health crisis, she said. Because hospitals and police departments, even from town to town, are not hard-wired to communicate, people in this group are treated on a situational basis, not as a whole.
"So what we were seeing is people were getting this very fragmented and uncoordinated care," Overmann said.
The Laura and John Arnold Foundation is looking to connect those different agencies, so patterns emerge, and frequent utilizers go where they need, instead of an emergency room or the back of a cruiser.
Some MetroWest police departments already implement smaller scale versions of jail diversion, but need the help to take the effort to a regional level.
"We're expected to handle this (public health issue) and we really don't have the sufficient tools to do so," Davis said, of police. "We've never been trained properly; we've never been educated properly; we don't have the right resources."
Davis started a program in Framingham that embedded a public health clinician into the police force, to evaluate people with mental health issues they encountered in the field. Certain individuals could then be connected to the services they needed, from a veteran's services office, to an alcohol or drug treatment plan, to a housing agency.
That program has been replicated in Marlborough, Watertown, as well as the four-town collective of Ashland, Holliston, Hopkinton and Sherborn.
Using this type of diversion service, David estimated those seven towns have collectively saved $11 million since 2003. The first year it was put together in the four-town collective, Davis cited an 83 percent jail or emergency room diversion rate.
"It's not just to get them away from law enforcement or from hospital ERs, but to get them the treatment they deserve because they're living a life that is not really fulfilling," Middlesex Sheriff Peter Koutoujian said. "There was already a culture in Middlesex of understanding this issue from which we could build on."
The pilot will take about two years, and cost the foundation $1.6 million across the three communities. Expenses will include program managers, technical support and a cloud-based system where agencies can access the data.
Medical information will not be accessible to police, Overmann stressed, or anyone else who is not authorized to examine it.
This is only the beginning, Overmann said.
"We're looking for good right now," she said. "I think we're going to be far from perfect for a while, but good is going to be much, much better than what we currently have."
The foundation hopes to find risk factors that help identify frequent utilizers, and evidence of treatment options and intervention points that work, as well as hard data to prove what first responders are seeing anecdotally.
©2018 MetroWest Daily News, Framingham, Mass. Distributed by Tribune Content Agency, LLC.
