Collaborative efforts in mental health crises may yield better outcomes


Monitor staff

Published: 09-19-2023 7:15 PM

Lisa Madden sees progress in the state’s collaborative efforts to better handle and de-escalate volatile mental health crisis situations without the use of deadly force.

By engaging in collaborative efforts and leveraging the expertise of both law enforcement and mental health professionals, Madden said better outcomes will occur when mobile crisis teams and police officers back each other up during critical moments instead of working independently

“I feel confident in saying, anytime systems align and provide a comprehensive approach to a crisis, you will have a better outcome than when they’re not aligned,” said Madden, president and CEO of Riverbend Community Mental Health. “That’s just logic taking over.”

Since its launch in January 2022, the New Hampshire Rapid Response Access Point (NHRRAP) Helpline has offered a new level of coordination between law enforcement and mental health workers.

While the helpline offers a marked improvement from the past, it still falls short in terms of offering timely assistance in emergencies.

The helpline strives to ensure that a mobile crisis team, typically staffed with both a peer support specialist and a clinician, arrives at the location of an individual in a mental health crisis within one hour.

Meeting this goal can be difficult, especially in the North Country, because the mobile crisis teams are thinly distributed throughout the entire state.

In cases of imminent danger, police race to the scene in vehicles with lights and sirens, often arriving before a crisis team is even mobilized. Police use of deadly force with someone in a mental health crisis often happens in the first few minutes of an encounter.

Who to call

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Unlike the easy-to-remember three-digit number 988 for the national suicide and crisis line, the New Hampshire helpline uses a harder to remember 10-digit number (833-710-6477), which can make it difficult for those seeking mental health treatment.

The NHRRAP helpline, operated by Carelon Behavioral Health, received a total of 24,172 calls between January and June either direct calls to the helpline or calls routed through the 988 suicide and crisis helpline, out of which 222 were initiated by law enforcement agencies.

However, the situation was different on November 4, 2019, when John Swanson experienced a mental health crisis more than two years before the helpline was available for immediate assistance. Swanson’s mother had to rely on a friend to call 911, according to a report from the Attorney General’s Office.

Responding to the call, officers arrived at the scene and noted that Swanson appeared “amped up.” After emergency medical services assessed Swanson, he was admitted to Memorial Hospital but was discharged later that same day.

Swanson’s interaction with law enforcement, however, did not end there. Over the following days, according to a report from the Attorney General’s office, Swanson made over 25 calls to 911, sometimes threatening police officers and in response, an arrest warrant was issued against him.

On November 7, 2019, Ossipee Police Department and the New Hampshire State Police Special Weapons and Tactics (SWAT) Unit, established a perimeter around Swanson’s residence and fired tear gas inside to force him out of his house.

After nearly five hours of negotiation, Swanson exited his house, armed with a firearm.

Responding officers, Sergeant Nicholas Levesque, Trooper First Class Nicholas Cyr, and Sergeant Michael Cedrone fired multiple shots at Swanson, hitting him four times.

A police dog was also released on Swanson.

The investigation into the incident deemed the actions of the officers, including the use of lethal force, legally justified given the circumstances.

Swanson was hospitalized for his injuries and the charges against him were later dropped.

“John is forever marred by being shot by the police in the back and shoulder. He is now paralyzed in one leg, has drastically restricted use of an arm, and suffers from PTSD. He’s wheelchair bound and needs help with basic tasks, such as showering,” Jared Bedrick, Swanson’s attorney said in an email statement.

Bedrick also said that Swanson maintains that the police had no justification for shooting him or siccing the dog on him. He never fired any shots, as the police have claimed, nor did he even point a firearm at anyone.

The three officers who engaged with Swanson have received Crisis Intervention Team training, although it is unclear whether they were trained during the time of the incident.

More to do

While CIT training is considered the “gold standard,” some states across the country are adopting multi-layered approaches to address the issue.

Some police departments, like those in Kansas and Colorado, have implemented co-responder programs.

For instance, in Colorado’s Douglas County, a mental health professional rides along in a car with law enforcement officers and the mental health crisis call is handled together.

“I think there’s certainly more that we can do to build on the CIT model,” said Susan Stearns executive director of the National Alliance on Mental Illness New Hampshire. “I think the CIT is a really good foundational training that has been readily accepted by first responders, including law enforcement in New Hampshire.”

While no bills were presented during the recent legislative sessions to establish a mental health incident review panel, Stearns said there is a plan to introduce legislation in the upcoming session.

This would allow law enforcement and mental health professionals to analyze and learn from incidents such as the Ossipee case and the death of Mischa Fay, a teenager from Gilford who was fatally shot in January following a mental health call.

If you need help

NH Rapid Response Access Point: Call or Text 833-710-6477 for free and immediate, 24/7 access to mental health and/or substance use crisis support via telephone, text and chat services.

National Suicide and Crisis Lifeline: If you or someone you know needs support now, call or text 988 or chat at

Veterans: Veterans and their loved ones can call 1-800-273-8255 and Press 1, chat online, or send a text message to 838255 to receive confidential support 24 hours a day, 365 days a year. Support for deaf and hard-of-hearing individuals is available.

Crisis Text Line: Free, 24/7 support for those in crisis. Text 741741 from anywhere in the U.S. to text a trained Crisis Counselor.