Heat lightning flashed against the night sky as Richard Collins and three Pittsfield Police officers descended on a Memorial Drive home. The lights were on and the door was ajar.
Just inside, child-size shoes lay askew on the hardwood floor.
No one was there, but a 911 caller had just warned that her daughter, the woman who lived in the home, was in danger. Earlier that evening she promised to drive off a bridge, then gave her 8-year-old son a stuffed toy and said goodbye, the caller told dispatchers.
"What do you think, Richard?" Pittsfield Police Lt. Jeffrey Bradford asked Collins, a social worker with the Brien Center.
"With those kinds of statements, we should," he replied, launching the group toward a Section 12 order. The measure empowers officers to bring someone to a hospital for a mental health evaluation.
Police officers regularly face decisions like this one, and now cops in Berkshire County have backup. What began three years ago as a partnership between the Pittsfield Police Department and the Brien Center has evolved into a countywide effort to provide mental health services as a first response and to reduce the number of involuntary transports.
On Memorial Drive, Collins called the mother who had dialed 911 as officers worked to reach the woman on her cellphone. A sedan slid into view about 10 minutes later. The woman they were searching for shuffled out of the car.
Her eye was black. She was angry to see police.
"We're concerned," Collins said, his voice low. "We're just checking on your well-being."
It wasn't her boyfriend who hit her, she told them. It was "a girl on the street."
"You guys are ridiculous right now," she said, slurring her words. Two officers flanked her and guided her into a police cruiser.
Collins later likened her behavior to a child in trouble. Her defense mechanisms were kicking in, he said. "You have to look for those little clues," he said.
In a rear wing of Berkshire Medical Center, hospital staff admitted the woman, taking from her anything she could use to harm herself. Collins filled out forms and briefed nursing staff.
By this time, the officers had left.
"Police are always getting called away," Collins said.
And that's why he's embedded with the department four days a week, responding to calls for which mental health services are needed. The program began three years ago with money from the Massachusetts Behavioral Health Partnership, but now it's entirely funded by health insurance.
Last fall, Collins expanded the work into North Adams, where he spends one day a week. And in April, the program stretched south into Great Barrington, with another clinician working alongside police officers in South County twice a week.
The program has helped 1,636 people to date across the county, Collins said. He hopes to build relationships with more departments.
"We know the need is there," he said. "They tell us constantly, everywhere we go."
"We don't want to wait for that person to get to that bridge, ready to jump," Collins said.
Many of the Pittsfield department's mental health calls, including streetside disturbances, suicidal statements and distraught seniors in care facilities, repeatedly involve the same people. Officers move on, but Collins stays involved.
A mother's struggle
Laura Gingerich said her son, Billy, was diagnosed with schizophrenia at age 18. During his first year of college, she felt something was wrong when he started talking about CIA cameras in trees.
She knew her son was sick, but when he suffered his first psychotic break, the yard filled with cruisers.
"The ambulance doesn't come," she said. "The police do."
Gingerich, who lives in North Carolina, said she arrived at her son's house in Clarksburg this month and found him thin and eating from dirty plates and silverware. The carpets were pulled up and the crevices of the home boarded and blocked.
"I came up and I was concerned that he was spiraling," she said.
Billy was worried that a snake or a mouse would get in, she said, and was staying up all night. He had contracted food poisoning.
"I was afraid that he would die here," she said.
Collins started checking in on him last month, she said.
"It was great when Richard came on board," she said.
He, too, noticed Billy's decline. Everyone in Billy's circle, in fact — his mother, his medical provider, North Adams Police Officer Erik Thomas and Collins — agreed that he needed more care.
And so that circle worked to have Billy admitted for treatment at Berkshire Medical Center. It wasn't the first time his mother had to have him taken to the hospital involuntarily.
The process is painstaking. In the past, she has had to prove to a magistrate that her son poses a danger to himself. That involves a lot of paperwork and stress, she said.
She knows because she has done it 17 times.
Arranging treatment for Billy hinges on her ability to use the right legal jargon, she said. Sometimes, he calms down enough that he appears too functional for involuntary commitment and her argument falls flat.
With Collins on board, "I didn't have to do any of that."
Collins' program keeps people like Billy out of jails, she said, and gives those with mental health issues the support they need to avoid hospitalization, when possible. The police have been great, she said, but there's no substitute for having a mental health professional on the scene.
"It's an illness," she said. "It's no different than any other serious illness."
Without people like Collins, she said, "we're asking police officers to be psychologists."
A new model
Sarah Abbott started this work 16 years ago in Framingham.
She said she developed the so-called co-responder model after the Framingham Police Department requested support from the mental health field. Officers wanted help breaking the cycle of arrests for those with mental health conditions.
Arresting someone or bringing them to a hospital are any officer's "default position," Abbott said. It provides an immediate solution, but it's also expensive and involves taking someone with a mental health issue against their will.
"The police were doing this back then because there was no other alternative," said Abbott, who works as the program director for jail diversion at Advocates. "They were arrested, sent to the hospital or they were being ignored."
Meantime, she said, mental health professionals in the city worked in a separate silo. "It was ineffective. Doing the screening right there in the living room is not only more humane, it's cost-effective and it's a win for everyone."
Together, she and the department launched the Northeast region's first program in 2003 and expanded into Marlborough in 2008. In 2015, she helped launch the first regional program, based in Middlesex County.
More recently, she said the state's Department of Mental Health provided her organization with funding for a training center. Abbott said she feels driven to saturate the commonwealth with these kinds of programs.
There are more than two dozen co-response projects in Massachusetts, according to information provided by Abbott and the DMH. Some serve a single community, while others take a more regional approach.
The commonwealth spent nearly $2 million on those programs during the previous fiscal year, said Daniela Trammell, director of communication and community engagement for the DMH.
The co-response programs exist largely in the eastern part of the state. The Berkshire effort launched under Collins is the only such program in Western Massachusetts.
Pittsfield Police Chief Michael Wynn praised Collins' work to reduce the number of involuntary transports.
"It's better for the patient; it's better for the outcome; it's better for the Pittsfield Police Department," he recently told members of the newly formed Police Advisory and Review Board.
Paul Hickling, vice president of service operations at the Brien Center, said his organization's mission is to keep the people it treats in the community, where they can access their support system. Collins is part of a national movement to embed clinicians in police departments, Hickling said.
Social workers are in the field all the time, but they mainly help those who voluntarily have sought them out. This program serves those who don't normally ask for help.
"That's where there's a big gap, I think," said Ivy Goodwin, the clinician spearheading the Great Barrington-based branch of the program.
In the work that they do — embedded with law enforcement — clinicians meet people where they are at, in a moment of need, and try to build a relationship. They're often people who don't realize or don't want to acknowledge a mental health issue, Goodwin said.
"Those are people that would otherwise be refusing services," she said, calling the chasm between them and services a "no-man's land."
Progress in Pittsfield
Pittsfield Police Sgt. Nick Desantis has been working with Collins for three years.
"I think it's a very positive thing for the department and the community," he said. "It's changed the way we do things, I think, in a positive way."
Desantis said he can recall times when simply being able to say "we have a trained clinician" on scene made all the difference.
"The family would have a look of relief on their faces," he said.
Lt. Bradford said Collins has helped smooth relations between the department and the hospital. He's able to talk about medications a person might be using and help caregivers understand what happened at the scene of an incident.
Collins helps clarify what's really needed. Too often, before, people would end up back out in the street shortly after officers brought them in. But if they were showing the same unsafe behaviors, officers might bring them back to the hospital that same night.
"So, a lot of time there was friction between the police and the clinicians," he said. "Richard knows these individuals and can make real-time assessments. So we're not bringing the same person back later that day."
Bradford said Collins also earned the trust of the department's officers, and that isn't always easy.
"We tend to be guarded, especially about people from outside the organization," he said.
"Once the officers saw that he was actually helping and making a difference, they were calling him all the time," he said. "It got to the point, on nights Richard wasn't here, the officers were calling and saying, `What time is Richard coming in?' "
Their questions run the gamut. One cop asked Collins, in the belly of the Pittsfield police station, about a man "with Section 12 issues." The officer told Collins that the man's family had called again about him, and that he allegedly had vandalized a vehicle with ketchup and mustard.
"They're hoping you'll go talk to him," the officer told Collins, who nodded.
Goodwin, a clinician from Connecticut, kicked off the South County program in April.
It's still early in the rollout, she said, but the brunt of her Great Barrington work so far has involved helping people understand that they need mental health treatment.
She said police officers were called seven times in two days for help with one man, for example. People were concerned about his mental state, she said.
Goodwin spoke with him on the street and learned that he wasn't taking his medication.
"Did you have police in your life when you were taking your medication?" she remembered asking him.
He willingly checked in for treatment after their conversation.
Goodwin also has been following up with people who recently overdosed or were charged with drug crimes. She meets with them and offers to connect them with resources.
"People have been fairly receptive to that," she said. "Police officers will refer them to me, recognizing something in the person, that they may be ready for change."
With the program, the Great Barrington Police Department will be in a better position to evaluate mental health needs and how they can be fulfilled, the department says.
Great Barrington Police Chief William Walsh said an in-house clinician "could ultimately save lives." Officers receive extensive training to inform their interactions, he said, but "the clinician is best equipped to help people in need."
In an interview at the station, Great Barrington Police Sgt. Paul Storti said he already had been thinking about how to better serve people with mental health issues when he learned of Collins' work. Department leaders set up a meeting.
"It kind of took off from there, like really quickly," he said.
Police departments in Egremont, Sheffield and Monterey, as well as Southern Berkshire District Court, joined the partnership.
Goodwin works 11-hour shifts alongside officers Tuesdays and Thursdays. Storti said the program comes at no cost to the department, as it's paid for through insurance.
Goodwin's clinical approach is a valuable complement to the department, Storti said. He said her work already is decreasing the call volume stemming from certain members of the community with mental health issues.
"Having her here and watching her in action is educational," he said.
In North Adams, Police Officer Joshua Tracy recalled a recent incident in which a boy made suicidal statements during the school day. School officials called for help.
Because Collins was able to go to the school, Tracy said, first responders didn't have to take the boy to a hospital, which would have meant more stress for everyone involved. Instead, he went back to class.
Like all beat cops, Tracy sees it all. He drove his cruiser by an apartment complex in the city's south end on a shift. "We see a lot of people in crisis in that apartment building," he said.
His job involves helping people down on their luck, Tracy said, and Collins' work goes a long way. He said having Collins around "gives us a lot more options."
"A lot of the time we're the only one here to lend an ear," he said as he steered his cruiser through the infamous hairpin turn on Route 2. "We all come from different walks of life."
More than half the calls involve mental health issues, he said. Whether dealing with someone with substance use, post-traumatic stress or other disorders, he said he leans heavily on his crisis intervention training.
"Somebody could be going through a crisis and we don't even know it, yet," he said. "Even if it's someone stealing from Walmart, there's something behind it."
Collins' presence improves the department's handling of mental health cases, Tracy said.
"Having MH1 has sparked more conversations," he said, referencing the clinician's unit number. "That this is a serious issue and we always have to progress with it."
Michael Cozzaglio, who served as the North Adams Police director before retiring this year, said Collins' presence improved the department's sense of empathy. Eventually, he said, he'd like to see the program expand to full-time coverage.
"We want to see this grow," he said.
Art Barbeau, the dispatch supervisor in North Adams, said some people call regularly "just to talk."
"There's a handful that call multiple times a day," he said. "That's beyond what dispatchers should be doing. I'm not qualified for that."
Nursing home call
One evening, Collins was called to a city nursing home, Hillcrest Commons, to speak with a woman who did not want to be there.
"I'm claustrophobic," she told him on arrival.
She had tried to leave the facility that day, she said, and she felt she was being held against her will.
The woman was propped up in her hospital bed. Collins responded with a calm voice.
"You do realize there are people here who probably shouldn't leave?" he asked her.
"And I help those people!" she told him. "And I don't work here!"
"Do you want me to talk to them about your desire for different housing?" he asked.
Her knee bobbed up and down above stockinged feet. It's not easy to talk to the staff, she said, but Collins told her she had to find her voice.
"Listen, kid," he told her. "We're going to try to get you some resolution. Let's try to get to the bottom of this. What medication do you take?"
Down in the administrator's office, staff at the home had told Collins the woman had a personality disorder and that they're trying to get her to take anti-psychotic medication.
"She feels for nails in the ceiling that aren't there," one administrator told him.
"Well, she seemed pretty intact today," Collins replied.
Staff told Collins the woman was a tough case, and that her behavior made her difficult to help. Officer Thomas Bowler Jr. asked administrators if the patient could file a complaint so that, in the future, she wouldn't feel a need to call police.
"You can give her an avenue for her to get it off her chest," he said. They agreed.
Collins also asked staff to set clear goals for the woman to achieve in order to leave the facility, to help ease her mind.
Back up in the hospital room, he told her "the wheels are in motion."
On the road
"Headquarters to 950." That's how each of Collins' calls start.
That is, unless the call comes from points north or south, in which case the clinician's call sign is MH1 and BCI, respectively.
Collins recalled an instance in which Pittsfield Police officers were called to help a man who believed there were people in his basement and that his house had been bugged. He and officers at the scene had considered bringing him to a hospital, since he appeared out of touch with reality. Collins said he decided to call the man's psychologist.
That caregiver said the man wasn't sleeping well and that sleep deprivation had led to some "magical thinking," Collins said, but that he wasn't psychotic and not to take him to a hospital.
"Those are connections that a lot of other people can't make," he said. "That helps keep people out of the hospital, keep people in their own homes."
In another instance, Collins helped coax a young woman living in a residential facility out of a locked bathroom, where she was holed up with a kitchen knife.
Collins said the program is about more than his work on the street.
"This isn't about me," he said. "This is about officers that are more readily noticing the signs and symptoms of mental illness."
And the education goes both ways.
"I've never learned as much as I have from these guys," he said.
Clinicians like Collins respond to the same kinds of dark daily calls that police officers do — calls with stabbings and shootings and abuse. Abbott, who created the original program in Framingham, said the clinician must be an ally to law enforcement officials, many of whom need counseling themselves after years on the job.
Collins said he keeps an eye out for calls on which he might be of help. For example, if he hears officers responding multiple times in a week to an "unwanted person," he might look that person up and go check on them. "So, I generate my own calls, too," he said.
A woman named Andrea, of Pittsfield, said she first met Collins during a mental health crisis in spring 2017. She said she has borderline personality disorder, and suffers from bouts of depression and suicidal thoughts. She declined to give her last name.
Andrea said Collins' calm demeanor continues to help her.
"I called him this evening because I was having a very, very rough time," she said Thursday. "He came to the house and we decided I was OK, that I didn't need to go to the hospital."
She said she has been hospitalized countless times, but since Collins started coming by her house, she has been able to ward off hospitalization long enough to hold a job. When she's in crisis, she said, she calls dispatch or goes to the station and requests Collins, and he comes to her home.
"Just his calming presence is generally enough for me, just knowing that someone's here who understands," she said. "He doesn't talk down to me. He seems to really get it."
Before moving to Pittsfield from New York, Andrea said, she would end up in a hospital every six weeks or so. She has been hospitalized a handful of times total over the past two years, she said. The reduced frequency helps her to be more involved in the community.
"To spend all that time in a hospital, it really takes away your sense of independence for a while," she said.
The woman wishes Collins had more backup of his own.
"He's kind of stuck doing it by himself in Pittsfield right now," she said. "I think he needs more help so he doesn't get too tired out."
Hope for growth
What began with the simple goal of reducing Section 12 orders now presents "a real opportunity to make some differences," Collins said.
These services are needed seven days a week, he said, but there aren't enough people interested in doing the work, or money to pay them to do it. Municipalities have to be the ones applying for grants to fuel the program, he said, and that complicates regional programs like the one he's building.
"You're talking about people's lives and making decisions about them," he said. "And it's pretty scary."
Hiring clinicians who are skilled and willing to do this work is challenging, Abbott said. They need to fit into police culture or officers won't use them. Hiring and training the right people for the job is a prospect that "keeps me up at night," she said.
"You have to have a good sense of humor; you have to have thick skin," she said. "You have to be compassionate and you have to know who's in charge."
Her organization launched a state-funded program last year that helps programs like the Brien Center select the right clinicians.
It's a unique brand of social work, she said.
"The average social worker works with people, and occasionally those people will be in crisis. This — it's crisis all day long. You're responding to people at their worst," she said. "The average social worker might find that not sustainable."
Abbott remembered one call from "many years ago" involving a child who had drowned. She was with officers who responded to the scene.
"It just happened, you know, so everything was right there," she said. "There were other children right there. I had to help the mother through this. It was a very, very emotional call for me that I will never ever, ever forget."
Collins recalled the time he entered a man's Pittsfield home to help with a mental health crisis.
"There were many, many guns in that house," he said. "Many. So, that's just one tiny example."
Point being, he said, "the job is hard, emotionally." Still, he calls it an honor.
"People sit on the edge of the abyss often," he said. "And you sit on the edge of their world and you've got your feet dangling over the edge with them."
Amanda Drane can be contacted at firstname.lastname@example.org, @amandadrane on Twitter, and 413-496-6296.