Resilience Development in Action: First Responder Mental Health

E.234 From Arrests To Care: Building A Smarter Crisis Response For First Responders (Part 1)

• Steve Bisson, Sarah Abbott • Season 12 • Episode 234

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Crises rarely look like TV. Most calls aren’t bank robberies; they’re frantic welfare checks, neighbor standoffs over fences, a parent terrified for a missing teen, or someone hearing voices at 2 a.m. We sit down with Dr. Sarah Abbott, a pioneer of the police–clinician co-response model, to unpack how pairing a trained clinician with officers at the point of contact reshapes outcomes: fewer arrests, fewer injuries, and far more dignity for the person in distress.

Sarah shares the origin story from Massachusetts, where “jail diversion” began as a humane alternative for low-level offenses tangled with mental illness and grew into a comprehensive crisis response approach now spreading nationally and internationally. We get honest about the early skepticism and what changed minds: consistent data, strong command support, and the day-to-day reality that most police work involves behavioral health, not crime. We also go inside Section 12—involuntary transport in Massachusetts—and why sending officers with little background information is risky for everyone. The fix is coordination and clarity: share what you legally can, add a clinician to the response, and approach the door with a plan rooted in safety and rapport.

Training is the force multiplier. Sarah breaks down how academy curricula evolved to center practical de-escalation and communication, then explains why the biggest gains come later with advanced, scenario-driven refreshers once officers have real street context. We talk tactics for engaging someone in psychosis without lying or escalating, why 988 is essential but not a complete substitute, and how blending 988, CIT, and co-response builds a smarter, safer safety net. We close with Sarah’s work at William James College and the new Center for Crisis Response and Behavioral Health, designed to scale what works across departments and borders.

If you care about first responder mental health, public safety, and better outcomes for people in crisis, this conversation offers a clear roadmap. Listen, share it with your team, and leave a review so more agencies can find these tools and put them to work in their communities.

To reach Sarah, please visit her website at: https://www.abbottsolutionsforjustice.com

Sarah can also befound on LinkedIn at: https://www.linkedin.com/company/abbott-solutions-for-justice-llc/?viewAsMember=true

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SPEAKER_00:

Welcome to Resilience Development in Action with Steve Beast Home. This is the podcast dedicated to first responder mental health, helping police, fire, EMS, dispatchers, and paramedics create better growth environments for themselves and their teams. Let's get started.

SPEAKER_04:

You know you've heard me talk about this before. Get free.ai. Great for your note-taking, good for your transcript, good for your goals, good for everything that you do on a HIPAA compliant nature. And if you use code C50 at checkout, you will get$50 off your first month. And also if you get a whole year, you will also get 10% off the whole year. But getfree.ai has freed me to do more things with my life, including work on other passions. So get free to do your notes, get freed from doing your goals. Getfree.ai with code Steve50 to get$50 off your first month. Well, hi everyone, and welcome to episode 234. If you haven't listened to episode 233 A and B, or one or two, depending on how you look at it, it was Joe Rizzotti. He's one character and a half. Really great guy. I hope you listen to his stuff. He has a lot of stories. He believes in the mental health and protecting the first responder world and having people who are culturally competent, which is all up my alley. So go listen to that. But episode 234 is personal. And what I mean by that is this. When I came to this country, I got lucky enough to work on a crisis team within 10 months. And one of the first people who trained me in my triage job at that crisis work was the my guest today. She was supportive then. And then when she innovated something that I know we're going to talk about, she also invited me to those meetings and even let me co-respond a few times. She's a very important person. I don't know if she's ever known how important she is to me. So maybe this is a shock to her, but I thought I think about her regularly. Absolutely adore this woman. Dr. Sarah Abbott, welcome to Resilience Development Investments.

SPEAKER_01:

Wow, Steve, thank you. That's a great welcome. It's great to be here.

SPEAKER_04:

Well, it's a truthful one.

SPEAKER_01:

Well, thank you. I appreciate that. It seems like a long time ago.

SPEAKER_04:

I mean, we were both kids. Kids. I remember like telling you telling me, you know, I'm a kid and I'm teaching you how to do that.

SPEAKER_02:

Um, I think I was 27.

SPEAKER_04:

Yeah, and I was like 24.

SPEAKER_02:

Yeah.

SPEAKER_04:

And I was gonna change the world. Same. Look at me now, nothing. Um but no, I I really, you know, you were really helpful because we had, um, for those of you who will know us, there's the dreadful care track to manage. The sorry I didn't brought up PTSD. It's too early.

SPEAKER_01:

It's been a long time since I've thought about that system, but yeah, we had to manage that database and teach others how to use it and be excited about it at the same time. So, yeah, we've come a long way. We have AI now, which is writing notes for people. So we have seen uh quite a bit of improvement in uh documenting and and keeping records.

SPEAKER_04:

Well, I I I promote my own herefree.ai that I absolutely love. Yep. But I remember that DOS care track. Yeah. Press enter on this one, but don't press enter on this one. This is tab. And it's tab twice, not once on this one, and this one is three times, and then enter.

SPEAKER_01:

Yeah. And you're like while taking a hundred phone calls.

SPEAKER_04:

Oh, yeah, but suicidal with a plan and get a section 12.

SPEAKER_01:

Right, that's right. Let me just figure out how to enter this. Yeah, yeah.

SPEAKER_04:

But I have a lot of fond memories of our work together. Um, we have a few people that are in common that are friends. Yep. Um, and a few people who've been on here, including Jay Ball, obviously, and uh Sarah Cloud. Yeah, yeah, uh, who's been on here, but they don't know who Sarah Abbott is. If they don't know, I'm a little sad, but I'd like them to learn learn more about who you are.

SPEAKER_01:

Okay. So I'm Sarah Abbott. I came to the United States in 1992 to work for a company at the time that was called the Bridge of Central Mass. Um, yeah, and they brought over people from the UK uh in the 90s to work in uh the residential treatment programs and to uh really address a workforce shortage that we had here. I know they went to Canada too. Um I met Jay Ball's wife, uh Donna Marie, also at our previous job. And uh we were all on similar visas, came here to work uh and to help the economy and to help people in need. And we got thrown right in at the deep end. In uh I was an awake overnight person, uh, which was uh is ironic because I remember those. I cannot be awake at night now, and um I really felt you know fell in love with uh crisis, as you know, working in in residential programs. Um I feel like you learned so much about systems, about people's illness and condition and hope. Um, the hope that people have for the future, and I really enjoyed most of all the crisis work. I enjoyed when people um, you know, I didn't love that people were in crisis, but I enjoyed being able to help. Uh, we did many trips to uh PES to see people in crisis and uh the emergency department, and sometimes people would come to the program, and that was really my first exposure to um the complexities of crisis, the dynamics of crisis, and um how to best respond to it. Uh from there I went to Advocates where I met you and others. That was in 1997, and uh really spent the bulk of my career to date in that organization. Uh, five years on the crisis team in Framingham, and then um to date 22 and a half years uh working with the Framingham Police Department, where I got to be the first uh person in um, one of the first in the country, but definitely the first in Massachusetts, to ride alongside police officers to calls for service for people in crisis. We uh called it jail diversion then, uh, because the purpose at that time was really to divert people who were committing nuisance low-level offenses and divert them to hospital or to divert them from arrest in those moments. And um that changed my life. Um walking into that department and uh being part of a movement to improve uh police responses to people in crisis, to ensure that police have the tools that they need on calls, and they're not prepared or what or trained appropriately to respond to people in crisis, although that is uh a large part of what they do. So this model really made sense because of that. It's been incredibly successful in Massachusetts nationally and internationally. Uh been doing some work for about almost five years now with Angada Shikana, the Irish Police Agency, who are replicating the Framing and Police co-response model, and launched a pilot of that in Limerick this year in January. So kind of, you know, been doing a lot of reflecting as I think about my career, as I hopefully work towards my um my last decade of work. Um, what have I learned? What have um what do other people need to know? And um the role of resilience. So, you know, I think I'm really happy that you invited me to speak about resilience in particular today, uh, because it's been one of the themes throughout my career and uh the work that I've done.

SPEAKER_04:

Well, I think that you're all also not even uh not doing enough justice to all the great work you've done.

SPEAKER_02:

Thank you.

SPEAKER_04:

Um I remember going into those meetings with you. And we had everyone on board on the leadership side. Yeah, and then we had other people who saw us as the hug-a-tug program.

SPEAKER_01:

Yep, yep.

SPEAKER_04:

And we converted, I should say you mostly, but we and our team. Yeah, uh, I go back to Abby and Amanda and uh Caitlin and we were talking about Caitlin. Um and I was actually out not too late, like yeah, like a few hours ago with uh Catherine Branca.

SPEAKER_01:

Oh, no kidding.

SPEAKER_04:

So all people you know small world, and I think about how we changed. I know I give you more credit than the others because you were there for all that time, but we changed the view of mental health in such a dramatic way that you know it's become not only you say nationally, I think Massachusetts has adapted it nationally, internationally, and we changed the way to see the CIT program as the only answer. The co-response model being they can work hand in hand. It was not a one versus the other, yeah, but CIT was the way to go across the country for so long. Yeah, yeah. So I think that I you changing that and seeing that state to state. Yeah. And I was in California at one point a couple of years ago, and they had a co-response model there. And I'm like, does Sarah know about this? Um but yeah, I think that that's the stuff. And sitting there with um, I remember with Paul uh and Craig, and they would be like, You got carte blanche, go ahead. Yeah, and we just had a great support system and framing hand that just made it go so well. Yeah, and I think about all the great work you did. So you don't give yourself enough credit. This is a it was groundbreaking. Um, I was I was proud to be part of it, even as a small part of it.

SPEAKER_01:

Yep, my Saturday guy.

SPEAKER_04:

Exactly.

SPEAKER_02:

That's that's what I was, which was great. We needed coverage, you know, and you were great at it.

SPEAKER_04:

And after a couple of years, they became so used to us, they'd be like, you don't have anyone on.

SPEAKER_01:

Right.

SPEAKER_04:

I remember the next level would go off.

SPEAKER_01:

We are aging ourselves for Next Linefficience. We that it was like a whoppy-talkie, yeah, and it was fantastic in our role because you didn't have to call and wait for someone to answer, you just got right through. Um, and we used it uh extensively in the field, right? That was such a good innovation. Um, you know, I think when you talk about the longevity of working with this model of carrying it through uh some challenging times, uh there is an arc of kind of resilience related to that because, as you're right, you know, when this first started, we didn't really know what we were doing. We just knew that we needed that the the police knew, and this is a police-led model, um they knew that they had were constantly arresting people um for things that they wouldn't arrest um other people for if they didn't have a mental health condition because they had to stop the behavior, they have to respond to the community, and they um have limited time.

SPEAKER_03:

Right.

SPEAKER_01:

So, you know, I feel that over time the model has come under scrutiny, has come under uh skepticism, um, and and you know, staying with it, knowing what we know, knowing that it uh is the most effective work I've ever been part of, and I've seen it through my research and others change department culture, change officer behavior, reduce force, reduce injuries. Um I think you know, when you have a model like that, uh people have sometimes, you know, said, well, you know, you being there on these, on the crew in the cruiser, on in the department actually enhances the likelihood that police are going to get a call for service because you're there. And I think that that's a misunderstanding.

SPEAKER_03:

Yeah.

SPEAKER_01:

Um we do we have no control over the calls that come in. And one of the biggest shocks to me coming here, coming to a department, seeing inside the door what was going on was the number of calls police go to that have nothing to do with a crime. And so it's really been part of my mission to make sure if we're going to send police to these calls, if we're going to call well-being checks in, um, the police need to be prepared and equipped to respond to that. That is not a criminal matter. Um, but after five, um, there's no one really around to do this. And, you know, people use the police for all sorts of things, which blew me away. I didn't have any idea the number of social issues that police are asked to get involved with. Some of the cause I can recall, you know, there was a neighbor dispute about offense. And I was shocked at how upset people got about offense. But they did. And it this was going on for a long time, and there was violence threatened and restraining orders, and we're talking about the the placement of offense. So underneath all that was a lot of anger and a lot of um uh inability to kind of cope with with their emotions, which made it a call that I could be helpful on. But I was thinking, why are we calling the police to this? You know, why can't we resolve our own problems? But we are overdependent upon them. And, you know, 988 coming out um has been, you know, an attempt to redirect calls from the police, but and they continue to get them, and as long as they continue to get them, I think a social worker should be present.

SPEAKER_04:

That's exactly what I was gonna say. One of the things that I've seen in other places, they're like, oh, we'll let social workers or mental health counselors answer alone these calls. That's not the answer either. I think it's the co-response that's key and that you really pushed for.

SPEAKER_03:

Yep.

SPEAKER_04:

You know, I I remember getting a lot of, you know, we talked about Sarah, but you know, I go back to even Bill Taylor, the late great Bill Bill Taylor, yeah, who's like, I don't want to be a movie prop, I want to help these, and your idea is great. And we had so much support even with the resistance that really helped.

SPEAKER_03:

Yeah.

SPEAKER_04:

Um and I think that's the stuff that we we needed to see, and then we saw the use. You started writing down the stats, and you know, lo and behold, the state of Massachusetts or Commonwealth, I should say, paid attention to it. Yep, yep. And I think that's all again the stuff that you'd shown that we had maybe to have police there, but that could have been clearly something we could handle, we didn't need anyone else. And then there's times where we go to a call that's like suicidal, they might have weapons. Yeah, it's good to have a cop there in case. But ultimately, if you we can calm the situation down and not have it ended peacefully because we have skills that we can show the police, but also use ourselves. I think that collaboration was key because that was just another tool in our tool belt. Yeah, and for us, learning how the other side lives was so important because I remember again in '99 sitting in the triage right in the middle of the night. Yeah. And I'm like, huh, that section again or whatever. And then I'd be like, Why are they so annoyed by that?

SPEAKER_03:

Yeah.

SPEAKER_04:

And then you ride along and you're like, ah, yeah, I get it.

SPEAKER_01:

Yep. Yeah, I'm glad you raised the Section 12 issue, which is the Massachusetts commitment uh statute for involuntary uh trans section 12A transport to the ER for further assessment. Um, police are routinely asked to serve Section 12s uh with limited information. A lot of the training that we've been doing recently with police and co-responders is around evaluating the Section 12 and getting more information before you go out. Because sometimes these come in off the fax machine, an officer is sent, and uh we've seen across the country how uh these types of calls can go really badly.

SPEAKER_03:

Right.

SPEAKER_01:

And um if, for example, if the person doesn't answer, are we kicking in the door? Are they uh walking away? Liability risk, all of that falls on law enforcement from this one piece of paper that somebody faxed over to them. So we do need to be more cognizant about our utilization of the police, and when we have more information, I think in an emergency, you're allowed to share that information, and a section 12 is an emergency, then we should be providing police with all of the valuable information that we have instead of seeing them as our uh you know, the delivery of this piece of paper, this is taking away someone's Fourth Amendment rights, this is removing them from their home and their environment involuntarily. And when and if people get hurt or the police get hurt, or if force is used, or um, you know, people witness this, um, it has to, it has to really fall on the person that's issuing it to make sure that it's uh legit and um not just we well, we'd like to see them and we can't get them to go voluntarily. These Section 12s um are uh prolifically flying around the state, and uh police are going out and serving them and uh think a co-responder should be with them. I think if they want a co-responder, if they want a clinical person with them, every police officer in the Commonwealth should have access to that. That's part of my mission, the organization that I founded, our mission, but also to go beyond that. Um, and as you said, you go to California and they have co-responders. I was in Texas visiting my husband's sister, and I was in the coffee shop and I was standing behind a police officer, and we just it was in Austin, and we just said hi, and I just asked him, like, you know, how do you manage mental health cause? He's like, we have a co-responder. I'm like, of course you do, that's fantastic. Um, but that's when I started to realize, wow, this is really shifting, um, and departments are seeing this as a win-win, and uh the community is benefiting from this partnership.

SPEAKER_04:

But I think we bring a special touch when you're not a police officer is a different touch, right? Yeah. Um there's a few things I want to say to that.

SPEAKER_03:

Yeah.

SPEAKER_04:

Because in the Commonwealth of Massachusetts, which I just praised, but now I will criticize, a police officer can sign a section 12A. A licensed mental health counselor cannot.

unknown:

Yeah.

SPEAKER_04:

And I've had too many police officers who come to my like as individual sessions with me, like, how in the bloody hell does that make sense? And I'm like, that's a good question. Yeah, yeah, yeah. And then one of the things, which brings me to my other point. When I think about particularly mass state police, but I know like other um why am I blanking on the name? Um, trainings. Academies. Thank you very much. Well, I don't know why I was blanking. Um But with the academies, you did something too that you know you didn't toot your own horn about, but you helped bring the mental health part be longer for those trainings so they're more aware of how it works, whether they had a co-response model or not. And that's something I wanted to touch base, is because I don't think the police officers didn't want to know, they just didn't know because it was what eight hours, I think. When I remember sitting in the meetings and be like, it's eight hours.

SPEAKER_01:

Eight hours out of 26, 27 weeks. Yeah.

SPEAKER_04:

And you changed that. I just wanted also talk a little bit about that and how that also changed the way police officers see our job.

SPEAKER_01:

Yeah, and I, you know, it's still not long enough. I I don't think anybody would argue with that. Um, but I also, yes, we were involved in uh doubling uh the curriculum time, uh, but also the focus of it. And you know, when I I used to teach at the MBTA Academy many, many years ago, and at that time it was eight hours, and it, you know, the curriculum that I had had been used before was really about uh contained a lot of myths about people with mental health conditions, and so we were asked to be part of a team that redeveloped that curriculum to think more about how we can help uh de-escalate instead of um assuming we're gonna need force, assuming that um people with a mental health condition are more dangerous, which they're not, we know, then um really thinking about what our role in this is and helping with de-escalation and um further, I I do believe that it de-escalation, I know it it's a it's got it's bandied around a lot, but in its true sense, you know, I think that de-escalation should be weaved uh throughout the entire curriculum and that it's not a standalone topic because it shows up in all police calls, the ability to de-escalate is there probably 80% of the time, whether it's a mental health call or whether it's a car accident and someone's very upset, um, whether someone was arrested and now they're very upset, you know, it permeates the whole role. And being able to uh understand giving time and space and building rapport with people can actually prevent needing to use force, can actually move the needle and get people where we want them to be. So the curriculum is important. Um, also, they're new recruits. My experience of it when I taught that was, you know, many of them kind of were zoning out a little bit. And I said, you know, you probably don't think that this is gonna impact you. You probably think that you're going to be going to bank robberies and uh car chases and um murders, right? But you're working in, you know, in enter small town name, chances are you're not going to be doing a lot of that. Um, so you might want to listen because you are gonna be doing a lot of this, and they didn't really even believe me. They didn't really even think that once that, you know, that their first few calls may be someone in a mental health crisis or someone using substances or someone whose kid is missing, and they're completely hysterical, right, and how to manage that. So um I do think that there's a uh the space for that in the academy, but I think the the ongoing uh advanced training that we've been involved in, that I've been developing over the last four years at William James College actually builds upon the the experience that they have on the street. So they in the academy they don't know what they don't know, they have no context for it usually, they um aren't really even sure what their community uh is going to be like to work in. So I feel that having them come back after the academy, maybe a year or two years out, and get involved in some more advanced training, uh, they're much more receptive to it. They're like, you were right, we're doing more of the I mean, six estimates are 60, 70 percent of police work has nothing to do with policing.

SPEAKER_03:

Right.

SPEAKER_01:

Um, but they are the default providers of behavioral health services uh after hours, unfortunately.

SPEAKER_04:

100%. Yeah. You know, I even um you know, recently I I I did feel like I was cheating on you. I did a lot of trainings for CITs.

SPEAKER_01:

That's not cheating. There's room for both. I'm just kidding. I'm just kidding. Just wanted to make you laugh. Thank you.

SPEAKER_04:

But I you know, I think there's room for both, and that's certainly something that has changed in my thought process in the last 10 years or so. Yeah. But doing that CIT training, they would bring in more seasoned Right, right. As well as the younger guys. Yeah. And it was fascinating to hear these preconceived notion, even for people who've been done that in like 10, 15 years. And we're giving an example of schizophrenia at one point. I had shared. I'm like, look, if you're right, we're gonna prove them right. So just get on the, you know, just get get on the gurney and we'll we'll get you to the hospital. And someone said, Well, didn't you just validate that they were right? I'm like, I didn't make any promises. And I said, That's the important part. I didn't say I'm gonna get you off. But a lot of them are like, Oh, you can do that. I'm like, Yeah, you if you challenge the the the illusion, you're you're done.

unknown:

Yes.

SPEAKER_04:

And if you just feed into it a little bit without making any promises, you're fine. So that's the thin line that's really hard to explain for mental health people, frankly, yeah, as well as law enforcement people.

SPEAKER_01:

Yeah, I mean, we're in, you know, we're you know, in training as young clinicians, we we have um, you know, a very clear set of ethics and boundaries, and one of those is you know, you don't lie to your patients, right? And we and we shouldn't lie to people, um, but also, and it reminds me of one of the first days I was at the department, somebody walked into the station uh to report a crime, and they were like, Okay, what's the crime? Well, it was theft, somebody stole my checkbook, um, and they're writing checks. Okay, all right, we'll get a detective down, so they get a detective down. I was in dispatch at the time, so I was hearing all this play out, and it sounded very, you know, routine type of call. And the detective came down and he said, Do you have any idea who might be doing this? And the individual was like, Well, yeah, it's Adolf Hitler. And the officer said, Um, well, that can't be true. Adolf Hitler died in a bunker, and and I'm like, Well, yes, and and you know, you get it, right? You you you want you get why um not just law enforcement, lots of people think that they can correct that. Um, but but what's the what's the end goal, right? Do you are you trying to be right? Are you trying to prove them wrong? That's not building rapport, right? It's actually kind of um calling out something. So uh even in moments like that, to your point, I recognize that just to re reframe that um is very powerful. And it's like that you you don't need to, you know, there's no um, you know, com winning that argument with someone who's not reality testing, right?

SPEAKER_04:

Well, I want to wrap up by saying that William James uh college has not only offered a lot of great trainings on the subject, they now have uh part of it where you have created a um, I don't know what to call it, program. A center.

SPEAKER_01:

A center for crisis response and behavioral health.

SPEAKER_04:

Yep. And I want to give you a little chance to talk about it. You want to stay for another 20 minutes? I know you're on a timeline, but we would love to keep you down for another 20 minutes. That's fine. Just finish off on the JDP slash co-response model.

SPEAKER_00:

Please like, subscribe, and follow this podcast on your favorite platform. A glowing review is always helpful. And as a reminder, this podcast is for informational, educational, and entertainment purposes only. If you're struggling with a mental health or substance abuse issue, please reach out to a professional counselor for consultation. If you are in a mental health crisis, call 988 for assistance. This number is available in the United States and Canada.

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