BEST in care

Sweila Cardoso, a BMC social worker, reports to work each day to C-11. It’s not a hospital floor or unit; it’s the Boston Police district station in Dorchester.

Officer Jared Taylor, Sweila Cardoso, Arthur DePinho

BMC’s Sweila Cardoso, MSW, center, delivers mental health care through the Boston Police Department, pictured with Officer Jared Taylor, left, and Officer Arthur DePinho, right.

Cardoso is a member of the Boston Emergency Services Team (BEST) co-responder program, implemented in partnership with the Boston Police Department. Throughout the City of Boston, you’ll find BMC clinicians joining police on calls when mental illness may be a factor.

“We go everywhere,” Cardoso says, “to hotels, parks, shelters—anywhere a 911 call could originate from.” In 2023, clinicians joined an officer on the scene during 2,261 encounters. “We all come together for a person-centric approach with a common goal—to help people.”

This partnership is just one component of BEST, BMC’s mental health intervention program. BEST connects BMC mental health clinicians to the community—including the police, judicial system, and schools—to ensure people get the care they need, often in high-stakes situations. With philanthropic support, BMC continues to strengthen its efforts to meet urgent mental health needs.

The Need
Nationally, one in five American adults experiences a mental health condition in a given year. But there are too few behavioral health providers to treat each person who needs care. In an American Psychological Association survey, 60% of psychologists reported no openings for new patients, and average wait times were three months and longer. Inpatient beds are equally sparse.

For people struggling with additional issues such as substance use disorder and homelessness, regular care becomes further out of reach. This is where BEST fills a gap, intervening before someone lands in a traditional emergency room—where care is costly, and a patient may be stabilized, but not fully treated—or jail.

“The mental health system in our country is overloaded,” says Rachel Oblath, PhD, BMC’s director of methodology, psychiatry. “There are never enough inpatient beds. People in crisis can wait months, maybe even a year, to find an outpatient provider. And if the provider isn’t a good match, they may wait months to find someone new. There are huge shortages of mental health professionals, particularly those who serve the publicly insured or uninsured populations. BEST treats people when they are in crisis, regardless of insurance status.”

BEST Services
BMC’s BEST started as an emergency services provider contracted with MassHealth in 2003 to provide psychiatric crisis services in the community. Today, it is one of the country’s most comprehensive behavioral health crisis response programs with nearly 70 mental health professionals employed across a number of initiatives.

BEST’s home base is its Urgent Care Center, a walk-in clinic that includes a stabilization unit for those needing more treatment. It also serves as hub for a mobile crisis team, who can be dispatched to homes, schools and workplaces when someone is in crisis. BMC’s 24-hour call line at the Center fields more than 30,000 calls a year.

For those with mental illness who are in the judicial system, three special programs (Boston Outpatient Assisted Treatment Program, Mental Health Court, and Recovery Court) exist to ensure people receive a behavioral health treatment plan created by BMC clinicians—addressing the root cause of their behavior and ensuring their re-entry into society is supported for success. If people engage with treatment, their record can be adjusted accordingly, minimizing the damage a conviction brings, including effects on housing, employment, and more. In addition to the Boston Police Department co-responder program, a co-responder initiative with Boston Emergency Medical Services (EMS) launched in summer of 2023.

The goal of every BEST encounter is to deliver urgent, dignified care that people aren’t receiving elsewhere—keeping them out of jail and the hospital. These diversionary programs are desperately needed. According to the National Alliance on Mental Illness, 40% of people who are incarcerated have a history of mental illness, while 70% of youth in the juvenile justice system have a diagnosable mental health condition.

BEST Looking Ahead
BEST continues to grow to serve its patients. The co-responder program with the Boston Police Department, dating back to 2011, is just one example. Seeing the need to better train and support police and acknowledging the effectiveness of the co-responders, the City of Boston has invested in the program, funding two-and-a-half clinical positions in 2017 to 14 master’s-level clinicians today.

Officer Arthur DePinho, a member of the Boston Police Street Outreach Unit, assists with training new BEST co-response clinicians as part of his role serving those who struggle with mental illness, substance use disorders, and homelessness. “It is very helpful for police officers and the community as a whole to have a mental health clinician riding with us as we respond to calls,” DePinho shares. “Having their knowledge, skill set, and point of view allows us to see the situation from multiple lenses.”

A recent Department of Justice grant holds promise to help better understand those served through the program. To date, Boston Medical Center and Boston Police Department have managed different datasets. Grant funding will enable the integration of anonymized data of heavy users of both emergency police and mental health services. This data integration will enable BMC researchers, in collaboration with partners from the Boston Police and the University of Massachusetts Lowell, to answer foundational questions about emergency service usage in Boston.

“We’ll use data to give voice to our patients,” says Oblath.

Additionally, a generous anonymous donor’s gift is supporting multicultural training, education, and evaluation that champions proven practices in crisis intervention and de-escalation. Two postdoctoral research fellows are evaluating the efficacy of the services, and BMC is already sharing findings, including four papers in peer-reviewed journals, which other emergency response programs can adopt in their regions.

“The people we treat are brothers, sisters, parents, employees,” says BEST Program Director Tasha Ferguson. “They have something to offer our world, but they need our care. In partnering with the city and our community, with donor support, we’ll continue treating people with the care they deserve to live full, meaningful lives.”

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