Manuel Calero was looking through patient files when his shift partner knocked on the desk divider and handed him a notepad. With the phone still squeezed between her ear and her shoulder, Mary Brough nodded in a way that, Calero knew, meant they would be heading out shortly.
He scanned the scribbled notes – a woman calling about her 21-year-old son with bipolar disorder who had recently checked himself out of the hospital and was now home, emptying bags of trash in the living room. Calero was looking up the young man’s name in the patient system when Brough, still on the phone, bolted from her seat.
“Oh my god.”
“He broke his dad’s hand,” she told Calero, who was already punching in the number for the Montgomery County, Md., police department. “Tell them to go lights and sirens – she’s screaming.”
Calero grabbed a police radio, a folder of documents and a jacket. Brough reached for the car keys.
“Police are on their way,” she said into the phone. “But we’ll be right behind them, all right? We’ll be right there.”
Amid a nationwide reckoning over police brutality, crisis centers like this one are being hailed as a vital alternative to having officers respond to mental health emergencies – a way to keep police and their guns away from people in need of help, rather than arrest.
According to a Washington Post database, about a quarter of all fatal police shootings in the last six years involved someone in the throes of a mental health crisis. A man in psychological distress died after police in Rochester, N.Y., placed a bag over his head and pinned him to the ground. In Salt Lake City, a mother called 911 for help with her 13-year-old son, who has autism, only to watch as officers shot him 11 times, leaving him partly paralyzed. More than one-third of the calls where Montgomery County police exerted force in 2020 involved people “suffering from some form of mental illness,” a report said.
Montgomery’s crisis center has built a strong record over three decades of resolving conflicts peacefully and keeping people out of jail. But like many other government health services, it has seen funding cut in tight budget years. Saddled with a growing slate of responsibilities, the center’s 24 counselors have had to turn down more calls for help, leaving a service gap that has been filled by police.
After the killing of George Floyd last spring, Montgomery’s all-Democratic county council found itself divided over whether to cut the police budget. But lawmakers unanimously agreed to hire 12 more crisis counselors, part of a long-term plan that also includes having counselors respond to certain incidents without a police escort. Dozens of other cities and counties, including the District of Columbia and Baltimore, are taking similar steps.
Montgomery leaders tout the changes as an early step in their effort to “reimagine police.” But inside the center’s old, cramped operations room in Rockville, staff are ambivalent about being cast as the new face of public safety. Some are concerned about changing their long-standing protocols of working in tandem with officers; others say elected officials are asking them to solve social problems that stretch far beyond their control.
The crisis counselors respond when there’s a naked person riding a lawn mower down a highway, or someone yelling at the shadows underneath a bridge. They show up when a schizophrenic man is setting fires to his neighbor’s furniture, and when a 13-year-old finds her father hanging from a basement pipe. Most of the people they treat are poor, uninsured Black and Latino residents, marginalized by a host of racial and social inequities.
By the time their services are needed, the counselors say, the county’s social support system has in many ways already failed.
Calero and Brough tried not to think of any of this when they arrived at the two-story house in Rockville that morning. Several police cruisers were already parked along the quiet street. A man with white hair sat in his robe on the front deck, his hand limp.
Dressed in casual shirts and slacks, the two clinicians walked past an officer standing guard at the front door and then, without pausing, stepped inside.
Crisis centers have existed in the U.S. for at least six decades, a partial legacy of President John F. Kennedy’s campaign to stop warehousing the mentally ill in psychiatric institutions. They try to fill the gaps in a private health-care system that offers few resources for poor people in crisis.
Montgomery’s center treats walk-in patients, refers people to services and oversees a short-term residential program, in addition to running a 24/7 mobile crisis unit. It got a funding boost in the early 2000s, after a searing report concluded that the county’s behavioral health system was “in collapse,” with poor residents often unable to access care until their illnesses landed them in jail, juvenile detention facilities or homeless shelters.
But after the 2008 financial crisis, resources were slashed again. A team that took intoxicated residents somewhere safe to sober up was abolished; the mobile crisis team went on fewer calls.
It took 10 years for the center’s budget to be fully restored. Meanwhile, the number of mentally ill residents sitting in jail cells ballooned. In 2016, county officials said they tracked eight residents with mental illness who had been arrested a total of 250 times.
“We had to prioritize what the team was working on . . . and the place we squeezed was mobile crisis,” said Raymond Crowel, director of Montgomery’s health and human services department. “When we couldn’t go, we’d tell the police. Sometimes, they’d go and show up at the center with someone so we could do an evaluation; other times, they wouldn’t.”
The crisis center’s mobile team responded to an average of 40 calls a month in 2020 – less than half its caseload of 10 years ago. County police, meanwhile, were sent to about 582 mental health calls monthly.
“We never liked saying, ‘No, we can’t come.’ That’s never felt great,” said Dorne Hill, who manages the county’s crisis services operation. “But that’s all you can do when you don’t have the bodies.”
On every shift, about six counselors take calls from the public, other county agencies, hospitals and schools, with at least two assigned to the mobile unit. Veterans know to keep the calls short – less than 20 minutes if possible – because others on hold could be more urgently in need of help. The mobile team only heads out if the situation seems dire.
Like it was that Monday morning.
Calero and Brough entered the house in Rockville to find overturned furniture and dozens of lit candles. At the top of the stairs, two police officers flanked a young man dressed only in his underwear. His chest was covered in glitter and a bright red cross drawn with Sharpie marker. Calero asked the man’s mother about his medical history and tried to keep her away from the scene.
Brough moved up the stairs, past the officers.
In situations like this, the clinicians only have a small window of opportunity. If things escalate, they back away. They don’t chase if the patient flees or physically engage if he becomes aggressive. Their main strategy is to get the patient talking, buying time to evaluate his mental state.
“Hi,” Brough said gently. “My name is Mary. How are you doing today?”
Brough, 61, struggled with postpartum depression after the birth of her first child, an experience that she has come to think of as a gift – something that gave her a sense of what it felt like to be trapped inside her emotions. Looking at the young man, she saw he was animated, likely riding the tail end of a manic high caused by unmedicated bipolar disorder.
She listened as he said that he was a prophet from God, a rock star and a tennis player. She politely declined when he offered her tickets to the U.S. Open. Brough asked about the fight the man had with his father and what he did over the weekend, using different tactics to pull him into reality – and keep him burning energy.
After half an hour, he started to mellow. They wouldn’t need to restrain him in a stretcher, Calero told his parents. And there’d be no arrests. Just after 8:30 a.m., the young man put on clothes and let police take him to the hospital.
Sometimes, that was all it took, Calero said.
“You give them time, redirect them. And you listen.”
Back at the crisis center, the phones were still ringing.
The central operations room was bright, littered with whiteboards and Post-it notes that listed the phone numbers of virtually every county agency and service provider. A security monitor showed counselors meeting with patients inside private rooms decorated with inspirational quotes and equipped with panic buttons.
“We need a Spanish speaker. Anyone?” one of the center’s new hires asked, her hand over the receiver.
“Yup. 4404,” Calero said, munching on a bagel. “Transfer them over.”
A soft-spoken father of two, Calero, 41, is one of the center’s few Latino clinicians. Raised by a single mother from Ecuador who earned money cleaning houses, he feels an affinity for the Spanish-speaking immigrants who call in. He empathizes with the language barriers and other challenges that can make it difficult for them to seek help. And he understands that the stigma of mental illness drives some of them to say they have a “headache” or “muscle pain” when what they mean is that they feel depressed.
Calero doesn’t consider himself an activist, but he feels a pull to help the people he grew up around in the crowded rental apartments of Langley Park, Md. “I’m aware of everything going on in the world. I have my eyes wide open,” he said. “But I can only do what I can.”
Most days, he said, that means picking up the phone.
One desk over, Brough was thumbing through her client files, looking for a man who came in over the weekend and was referred to a hospital for outpatient treatment. “Ah,” she said to herself, finding it. She dialed the hospital.
“I’m calling about a patient referral,” she said. “His last name is . . .”
Brough had spent so much of her career doing this. Calling hospitals, child protective services, homeless shelters, community clinics and public schools. Listening to dial tones. Waiting on hold. Trying to track down and help the mentally ill navigate a system that rarely seemed to have a place for them.
She was glad that county officials decided to hire more counselors. But what would really help, she thought, was more case managers – people who could chase the “little things,” follow up with patients and make sure they went to their appointments. She also hoped the government would invest in long-term treatment options, including more state-run psychiatric beds, which have declined over the past two decades despite mounting demand.
“I can go out and evaluate people all day long,” Brough said. “But by the time we’re out there, it’s almost too late.”
Brough also has misgivings about potential changes to the crisis center – especially the possibility of having to respond to calls without police backup.
County administrators are working on a “red, orange, green” system that would require counselors to assess the danger level of a call before deciding whether to go with law enforcement. The proposal is supported by behavioral health experts and the federal Substance Abuse and Mental Health Services Administration, which last year released guidelines saying that crisis teams should not involve police unless absolutely necessary. Counties in Oregon and California, the agency noted, have successful programs where most calls are addressed by a clinician and a paramedic.
“Embedded co-response is the opposite of what we advocate for. It’s not what we consider best practice,” said Ron Bruno, a former police officer and the executive director of the advocacy group Crisis Intervention Team International. “That model still allows for involvement of law enforcement that is just unwarranted.”
But the change is controversial among Montgomery’s counselors, many of whom have long working relationships with the police and can recall specific instances where they felt protected by officers. There was the time a patient flew past Brough and grabbed something that his family initially thought was a gun (it turned out to be a knife). And then there was the woman who calmly invited Brough and another counselor into her home, only to suddenly lunge at them.
“I’ve been in situations where things change in the course of 30 seconds, and that’s why the police are there,” said Brough, who co-leads crisis intervention training for the county’s police officers. “I’m really afraid that something’s going to happen and somebody’s going to be hurt.”
“The police are there for our safety, that’s all,” Calero agreed. “We’re the ones in the lead.”
Nonetheless, he said, he knows some callers tense up when they hear that he’ll be coming with police. He saw the same fear in his community growing up. He’s made it part of his script to emphasize that there will be no arrests and likely no use of force, but it doesn’t always work, he said. Some residents, especially if they are Black or Latino, still look betrayed when he arrives with armed officers.
Crowel, the health department head, said he’s sympathetic to the safety concerns from counselors, but believes that some changes to protocol are overdue.
“[The counselors] are going to be a little bit out of their comfort zone, but all of society is, too, because we have to figure out how we respond to people in distress. . . . And the answer cannot be jail,” he said.
“This is going to make us all uncomfortable,” he continued. “And then we adapt.”
Crowel was leading Montgomery’s behavioral health division in 2018 when a county police officer approached Robert Lawrence White, an unarmed man wandering near his home in Silver Spring in apparent mental distress. Crowel remembers watching body-camera footage of the incident, where White, described as kind and considerate by his neighbors, appeared to yell erratically at the officer. After a tussle, the officer fired eight rounds at White, killing him. He was 41.
It’s not clear why police didn’t call the crisis center to intervene in that situation, said Crowel, who, like White, is African American. But he still thinks about how a behavioral health clinician could have handled it differently.
“It’s painful. And my pain doesn’t stop at the county borders,” Crowel said, referencing national data showing that police officers kill Black people at far higher rates than White people. “It’s painful every time this happens. And it’s frustrating.”
Brough was struggling to understand.
It was just after noon, and she was on the phone with a woman speaking with an accent that she didn’t recognize. She made out that the caller was a mother whose 25-year-old son was pacing anxiously around the house, rearranging the dishes, and banging his head on the wall. He hadn’t slept in days and hadn’t showered in weeks, the woman said. He used to go to a clinic where they gave him injectable medication for his schizoaffective disorder, but it went online-only during the pandemic and he hadn’t adjusted well.
“Has he been going to the bathroom?” Brough asked. “And has he ever been violent?”
Walking by with a clipboard, Calero caught the nod from Brough that he recognized.
“We’re bringing the police with us, okay?” Brough said to the woman, pausing as she interjected. “He wouldn’t. No, ma’am, no, he wouldn’t be under arrest. They’re there for us.”
This time, the clinicians got there first.
They waited 20 minutes outside the blue townhouse in Silver Spring before the police arrived.
Inside, a mother was watching nervously over her son, a Black man with a severe thought disorder, who was staring vacantly at the walls.
Calero approached the house with Brough and three police officers behind him. He steadied his breathing and knocked four times. The door creaked open.