WMed awarded $500,000 grant to develop mental health education program for emergency responders

Dr. Bill Fales
Dr. Bill Fales

The medical school has been awarded a $500,000 grant by the Michigan Health Endowment Fund to develop and implement a comprehensive mental health education program for police officers, EMS and other emergency responders.

The Michigan Crisis Intervention System (MI-CIS) was born from what the Michigan Health Endowment Fund identified as a need for improved training for first responders who regularly deal with people and patients in the field with acute behavioral health conditions, said Dr. Bill Fales, associate professor of Emergency Medicine and division director of EMS and Disaster Medicine at Western Michigan University Homer Stryker M.D. School of Medicine.

“The need is based on increasing encounters with patients experiencing behavioral health problems that may … often result in engagement with the law enforcement and EMS communities,” Dr. Fales said. “Ultimately, the hope is that we can further improve the safety of responders and citizens.”

The grant, which was awarded to WMed November 2, is the result of a collaborative effort by the medical school, the Michigan Department of Health and Human Services and Kalamazoo County Mental Health and Substance Abuse Services.

Dr. Fales, who also serves as State Medical Director for the Michigan Department of Health and Human Services’ Bureau of EMS, Trauma & Preparedness. is a co-principal investigator on the grant along with Dr. Debra Pinals, medical director of Behavioral Health and Forensic Programs for MDHHS. Dr. Robert Satonik, an associate professor in WMed’s Department of Emergency Medicine, is the principal investigator.

Satonik said he is hopeful that once MI-CIS is implemented, it will deliver for emergency responders an improved ability to recognize a behavioral health emergency and take “a better course of action so that we have a better resolution and a better outcome for all of those involved.”

“The idea is to really take this and make it more practical and hopefully give those folks a better skill set so that things go well,” Dr. Satonik said.

Fales said the idea for MI-CIS was birthed by the Michigan Health Endowment Fund and its desire to offer first responders in the state of Michigan a “truly comprehensive, integrated mental health education program that includes multiple disciplines and multiple levels and hierarchies of training.”

Fales said officials from the endowment fund approached the Bureau of EMS, Trauma & Preparedness about developing the training program and WMed was brought into the fold to make it a reality.

Fales said the medical school was a viable candidate for the grant given Kalamazoo County’s reputation historically of working closely with local law enforcement agencies through Crisis Intervention Team (CIT) training. The effort is a 40-hour course specifically aimed at police officers to learn about different behavioral health problems they may encounter in the field with the goal of improving officer safety and the safety of community members.

“Kalamazoo has experience, it’s well-known for police level mental health training,” Dr. Fales said.

Robert Butkiewicz, criminal justice services supervisor for Kalamazoo County Mental Health and Substance Abuse Services, said his agency has been doing CIT training for law enforcement officials for the past eight years. They’ve also offered the trainings to prosecutors and judges, as well as probation officers.

Dr. Fales said the medical school, MDHHS and county officials plan to build upon the success of CIT with MI-CIS and have identified some of the program’s best features, as well as shortcomings, as part of the development of MI-CIS. They also are doing an inventory of other existing training programs and identifying their strengths and weaknesses to develop the curriculum for MI-CIS.

For example, Dr. Fales said that, despite the successes of CIT, the program lacks a standardized curriculum, it relies heavily on classroom lecturing and targets only police officers, among other things.

With MI-CIS, officials will expand the training to EMS workers and it may eventually be broadened to include 911 dispatchers, corrections officers and hospital emergency department personnel. Dr. Fales said the program will be vertically integrated and include an awareness course for all first responders, as well as intermediate and advanced courses.

“The opportunity that (MI-CIS) affords is primarily to broaden the target population,” Butkiewicz said. “The curriculum development is a huge piece and being able to put a half million dollars for two years into curriculum development to try to standardize this is fantastic.”

Dr. Fales said each course will boast an online learning component and the intermediate and advanced classes will have one- to two-day trainings that will be hands-on and include problem-solving and role-playing exercises with the assistance of standardized patients from the medical school.

Additionally, technology will play a key role in MI-CIS, including traditional and immersive video-based scenarios through a system known as MILO Response. MILO Response is a simulation system originally designed for training police in use of force. For MI-CIS, the system will be adapted to provide an immersive simulation system replicating scenarios involving behavioral health emergencies and requiring verbal de-escalation.

“We think if this is done right, there’s definitely a return on investment,” Dr. Fales said. “We have not seen anything like this in the country.”

Dr. Fales said the return on investment that he and others are hopeful for is a training program that helps to quickly de-escalate interactions between first responders and residents or patients they may encounter who have underlying mental illness. Dr. Fales said the interactions, at times, can prove volatile or even fatal.

Butkiewicz said that building upon CIT with MI-CIS will prove beneficial for first responders and the communities they serve. He said there is “good evidence” now that CIT training reduces use of force by police and decreases the number of injuries to police officers and residents or patients they encounter during a behavioral health emergency.

“We’re very supportive of this model,” Butkiewicz said. “The focus is on verbal de-escalation and prevention. Also, the hope is to help people with services when appropriate as an alternative to jail.”

MI-CIS will begin December 1 and will run until Nov. 30, 2018, Dr. Fales said. He said officials plan to have the initial MI-CIS awareness course ready to go by June and will role out the intermediate and advanced courses in the latter part of 2017.

He said he program will be piloted in Kalamazoo County and at least two other areas of the state with the goal of integration across the state of Michigan. Dr. Fales said MI-CIS will be “a readily replicable program” and trainer courses will be offered so that first responders from across the state can learn and take the information and knowledge back to their respective jurisdictions for implementation.