Tony Mantor: Why Not Me the World

Sherri Witwer: Rethinking How We help People in Mental Health Crisis

• Tony Mantor

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Sherry Witwer, board president for CIT Utah, shares her insights on improving crisis response systems for people experiencing mental health emergencies and creating alternatives to incarceration through specialized training and community partnerships.

• CIT (Crisis Intervention Team) training provides law enforcement with tools to effectively respond to mental health crises and connect individuals with appropriate treatment
• Mobile crisis outreach teams staffed by behavioral health providers and peers can handle most crisis calls without police involvement
• Receiving centers offer alternatives to jails or emergency rooms, providing specialized assessment and stabilization for those in mental health crisis
• Proper training helps officers distinguish between substance use and mental health crises through scenario-based practice and building community partnerships
• Access to care remains a significant challenge, particularly coordinating services for people with serious mental illness across different systems
• Better case management and peer support services are needed to help individuals navigate complex systems when they're least able to do so independently
• Affordable and supportive housing is essential for recovery and breaking cycles of hospitalization and incarceration
• Including voices of people with lived experience and families is crucial for designing effective mental health services that people will actually use


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intro/outro music bed written by T. Wild
Why Not Me the World music published by Mantor Music (BMI)

Speaker 1:

Welcome to why Not Me? The World Podcast, hosted by Tony Mantor, broadcasting from Music City, usa, nashville, tennessee. Join us as our guests tell us their stories. Some will make you laugh, some will make you cry. Their stories Some will make you laugh, some will make you cry. Real life people who will inspire and show that you are not alone in this world. Hopefully, you gain more awareness, acceptance and a better understanding for autism Around the World. Hi, I'm Tony Mantour. Welcome to why Not Me? The World Humanity Over Handcuffs the Silent Crisis special event.

Speaker 1:

We're delighted to welcome Sherry Witwer, a dedicated and passionate advocate for mental health and community well-being. With an extensive career spanning numerous roles, sherry has made significant contributions across a wide range of sectors. This includes community non-profits, government and corporate environments. She currently serves as board president for CIT Utah, sits on the National Advisory Board for the CIT Assist Program and holds the position of board vice chair for the Utah Housing Coalition. Additionally, she is a founder and board member of Peers Empowering Peers Utah, an organization devoted to advancing mental health peer support. It's an honor to have her with us today to share her wealth of experience and insights. Thanks for coming on.

Speaker 2:

Thank you, thank you for the opportunity. Oh, it's my pleasure.

Speaker 1:

I understand that you are the president for CIT Utah. Can you expand on what that is?

Speaker 2:

Yes, I guess, as a matter of introduction, I'm a longtime mental health advocate.

Speaker 2:

I've worked in various capacities in our mental health system, primarily in public policy advocacy.

Speaker 2:

I'm a family member of someone with a serious mental illness and that's what has driven my work and my interest in the mental health system.

Speaker 2:

That is, training for law enforcement, behavioral health providers and families and people with lived experience. They come together to provide training for law enforcement and, more importantly, to have an effective crisis response. When someone is in crisis, that law enforcement has the training and the support of the mental health system to help them respond effectively and get the person to the treatment that they need. Now really positive development is that with our crisis response systems, we have developed mobile crisis outreach teams that are driven by behavioral health providers with peers, people with lived experience, who can respond to the overwhelming majority of those calls, and that really provides better outcomes and helps us to treat mental health as a mental health condition. However, there are times when law enforcement needs to be involved or behavioral health team is uncertain in their response, and so they can co-respond or have law enforcement take the lead in that response. But having that training and that understanding is critical to having better outcomes for everyone involved.

Speaker 1:

With what you're involved. I believe they have created a new number for crisis response.

Speaker 2:

So CIT is still an important piece and I don't want that to be overlooked in our crisis response systems, because there just are times when law enforcement needs to be involved. They are called out and to recognize oh, this is a mental health crisis and we need to get our CIT team to be able to respond differently to that situation.

Speaker 1:

When police are involved, the goal is, of course, to improve outcomes and prevent situations from escalating. How have they responded to the training efforts aimed at teaching the officers to quickly assess situations and make decisions? Given their limited time and, of course, their budget constraints, have you seen as good a response as you hoped for?

Speaker 2:

Yeah, I think, first of all, when you talk to law enforcement, they are inundated with mental health calls and they really would rather not be responding to those calls, so they welcome mobile crisis outreach teams and some of these responses really takes the burden off of law enforcement and having to make all of those decisions.

Speaker 2:

Still, there are times when they need to and that's where having best practice CIT program is involved and that means having everyone have all law enforcement, get basic mental health training and build those relationships, know who the partners in the community are that they can call in crisis response. It also is in having a specialized CIT team that responds, have them follow best practices and that means that they self-select, that there are people who say, yeah, I would like to work with this population and build these relationships and know the system and know the civil commitment process and take their education and their tools and training down that path. When you are talking to law enforcement about this, they get it that having that support in response and having the best tools and training for their officers is a win-win for everyone. A good CIT program has oversight that involves people with lived experience and family members who can help inform that crisis response as well. It's just a very unique partnership when done correctly, and it can make a huge difference in how things are addressed.

Speaker 1:

Okay, let's do a scenario here. A police officer responds to a call about a person whose behavior might typically suggest they're under the influence of drugs or alcohol erratic movements, slurred speech, other telltale signs. This individual is also holding a knife or a gun, something that could drastically escalate the situation. With only seconds to react, how does the officer distinguish between someone experiencing a mental health crisis, like psychosis, or someone who's simply high or intoxicated?

Speaker 2:

They definitely will encounter people who are using substances, as you point out, but this is part of the CIT training.

Speaker 2:

They do this very thing, where they have different scenarios, scenario-based trainings, and they help to create some time and some distance from what's happening to be able to make those calls.

Speaker 2:

And, there's no question, they often don't have a lot of time.

Speaker 2:

But that's where having officers who have had some time on the street first of all before they become CIT officers, so that only time and experience can really help them differentiate between what are we dealing with here and then having that training and ongoing recertification for officers, because there are always new things that come out that they need to be aware of, and I just think that kind of training is so critical, and CIT is critical in helping to divert people.

Speaker 2:

So, rather than taking people to jail, if there are receiving centers which is another thing that has been developed and is starting to get traction where, rather than taking people to jail or even an ER, they go to a receiving center which can do an initial assessment and decide what level of care the person may need, and it helps law enforcement in being able to take the person to a safe place, that's a real tool as well. That has been very important in crisis response. We need more of those in assisting law enforcement and behavioral health in crisis response. Again, helping to take all of the decision-making off from law enforcement and have them get behavioral support, behavioral health support in that response just makes a big difference for everyone.

Speaker 1:

I'm really interested in getting back to that center you mentioned, but first could you tell me what a typical day looks like when you're setting up a conference for police officers or other first responders? What does the schedule involve as they go through the process of learning all this material, which seems like a lot to take in?

Speaker 2:

So 40-hour training for CIT in Utah and I can just speak to how it is. It's a 40-hour training in order to get that certification and they bring in experts who can talk about. Here's what mental illness is. Here are the different medications, here are the different ways it can present. Here is how someone who is in psychosis can present and talking about a condition called anosognosia, where the person does not have insight to their illness or that they're ill, and it's not just denial or being difficult or belligerent. They truly do not believe they have a mental illness.

Speaker 2:

And helping law enforcement to identify that and bringing in speakers who have expertise in civil commitment law, who are family members, who are people with lived experience having them spend time at different locations with people who are in recovery is really important. So it's just giving an overview of the system. The big part of CIT is helping to build those partnerships so law enforcement knows who to call, who are the contacts, where are the resources in our community that they can lean on, and really it's creating relationships. So much of CIT and, frankly, with the whole mental health system, so much of providing an effective mental health system is building those partnerships and relationships and points of contact, so that people know who to call and how to have an effective response. And that's what the training is.

Speaker 1:

Now you mentioned a treatment center. When someone reaches a point where intervention is necessary, you mentioned a treatment facility where they can go to for diagnosis and support. What factors determine whether they end up in jail, going through that legal process, or are directed to a treatment center instead, where they can get help and potentially avoid incarceration?

Speaker 2:

That is a big question and that's constantly being discussed how do we help law enforcement get as much information about what's taking place as possible? Get as much information about what's taking place as possible. Part of this is we encourage families to be able to talk to law enforcement and give them information and give them some history and background, having the behavioral health contact in that crisis response. A lot of times the behavioral health system will know the person and will be able to enlighten law enforcement in what's taking place and be able to have an effective response that way. And so it's about helping law enforcement to get as much information as possible. This means also there needs to be effective training for call takers, dispatchers, and help them to get that information as well.

Speaker 1:

Right. When someone calls 911 for assistance but provides insufficient details, it leaves the responding officers unprepared for what they might encounter. Counter Situations involving civil disturbances can be particularly volatile, making them some of the most dangerous scenarios for police to handle without the proper information.

Speaker 2:

That's right and it's not always possible in every area, depending on the size of the police department, but ideally there's time to say we need a CIT team to respond to this and that's ideal where we have these trained teams that respond and are able to use their skills in that response. I would say overall we really need to provide more avenues for families to be able to give information and explain what is happening and provide background and history to the situation as well.

Speaker 1:

When individuals enter this facility you spoke about, does it remove the legal aspects or do these legal elements remain in place? How does this all connect and work together?

Speaker 2:

Yeah, so they're going to sort things out. There. There are 23-hour stays and so it gives them time to sort things out, to decide what level of care the person needs and then let the legal system and that's got to work its way through as well. But again, understanding that behavior is driven by a serious mental illness or psychosis or anosognosia is important information in knowing how to help the person from there and with the legal system, how to manage the court system with that person as well. Manage the court system with that person as well.

Speaker 1:

As someone who's been involved for about 20 years, what positive changes have you observed, particularly in the last five or six years? It often seems like five years is the window it takes for things to process and start working effectively. So in the past five years, what specific changes have you seen that you'd say are definitely positive and moving in the right direction?

Speaker 2:

Well, I think we've been talking about one area, which is crisis response. I think that has been a big improvement. I think having a number that people can call 988, to be able to get assistance and just help to sort things out on their end A person with lived experience or family to have that resource. So I think the establishment of mobile crisis outreach teams that use behavioral health providers and peers is very significant, very important. Receiving centers are very important as well. So I think those are big areas.

Speaker 2:

I think, in some ways at least, for general mental health and wellness, we're talking more about that. I think we're focusing more. We understand that mental health is something we need to address and try to intervene early, Focusing on mental wellness, and try to intervene early focusing on mental wellness. I think that has been significant. For the most part, I think we've addressed stigma in a significant way, although for people with very serious mental illness. In some ways it may be rougher for them where there's less tolerance and patience around that, but for the general population, I think we've made some big improvements in that way.

Speaker 1:

Having observed these transitions, what key areas do you believe still demand greater scrutiny and effort? While these topics may have been initially explored, they clearly warrant deeper attention and development. Can you identify any areas where you would assert okay. This absolutely requires us to prioritize and address it thoroughly, because you see the need for it to get better for everyone.

Speaker 2:

Yeah, I think we do need to be focusing first of all on access for everyone. How can people get timely access? When someone decides, yes, I need help, how do we help them get help quicker and in a way that works for them? So there's that. But if we look at this population with serious mental illness, we need to be focused on how can we provide better services for them. This is a population that cycles through different systems our criminal justice system, the ERs, hospitals and too often the care we provide is facility-based and so focused on okay, now they're in this facility, now they're in this facility, but we're not talking about how do we help people get from point A to point B. And that really is care coordination. And that needs to happen on a high administrative level, where you have partnerships in place between agencies and departments, where there are points of contact that the buck stops with this person in helping to address people with mental illness, because people with mental illness will show up in various different systems. There has to be a point of contact within the mental health system that the other systems can go to for assistance, and that means wherever a person with mental illness appears, the mental health system needs to be there and be there also to help that person be diverted and navigated to the services they need. So on an administrative level, that needs to happen, but also on a boots-on-the-ground level, we just need more peers.

Speaker 2:

We need more case management One of the most cost-effective interventions and one of the most effective interventions when we can have people who can help people with serious mental illness. Just get from point A to point B when someone is very ill to tell them okay, you have an appointment downtown at 10 o'clock on a Tuesday. That can be very difficult for them to navigate and there are a lot of barriers to them, just with transportation and being able to know how to find this location and get there. No-transcript, and I think we've made great strides in at least recognizing that people can do well if they can get treatment and get the services they need.

Speaker 2:

But there are people who need more than just basic outpatient treatment. They need that intensive case management within the system to help them get from place to place. It's a simple intervention but we really don't do it very well as far as coordinating care for that person. The other big challenge that we have had and you see this nationwide is the lack of housing for people and we need deeply affordable housing. But we also need permanent supportive housing which is providing on-site supports and services for people with serious mental illness or just people who have had a lot of experience being unhoused or being in the criminal justice system that they need more intensive support on site to help them get from again point A to point B and have a safe place to live so they can even focus on getting and building a life.

Speaker 1:

How do we get legislators to truly understand the value of funding systems like health care and judicial support for the mentally ill? Beyond just knowing they exist? They often dismiss it as throwing money into a black hole, missing how it's a long-term investment. I've spoken with people who say they've lost 10 years navigating these systems, fighting for the right medication, battling through the court system, before finally thriving. How do we move past vague calls for education and make lawmakers see that this isn't a bottomless pit, but a step-by-step process that, though it may take years, ultimately transforms lives and benefits society?

Speaker 2:

A key component of that is to be able to show outcomes, and I can only speak for the system. I know we're not great at showing outcomes and showing what interventions work. I think the mental health system has to be able to make that case and be able to show here are our outcomes how do people lose 10 years of productivity and, in that time, what the damage that has done to that person's life, their family, their employment, their life situation and involvement in utilizing resources in typically multiple systems. It is a cost savings mechanism for everyone to be able to have an effective, accountable mental health system, to make sure it's properly funded, but also that it's targeting interventions that we know work and we do know what works, and using best practices and evidence-based practices and really being able to identify these issues earlier on and really wrapping services around people who need them, not make people have to fail several times and cycle through. Too often what happens is we blame the person and the person blames themselves, and that compounds their feelings of worthlessness and difficulty, when really we are asking people to navigate systems that are incredibly broken, fragmented, siloed, and so then the thinking is oh, we really need to just use a hammer, and then people tend to spend more time in the criminal justice system.

Speaker 2:

There's a lot of discussion there has been for decades now about how jails and prisons have become the new mental health providers, and that does not work. Jails and prisons cause trauma, they compound the problem again and it is far more cost effective to have interventions that are community-based, that have people living in the community with wraparound services. We know it's more effective, we know it's more effective, we know it's cost effective, we know people can do well. I guess my answer twofold being more accountable in the services that are provided, and two, really focusing on again point A to point B. So we have this great program and once the person is released from that program, then what and I think that's the question we should continually ask Then what? Okay, the person's released from jail, then what? Discharged from an inpatient facility, then what? How do we get them from that to a home in the community where they can live and engage and live a life? And we know that people can do well if they can get access to those services.

Speaker 1:

While we could dive into countless fascinating topics and keep this discussion flowing for hours, I'd love for you to reflect for a moment. What's one critical insight, idea or piece of wisdom you feel compelled to share with our listeners, Something you consider truly vital for them to grasp and carry forward in their lives?

Speaker 2:

Yeah. So I come to this work as a family member and I think we really need to hear more from families, from people with lived experience, about what works and what works on again, that very granular level. I think too often we have people building programs and systems and service delivery models that when you talk to the person with lived experience or their families, they don't know how to access or they say that won't work and so, rather than continuing to build things that people don't want or won't use, we really need to have more voices in that space. More voices in that space, and if we could get our systems to be curious, to show some curiosity around, why do we continue to have these issues and these problems? And not be so protective of the status quo but be willing to hear fresh voices, hear from people who are living it, they could get the most important data of all and that will help them determine how to build effective systems.

Speaker 1:

Yeah, that's great information. This has been a tremendous conversation with a lot of great information. I really appreciate you taking the time to come on.

Speaker 2:

Yeah, thank you, appreciate it.

Speaker 1:

It's been my pleasure. Thanks again. Thanks for taking the time out of your busy schedule to listen to our show today. We hope that you enjoyed it as much as we enjoyed bringing it to you. If you know anyone that would like to tell us their story, send them to TonyMantorcom Contact then they can give us their information so one day they may be a guest on our show. One more thing we ask tell everyone everywhere about why Not Me, the world, the conversations we're having and the inspiration our guests give to everyone everywhere that you are not alone in this world. You.