- [Narrator] Production and distribution of City Club Forums on Ideastream Public Media are made possible by PNC and the United Black Fund of Greater Cleveland Incorporated.

(upbeat music) (audience chattering) (bell ringing) - Hello everyone.

Hello and welcome to the City Club of Cleveland, where we're devoted to conversations of consequence that help democracy thrive.

It's Tuesday, September 13th, and I'm Scott Osieki, the Chief Executive Officer of the ADAMHS Board of Cuyahoga County.

So, ADAMHS stands for Alcohol, Drug Addiction and Mental Health Services.

We're proud partners of the City Club and I'm pleased to introduce today's forum, part of a series in our region's behavioral health continuum, which is presented with support from Metro Health, the Woodruff Foundation, and the Sisters of Charity Foundation of Cleveland.

Today we will take a look at how behavioral health crisis care is changing throughout our community.

Just two months ago, a new national suicide and mental health crisis hotline was launched.

988 is the number and for anyone in a behavioral health crisis, it's meant to be a lifeline.

It's hard to explain what a profound change this actually is, one number, three digits, no matter where you are in the country.

Served by over 200 independent, locally owned and operated crisis centers, this is just one part of the many changes coming to the world of responses to behavioral health crisis.

Our community is increasingly understanding the value of providing trained crisis care, response teams as additional first responders when appropriate, and if the need for this change wasn't already clear, recent tragedies here and around the country continue to demonstrate the need.

Joining us to discuss this issue are Joan England, the executive Director of the Mental Health and Addiction Advocacy Coalition.

We have Rick Oliver, director of Crisis Services at Frontline Service.

We have Josiah Quarles, Organizing and Advocacy Director of the Northeast Ohio Coalition for the Homeless.

And our moderator today is Gabriel Kramer.

Mr. Kramer is a multimedia reporter and producer with Ideastream Public Media where he has worked since 2015.

If you have any questions for our panelists, you can text them to this number, (330)-541-5794.

That's (330)-541-5794.

You can also tweet them to @theCityClub and our City Club staff will try to work them into the second half of the program.

So, members and Friends of the City Club of Cleveland, please join me in welcoming our panelists and Gabe Kramer.

(audience applauding) - 988 is going to be a big part of this conversation.

It's certainly top of mind for a lot of people, but crisis care is broad.

It's more encompassing than just those three numbers.

Joan, tell us, what is crisis care?

What does that look like?

- So, I would go back to what is a crisis, right?

We commonly, many of us, myself included for a long time thought crisis is just that call to Rick's organization that I need help, right?

But crisis is much more than that.

Whole bunch of things led up to that moment when the call was placed.

There was that escalation of the situation, the escalation of the feeling.

Then the call happened and then beyond that, a whole other series of events occur.

Rick's team answers the call, decides what needs to happen next, does mobile crisis get sent out?

Do other kinds of things happen?

So, then there's a response to that.

Then there's further response in the ideal system, right?

So, there's further response, whether it's inpatient services that may be needed, outpatient services, whatever the services are needed to help this person and to stabilize.

And then we would argue that there is almost a fourth component that we need to find ways to make sure that people thrive after a crisis and remain in the community.

So, crisis systems are someone to call, someone to respond, a safe place to go and support so that you can thrive and hopefully not enter into a crisis state again.

So, the continuum is broad, and a crisis isn't just that one moment.

It's much more than that one moment.

- 988 is the National Crisis Hotline for Mental Health and Addiction Response, it was launched in July.

Rick, Frontline Service has been at the forefront of this.

How's that been going in the last few months?

- Well, I think it's been going very well so far.

You know, it's important to know that Frontline has been operating a crisis call center since 1995, funded by the ADAMHS Board way back in '95.

And in 2005 we started taking calls on the National Suicide Lifeline.

988 has just simplified the process for that national hotline number.

So, it's, remembering a 10 digit number is a challenge.

Remembering a three digit number is much easier.

And the 988, they chose that number because we're, there's a plan, a future plan to take calls from 911 and hopefully bring them over to 988 so that you can have a, for behavioral health crises so that you can have a response that's appropriate for what the situation is.

- Rick, can you break down how this 988 call works?

So, if someone has a need to call it, what do they receive and what is the process on your end?

- Sure, so when someone calls 988, they do get a recording that tells them that they are, that they've reached a crisis hotline.

There is an option to press one or two for veterans, can press one number, and you press the, or don't press anything.

It rings through to the Crisis Call Center.

And then Scott said there's about 200 call centers right now taking calls on this line across the country.

The calls right now are not geo-located.

They go by the phone, by the area code on each person's phone.

So, Frontline takes calls from people who have a 216 or 440 area code, no matter where you are in the country.

Hopefully next year they'll have the geolocation.

So, you'll, every call will go directly to the closest center to where you physically are located.

But right now they're not doing that.

But so you, the call rings through.

If it comes to our center, we have licensed staff and unlicensed staff who answer the calls.

And their goal is to listen compassionately, understand why the person's calling, what kind of assistance they're asking for, and figure out the best way to get that assistance to them.

80% of the time the call can be dealt with on the phone, just a phone call only.

Sometimes it's information, sometimes it's just support that people are looking for.

If people are in more of a crisis than our staff will go through the process of determining what's needed.

We do, again, since 1995, our service, our center has a mobile crisis team fairly limited as far as what we, our teams, how many we're funded to do.

But at the same time, Cuyahoga County funds this service probably better than the vast majority of the country at the moment.

We have the ability to, we send licensed staff out to do an assessment.

If the person needs something more urgently, then we can provide, we do involve law enforcement.

The plan someday is to provide a more robust response so that we can reduce the number of times law enforcement's involved.

- Josiah, I imagine, you know, you're a big advocate for this type of care.

Can you explain to us why this is necessary or perhaps a step in the right direction?

Because I imagine some people are pretty skeptical of such a thing.

- Yeah, sure.

It's absolutely necessary because the systems that, most of the systems that we have, when you talk about crisis, we recognize that like racism is a health crisis, right?

That it insidiously infects every system and institution that we have in America, and regardless of the good people doing the work, these systems were not necessarily built to care for everyone.

The accessibility and the equity is not there.

The lived experience and understanding and cultural competency is often not there.

And there are a host of support systems that are not there.

So, when you look at the housing situation in Cleveland, there are so many unhoused and transient individuals who are kind of just living from crisis to crisis, right?

And so there needs to be an escalation of our commitment and our will to provide, wrap these people and communities in care.

And we have to think outside the boxing creatively outside of the structures that already exist to do that.

And there are a host of examples across the country where that has been done.

Cahoots has been running a program for 30 years out of Eugene, Oregon.

And they have a impeccable history, in their 30 year history not a single individual has died or been seriously injured in their crisis response and that does not include any police unless it's absolutely necessary, which is less than 2% of their calls.

So, I think really investing in models that don't strictly use the institutions that we have, but pull them together in new networks that are informed by the needs of the community and as members is really important in this process.

- July, August, September, it's been a very short period of time.

You said, Rick, that you want to build up the services.

What needs to be built up in terms of what do you want this to be?

Not three months from now, but several years from now?

- Well, I, the calls when I said we're doing well, we're doing well, answering the calls, that's the first step that Joan talked about.

You need someone to answer the phone.

And we have people, our call rate, our of answering calls has actually gone up in the last few months, even though our call volume has gone up as well, because we were able to add some staffing.

So, in anticipation of 988, but the second step is that, is getting people to respond, that's the critical thing.

We can't rely on law enforcement to do this.

The behavioral system needs to own this and take steps to provide the staffing so that we have other alternatives besides law enforcement to respond.

And then, so we need to build that part up.

We also need to build up the part about where people can go safely.

We, especially for kids, there's not enough places for kids to go.

We all know that, it's been all over the news that we need to build that system up and there are steps being taken.

So, that's encouraging.

- What are some of the growing pains in this process?

You mentioned in the green room before this, that there needs to be a collaborative effort with 911 to really make this work smoothly.

So, what are some of the growing pains in regards to that collaboration?

- So, in my vision, you have 988 and 911 who both have the capability to send out police if needed, with co-responders, which is a police officer and a clinician, or a care response, which is non-law enforcement.

And there can be multiple ways that you can put a care response together.

You can have peer supports are very, would be very valuable.

Other places like use EMTs as part as an option and licensed clinicians, unlicensed people who have been trained to respond.

That's what we need to build those resources up so that we can provide a more robust response to people in crisis.

- Joan, this is experimental in a sense.

There's some growing pains, as I mentioned, this trial and effort method.

Is this the way, the proper way to go about this?

- I think the critical thing, it's not unusual, right?

And we're certainly not the only state in the country that's doing this.

988 is a national initiative.

So, everybody is going through this.

I think what's critical to think about in these is making sure that initiatives are properly supported and properly resourced and properly staffed.

And when we think about one of the major challenges in the behavioral health world, right now, it's staffing.

And you know, when I talk to public officials, I know they're hearing it on every sector, right?

Early care, there are staffing issues, nursing homes have staffing issues, but behavioral health has a really critical staffing issue right now and there are multiple reasons why.

But the one that I lift up oftentimes is we just went through a pandemic like we have never experienced, most of us have never experienced before, right?

And these guys on the front line, were on the front line too.

All of those behavioral health folks, they were out there like the rest of healthcare.

So, they have ramped up to respond to Covid, physical health, thankfully, knock on wood, is now beginning to come down the back end of that hill, right?

These guys aren't, we're seeing a surge in behavioral health.

So, they've been tapped out at their highest level for two and a half years and they're going up even higher right now.

So, when I think about what we need, right, when I think about what we need, we need resources for these organizations to make sure that they can do what they need to do and are increasingly being asked to do.

(audience applauding) - Josiah, you shared some stories with us earlier this week.

Put us in the shoes of someone who is in need of crisis care and can't get proper care, what's that like?

- You know, from my, you know, from my own lived experience myself, I've been in moments of crisis.

I'm not diagnosed with anything.

I don't know, probably if somebody sat down long enough with me, they could figure out a diagnosis.

But I have been through mutual aid efforts in the street largely with, you know, transient or unhoused folks have seen crisis present itself.

And there is just an inordinate amount of panic, distrust, fear, and desperation.

And you know, when we look at, you know, people love to throw around crime statistics and we look at what the roots of crime are, it is desperation, it is crisis.

It is a sense of no one cares, that you're on an island.

And what most people need more than anything is for someone to be with them.

And unfortunately, as you stated, we just don't have enough people to be in all of the places right now.

But there are so many places that are stepping up with little to no funding.

And several people who I invited here today couldn't attend because, you know, they had jobs and couldn't get out of 'em.

But I know Walter Patton with Ghetto Therapy is doing a great job of bringing the issue and destigmatizing the issue and creating spaces where people can provide the care to each other.

And I think if we invest in that kind of model, that community model, that can address some of the lack of resources we have as far as human capacity, when we empower our communities to help care for each other, it takes stress off of the institution and then those people can be brought up and actually have good paying jobs, right?

So, you are addressing two things at the same time, but there's just a lack of immediate care on the spot in our communities and I've been confronted with that.

And when things are beyond what I can do for someone, and I'm grateful for the work that my team at NEOCH does in this.

But if you call 911, generally you're just going to get a police response.

And they're not trained to handle that.

They do not know the system well enough to navigate people through it.

And a lot of folks do not necessarily have them mentality to really do that work either.

- Rick, you mentioned that this needs to be a collaborative effort with 911, 988, 911 working together.

Has there, have you seen a resistance from law enforcement to cooperate or is there a willingness to recognize that as Josiah is saying they might not be the best person to be sent to a crisis?

- The calls that come into 911.

So, many times I think people wait, if they call a little bit earlier, maybe there would be, some services could be available, but people, we have a tendency to wait until things need to happen right away.

So, we'll call, people will call our service and we'll say, well, we can be there in two hours.

And they'll say, I need something sooner than that.

I need something quick and the only service that can respond faster than that is law enforcement is, or, you know, emergency services.

So, they provide a role, they fill a need.

I don't think there's resistance.

If you talk to law enforcement, the patrol officers, they would prefer not to respond to behavioral health crises.

They would rather have somebody else do it.

They're not sure the system's set up to do it yet.

And I would say that 988 turning on that number is the first step where we need to follow it with funding to support the rest of the system.

If you had to start somewhere, I think it was a good place to start.

Let's get the calls funneled to the right source and get the, and then, well it would've been better if we had funding up front, but that's not how it happened.

So, you know, we get the funding turned on after the calls are going and they're basically saying, we need the statistics to see this is happening.

We need the metrics so we can provide the funding.

So, that's what we're in the process of doing right now.

I think law enforcement would be happy to give this up to behavioral health when behavioral health is ready to take it over.

- With law enforcement, particularly with minority communities, there is often a big distrust with law enforcement.

I wanna hear from both of you.

Where is that at play in all this?

Whether it's training, whether it's skepticism?

Josiah, we can start with you.

- I'm sure most of the people in this room don't understand what the origins of law enforcement in this country were, basically slave patrols and night watchmen in Boston shipping yards.

Those two things came together to protect the property of the well landed and rich of this country and for the rest of our history, that's kind of largely the model.

And we've expanded it and expanded it and expanded it and given them more roles and more things that they need to do.

But the intrinsic kind of point of conflict with underserved communities remains and there is a lot of distrust for a lot of good reasons.

A lot of people have seen them all over the news, and that's something that just must be acknowledged and in order to have truth and reconciliation, you have to have truth.

And so I think we still have a long way to go with that.

I think that, as you said, like law enforcement doesn't want to do this, however, they don't want to see any of their resources gone, they do not want to disinvest in the militarization of their forces.

They do not want to disinvest in surveillance.

They do not want to disinvest in the prison industrial complex.

We are currently spending, proposedly spending over half a billion dollars on a new jail to lock people up, where we constantly say we don't have money for these kind of supportive and care-based projects.

So, I think it really has to be a shift in the political will, honestly, in order to get us to the point where 988 can fully function, in Cincinnati, they've had it contingently for a very, very long time and part of that contingency was was separating 911 dispatch from the police department and that has enabled them already, they are far ahead of the game, the first in the country to already be sending calls back and forth from 988 to 911.

So, if we shift our priorities and our ways of thinking about the problem, I think a lot of solutions can be found.

(audience applauding) - Rick, as someone who's, you know, working with 988 in collaboration with 911, what is your feeling about Bipoc communities often not trusting law enforcement?

- Well, you know, I've, we've seen it, we've been part of that response for 25 years and you know, and when we're on the phone, we are trying to offer other options besides law enforcement and luckily it's about 2% of the time of our calls are result in a law enforcement response, and half of those, the person is wanting that to happen.

The other times we're trying to get someone to a safe place as quickly as possible.

I think that law enforcement's role in this is on top of everything Josiah said, their role is coming, responding, transferring someone to an emergency room.

The emergency room does an assessment to determine whether they need to be admitted or not.

Frequently they do not and the person's sent back home.

Nothing has changed in that equation.

Nothing.

And sometimes it's been made worse by being taken to the emergency room, sitting there for a while.

The emergency rooms and backseat of police cars are not the right place for behavioral health people and behavioral health crises.

So, we need to change that and have a much, much different response than what's going on now.

- Joan, what is the responsibility on, I'll say us, whether it's someone who is experiencing crisis, someone who is witnessing crisis, or just someone who wants to be mindful of these new services, what responsibility should be on us?

- Well, I would say first and foremost, I run the Mental Health and Addiction Advocacy Coalition.

You're here because you care about this topic, right?

Your voices matter.

What we need, what we've been talking about is we need a complete shift.

We need a healthcare response to a healthcare crisis.

That's what we need and we need to make that happen.

That's going to take political will, it's going to take the collective will, it's going to take support, it's gonna take money, let's be honest, to support those teams.

But I was thinking about this, I've been thinking about this a lot.

If I'm having a heart attack, 911, their first reaction isn't gonna be to send the police out to me, right?

Why do we do that when someone is having a behavioral health crisis?

(audience applauding) So, we need to shift the complete paradigm.

You all can help do that.

There is advocacy going on right now with the city of Cleveland and many of you are involved, but not all of you are involved.

There is advocacy going on with the city of Cleveland to create, in addition to their focus on co-responder models, which is great and increasing those, we need to encourage the city of Cleveland, namely Mayor Bibb and Cleveland City Council to also support care response teams, provide a healthcare response to a healthcare crisis.

And all of you have the ability to do that.

You may not be direct clinicians, but you can all weigh in and advocate and share your voice and demand that we create a healthcare response to a healthcare crisis.

- I've got one more question about 988 before we step back a little bit for Josiah, what's missing in all this when it comes to this new program, which, what's, we're early in this process.

- I can't speak from a national perspective on that.

I think what's missing here in Cleveland is the connection between the county and the city largely.

And I think to piggyback on what you said, there is a county council meeting today hopeful if you'd like to show up and give your comments there.

I'll be there, you can say hi, but the county receives most of the funding for mental health.

The city has all of the nuts and bolts of emergency response, right?

So, the city is on one track, the county is on another track and we need to bridge that gap, right?

We need to get those mental health service funding put in and injected into the crisis response apparatus within the city and merging those two and connecting those two, I think will go a long way to empowering what 988 can be.

- I know, I said one last 988 question, but I do have one more now, Rick, in response to that, getting the city, county, even state and federal level on board with all this and on the same page, what does that take?

- Well, I think we need to have people, the decision makers of those organizations come together and be committed to saying, this is something we wanna have happen.

It's not something I can do.

I can't make those things happen.

We can talk about it, the three of us are here talking about because that's what, we're passionate about it.

So, we need the decision makers to come together, hear what we're asking for, hear what everybody else is asking for, and take the steps that need to be taken to make it happen.

- All right, thank you so much.

Joan, 988 is not the only form of crisis care.

What else does that mean?

- So, it's that response, it's that stabilize in the community, it's that thrive.

There are a number of initiatives going on right now at the local level and the state level.

Ohio has recently launched Ohio Rise with the tremendous assistance of Ohio Medicaid and the Ohio Department of Mental Health and Addiction Services that's focused on young Ohioans, making sure that those young Ohioans with complex behavioral health disorders and that are touching multiple systems are able to access some of those deep end wraparound services that they and their families need.

So, Ohio Rise is launching out as part of that is also what's called MRSS, mobile response stabilization services.

Those are crisis services for young Ohioans up to 21 provided wherever these kids are, community, school, home, whatever that may be.

Providing them with those high fidelity wraparound services so that to stabilize them, keep them in their home and if they have a crisis in the future, to make sure it's less frequent and less severe.

We also have crisis funding that's been rolling out for crisis stabilization services and other kinds of things like step downs from inpatient psychiatric facilities as well and locally we have things like new urgent cares.

That's a new model in our community.

New behavioral health urgent care centers on both the east side and on the west side that serve both children, adolescents and adults.

So, there's a lot of focus in this area, a lot of development.

To your earlier question, a lot of it's new, but part of that is also we're seeing an increased, thankfully focused of the community and policy makers on behavioral health.

- And this isn't just something that, or this conversation stops at nine, at eight for these programs, this is a continuum.

This is something that is, needs to be addressed and attacked and approached time after time again differently after each time.

Can you talk about how that, about that?

How it's something that, you know, we can't just say we fixed it.

- Yeah, that's a good question.

So, we have a continuum of crisis care, like I was saying at the very beginning when we opened up a crisis evolves from before the crisis, during the crisis to after the crisis.

And then making sure that a crisis doesn't occur again.

Or if it does, it's less frequent and it's less severe.

There's a whole continuum of services within that kind of span of a crisis that need to be available.

We need them all available and we need them fully staffed, fully supported and functioning at their optimal level.

So, we need to build out and ensure that that continuum exists for the continuum of the crisis.

- Josiah, Joan was talking about services for children and the headlines are not unfamiliar of reading or listening about a child who could have used these kinds of services.

How neglected is that in terms of as we think about crisis care?

- Very, not long ago, CMSD led the country in suicide attempts by its students.

We do not have nurses in all of our schools.

We do not have mental health professionals in our schools.

We do not have art teachers or music programs in all of our schools.

The things that can help stabilize an individual, provide comfort and build community within our schools, we have not funded, we have not resourced and we are leaving these youth on an island, many of them are in transient states and they are moving from school to another school and they are moving through through different neighborhoods and areas where they feel themselves unsafe, right?

And they seek protection in ways that our system deems unacceptable and are met with very severe consequences.

And we roll them over into the justice system and binding them over and we give them bars, we give them cages instead of the care that they deserve.

This work must penetrate into the youth and the juvenile sector.

Otherwise we're just spinning our wheels.

This is a generational trauma that we have to invest in to stop.

(audience applauding) - All right.

Thank you all so much.

I appreciate you all, you know, dealing with my questions here.

We're now going to begin the audience Q and A.

A reminder, I'm Gabriel Kramer with Ideastream Public Media.

We are here with Joan England, executive director of the Mental Health and Addiction Advocacy Coalition.

Rick Oliver, director of Crisis Services Frontline Service, and Josiah Quarles, organizing an advocacy director Northeast Ohio Coalition for the Homeless.

We welcome questions from everyone, City Club members, guests, students, those joining via our livestream or CityClub.org.

If you'd like to tweet a question, please tweet it @theCityClub.

You can also text us, (330)-541-5794.

Once again, that's (330)-541-5794.

And City Club staff will try to work you into the program.

Do we have a question lined up for us?

- Yes, we do, the first question is a text question that we received, what is the plan for addressing the inherent systematic racism and transphobia that permeates these systems and often poses an insurmountable barrier for the marginalized populations that need the most?

How are we going to ensure this new program is not propagating the status quo?

- Wow.

- Joan, you have any thoughts?

- So, I think Rick can probably talk to this more deeply on what we're doing with 988 that has been on the table.

So, through the year, year plus that we've been talking about 988 in particular, those have been real conversations.

How do we address the racism, the transphobia?

How do we address ageism?

We respond to kids that are calling, how do we address all of that?

And Rick's point about it evolving, it will evolve.

It is by no means perfect at this point.

It's not even close to perfect, but that is something that we are all talking about and really focused on.

And I know that will continue.

And Rick, you can probably talk more about the 988 conversations on that.

- Yeah, I can just respond by saying that the state who is providing some funding to the agency, there's, I think there's 20 agencies in Ohio that are answering hotline calls and the state is providing funding specific to training so that we can train the staff not only in how to compassionately answer the phone from a clinical perspective, but also with different, with a different, with an anti-racism lens, with an understanding what childhood trauma is about.

There's a multiple trainings that Ohio is made available for free to every one of the call centers available.

So, I think they're looking at these issues and trying to take steps around educating the staff who are taking the calls and handling these crises.

- Can I hop in real quick too?

- Please do.

- I think another thing is just, you know, who are we including in this process, right?

Who is sitting at the table, who has input, who is helping do the evaluation, right?

Who are we recruiting to take calls to do outreach, to bring these services into community?

So, I think that is something that we have to be very intentional about as we develop and implement these programs.

- And I would add, who's providing these services?

What kind of treatment are they getting?

What does the funding look like?

Who is funding flowing out for to whom, for what services and where, I'll put in a plug 'cause this is gonna be coming out soon.

Our organization along with Ohio University, Multiethnic Advocates for Cultural Competence, which has been in that business for 20 years and Central State University, one of two HBCUs in the state of Ohio and the public HBCU are working on a series of reports right now that will begin to roll out before the end of this year focused on racial and ethnic inequity in Ohio's behavioral health system.

We're gonna pull together what data exists so folks can see it, demand that additional data be tracked, that it be public facing and that it be analyzed on a regular basis 'cause we don't do that right now.

We can't answer a lot of questions regarding inequity in behavioral health to the great question that was posed 'cause we don't know what the numbers look like and that's awfully convenient for a whole bunch of folks.

- So, when we talk about crisis, mental crisis and young people who have had horrible experiences with police officers, Josiah, what effect do you think demonstrations and role playing in the classroom will have on those students?

- I think you already know my answer.

(audience laughing) You know, we have a habit of laying trauma on trauma and I think that's just another example of it.

I remember seeing a video of a school where they were doing bullying training and they were doing role playing and you know, it was just like they brought in somebody to facilitate kids bullying each other and like, you know, they're like, all right, let's, no be meaner.

No, no, say it like this.

And it's just ridiculous that you think that you're gonna solve a problem by recreating a mock version of it.

It's just wrongheaded as much of what's going on in the Ohio legislature is so, I commend your harm mitigation work, but yeah, that's just an awful idea.

- Over here.

- Hi.

I'm surprised no mention of the Diversion Center so far in this conversation and I'm hoping, you know, we've all read about the under utilization of that new resource.

I'm hoping you can talk about some of the barriers and reasons for that and what you think the future is there.

- Yeah, I can adjust that.

Frontline service has the, we screen people who are going to the Divergent Center.

So, originally it was designed for law enforcement officers as a way to, instead of arrest to take someone into treatment.

It's excellent idea.

Law enforcement has not embraced it to the, so far, as to the degree we'd like them to.

They still, we still get calls every day from law enforcement.

It's not not being used, it's just being underutilized as you said.

Then there was a change last November that we opened it up.

Oriana House is the end agency who runs the diversion center.

And so they allowed, or the decision was made to allow for individuals to refer themselves, family members to refer themselves.

And that has certainly increased utilization.

We get roughly five to six calls a day and the vast majority of those are accepted into the diversion center.

Our rate is about one or two a day from law enforcement.

So, it's a lot, it's just, there could be more opportunities to be utilized.

We're working on educating the officers, reminding them, excuse me, of the importance of the resource of the difference in taking someone to an emergency room versus taking someone to a treatment facility.

We're hoping that these ongoing opportunities to train law enforcement will help in that process.

It has been a slower, slower rollout than we were all hoping for.

I'm personally like the idea that we are continuing, we're giving another two years to see what happens at the same facility.

Hopefully, I think we're challenged to make this work because it is, for my staff, it's been wonderful because they have, when you talk about someone answer the phone and a response and a place to go, we now have this extra resource that nobody else in the state has.

And for both mental health and chemical dependency, which is a huge plus.

So, we are doing what we can to get people over there.

We just need to get other law enforcement especially to take hold of this resource.

- And I think that shows some of the limitations of law enforcement and that apparatus and institution and it's unwillingness to change because it is a very old institution, very kind of set in its own ways.

I know that our street outreach workers at NEOCH probably take twice as many people over to the diversion center than the entire Cleveland Police Department, right?

The more open that we can have it be, the easier to access it, the better.

And I think it is the perfect companion for a care response model.

- Over here.

- Thank you.

My community newspaper framed the 988 number as a suicide prevention number and I feel like it, it does a disservice to other issues of mental health illness to just talk about it as a suicide prevention number and it might have just increased the stigmatism surrounding mental health issues.

Thank you.

- Yeah, so I like a hundred percent agree and I think there are efforts being made.

You know, this has been a soft opening for 988.

There has not been a massive public marketing campaign because we wanted to make sure that it was functioned, that it was working, that the 200 call centers across the country could, that first of all the calls were routed where they were supposed to go and that the services were being able to be provided.

So, that test is going on right now.

In fact, they're calling me right now saying is, you know, is a call going through, they're doing a test call today to find, to make sure that the calls are going where they're supposed to go.

I believe that in 2023 when the full marketing effort's gonna happen, it will be billed differently than suicide prevention.

The National Suicide Prevention lifeline was the original number that came through.

So, that was really promoted suicide prevention.

988's gonna be pushed out when they really get to it in a much more fulsome behavioral health crisis.

This is the answer, this is where we want you to call, one number for any kind of behavioral crisis.

That's the direction we're going.

They just wanna make sure things were in place before they really push that message out.

- Over here.

- Hi.

I know that Northeast Ohio has different kinds of crisis services, but we've talked a little bit here about care response, which we don't have yet.

And I wonder if one of you could speak to how we could build that and how we could make sure that it's built in a way that really responds to the people who are gonna be the most frequent consumers of it in northeast Ohio.

- Go ahead.

- I think, you know, thank you Elaine.

I think this is a perfect opportunity we have.

We have an influx of ARPA dollars with a lot of them that were supposed to be earmarked for mental health.

We have coming out of the pandemic an increased need for service in that area and to get it out into the community.

We have over the past few years, gotten all the really efficacy data from all these other programs around the country to justify its use in a broad way.

And I think what we have to do is really to push and to bring all of the different peoples within the continuum of care, all of the service providers and outreach workers and community members with lived experience who really want this to happen to the table, have their voices lifted up and think programmatically about it.

And with urgency because when we wait, they'll do something else.

This is just not top of mind for most folks.

People are thinking about economic development and the like, always.

So, if we do not seize upon a moment right now, I think we may miss our opportunity.

So, it is definitely important for us to push our city council, our mayor, our county council members, our county executives to really push forward with this and dedicate money to its development and bring people together to create it in a way that responds to the needs of our communities.

- Over here.

- Hello everyone.

This is for the panel itself.

The Bible says, "Suffer little children.

Come on to me and be at rest."

Everybody have children like me, I know in this room, grandchildren, nieces and nephews as well.

Long time ago when I was coming up I got bullied and picked on and everything.

So, what I started to do back, this was like 40 something, 50 something years ago.

So, I'm not even gonna tell you how old I am, but I walked away and I just learned how to just humble myself.

Okay, everybody don't have that humbleness I do.

I can speak for that 'cause I come from an humble family.

Number one, a child is not asked to come in this world.

Number two, when you try to do your best with your children, number three, you giving back to the Lord and letting, let them do their own life or what challenges that you done did the best you can by raising your children.

Okay, these children go to school right now.

We didn't have no computers back, what, 50 something years ago?

They have it going on right now.

All they have to do is right in front of them, hit their Enter button and it is, the work is done for them.

But like you said, it's a lot of bullying and picking on in these schools and stuff.

It's not enough staff nowhere, anywhere, I'm talking about restaurants, grocery stores, hospitals, it's a crisis everywhere in this world right now.

All of 'em, this whole globe.

And let's go for the whole panel.

What do we do?

What do we do, question mark, to get this problem solved?

And we can't hire nobody, just get somebody have some retirements or who are retired from their job, take out the ability of their time and just going to these services and volunteer 'cause that's what it look like it's aiming to, instead of hiring part-time and full-time, now it's more like a volunteer thing.

- Any thoughts here?

- I'll go ahead and start.

Thank you.

Thank you and I'm sorry to hear, it always breaks my heart to hear stories of bullying and it's trauma, right?

And we know so many people have experienced trauma and we know of the implications and what that can do to people.

And there is a growing awareness, I will think is a general community and also in behavioral health about the impact of trauma and the need for trauma informed trauma-based services, right?

- Yeah.

- But here's from a community behavioral health perspective, here's part of the challenge that we've had historically, behavioral health was stigmatized, underfunded, under prioritized.

You know, if the services were provided, they were way away from every other service that was being provided in healthcare, right?

We've only begun to talk about and invest in and support behavioral health.

So, mental health and substance use disorders, like we support everything else.

We're finally getting there.

The problem is that now there's this growing awareness because of the opiate epidemic and the pandemic that now there's this growing kind of looking at, for example, community behavioral health and some people say, well why, why can't you do everything we want you to do?

And I say, well, because we've never been supported to do that.

These folks did everything they could with two wooden nickels rubbing them together, but surprise, they haven't been able to do everything, including recruiting staff.

That's been a fundamental problem and to your point, we're having a really hard time recruiting staff and community behavioral health 'cause there aren't that many, they don't accurately reflect the people we are serving.

That's something we have to focus on or linguistically we need to be thinking about that as well.

At the end of the day, community behavioral health needs much more support to be able to do everything that it can do.

These guys have the ability to do it.

They've got the ability, if they can get the staff and they can get the support, they're remarkable, remarkable assets to our community.

- I just like to shout out New York real quick because I think one of the things that holds us back and really expanding the kind of staffing that we need across the board in a lot of different sectors is our over reliance and overestimating what a degree or a certification really means.

And excluding a lot of people who could do a lot of good work and relegating them to work that does not serve them and does not serve their community.

So, I think if we can push back on some of that, we can solve a lot of our staffing issues.

- I just have one quick comment about as well, you know, prevention is, many times prevention services lose funding because you can't prove something that doesn't not gonna happen.

Ace's study has been out for over 30 years.

We know what childhood exposure to trauma does.

We, it's been proven, it's there.

So, investing in prevention programs in the schools or wherever they need to be in the, you know, rec centers, wherever the kids are, we need to invest in that so that we can minimize the number of people coming to our behavioral health treatment service centers.

That's really, funding prevention is really, I think, very important.

I think it probably doesn't get the attention it really needs.

I think we have time for one more question.

- I do have a BSW from Cleveland State University, but I also have lived experience not only with homelessness but aging out of the foster care system.

And I can attest that my experience far weighs, I'm mostly pulling on that to inform the work and influence the work that I do more than the information that I got from earning my degree.

And so my question is, can you guys like talk about what the city of Cleveland is doing to hire folks in this work that looks like them?

Because when my job description was written, they required me to have a high school diploma, but they also required me to have lived experience and that was the first time I've ever seen anything like that in a job description.

So, maybe you guys can talk about what your organizations are doing or what other organizations are doing in this city to make sure that people can talk to someone on this crisis hotline that looks like them, have experiences like them.

Thank you.

(audience applauding) - So, I'll just, I'll say that our organization is moving and I think most behavioral health are finally understanding the importance of peers, of the importance of what they bring.

That someone who has lived experience isn't, while there's a potential for re-traumatizing in certain situations, but that's not something we need to, it's something we need to worry about.

But not to hold back from utilizing peers in this role.

People who have lived experience bring so much.

We have now when we took over the crisis stabilization unit, there were no peer support services there.

Now we have all three shifts, have a peer working on the shift to help connect in a different way with every individual that comes in the door.

And we're starting to bring that into the crisis hotline.

There's always been some hesitation to do that, but that is where we see that across the country now, people are open to bringing peer supports in, in crisis services in general because I think it's long overdue.

So, thanks for the point.

- I'd like to shout out Magnolia House and their model as a way to really push that forward.

(audience applauding) And I'd also like to shout out the Homeless Congress, who most of them are not able to be here today because they have a community meeting.

I know you here, but most of them, most of them are attending a community meeting.

But they were instrumental in us doing the community surveying work that we're hoping will inform a care response program because they are trusted and they know the community, right?

So, they can have conversations that can elicit honest responses.

They can go into spaces and feel comfortable because they've been in those spaces before.

So, it's really important.

And when I got my job, I would never have thought, you know, five years ago that there would be a director in front of my name because there were so many obstacles in front of me that would prevent me from doing that.

And I'm so grateful for Chris who's not here for actually like, being really intentional about what we really want, what is really important, what are we looking for when we're hiring people to do this kind of work?

So, I'm really grateful and I think that that needs to be expanded across the board in this service.

(audience applauding) - I want to thank you all for joining us here at the City Club.

What a great conversation we've had about the present, future, and of mental health crisis care with Joan England, our executive director of the Mental Health and Addiction Advocacy Coalition, Rick Oliver, director of Crisis Services, Frontline Service, and Josiah Quarles, Organizing and Advocacy Director of Northeast Ohio Coalition for the Homeless.

Today's forum is also part of our series on the region's behavioral health continuum presented in partnership with Metro Health, the Woodruff Foundation and Sisters of Charity Foundation.

We'd also like to welcome guests at the tables hosted by the ADAMHS Board of Cuyahoga County, Frontline Service, Life Act, Magnolia Clubhouse, Policy Matters Ohio, Reach, NEO, and the Northeast Ohio Coalition for the Homeless.

You can join us again this Friday, September 16th.

We'll be celebrating Cleveland Book Week here at the City Club with our friends at the Anfield Wolf Book Awards.

We'll hear from Ishmael Reed, we will hear from Ishmael Reed, who is quite a character, author, poet, playwright, America's most fearless satirist.

He's a self-proclaimed crank.

He'll be joining us at the 2022 Anisfield-Wolf Book Award lifetime achievement.

He is the 2022 Anisfield-Wolf Book Award lifetime achievement winner.

He'll be honored this Thursday.

Join us here on Friday for a great conversation.

There's just a few tickets left.

You can find more about this forum and others at our website, cityclub.org.

And that brings us to the end of today's forum.

Thank you once again to Joan, Rick, and Josiah, thank you to our members, the Friends of City Club.

I'm Gabriel Kramer and this forum is now adjourned.

(bell ringing) (audience applauding) - [Narrator] For information on upcoming speakers or for podcasts of the City Club, go to cityclub.org.

(upbeat music) Production and distribution of City Club forums on Ideastream Public Media are made possible by PNC and the United Black Fund of Greater Cleveland Incorporated.