Behavioral health emergency assistance may soon be a 911 call away for more residents of Madison and Dane County. Earlier this month, the Dane County Board approved the county’s 2024 budget, including $200,000 for the expansion of Madison’s CARES program into neighboring communities. And last Tuesday night, the city approved its 2024 budget, including an additional $300,000 for CARES.
In September 2021, Madison launched CARES — short for Community Alternative Response Emergency Services — a partnership between the Madison Fire Department and Journey Mental Health Center to supplement current Emergency Medical Services for behavioral health emergencies in Madison. Essentially, if someone in Madison experiencing a non-violent behavioral health emergency calls 911, they will be visited by a two-person CARES team — a paramedic and a mental health crisis worker — instead of police. That is, if one of the teams currently in service is available.
Since its formation, CARES has gone from operating only downtown on weekdays to now being available seven days a week: weekdays from 8 a.m. to 8 p.m., and weekends from 10 a.m. to 8 p.m. They’ve responded to more than 3,500 calls since 2021.
On Nov. 14, Madison’s Common Council passed the 2024 city budget after hours of deliberation. Ché Stedman, an Assistant Chief of EMS Operations in Madison, says the approved city money will go to new CARES transit vans.
Currently, CARES teams are using old Fire Department vehicles, which require frequent maintenance and aren’t optimized for the teams’ needs. The new vans “are widely used around the country for this type of work, as they allow for more room in the back for patient consultations, more providers and equipment,” Stedman said.
And soon, neighboring communities will also be able to take advantage of CARES thanks to outgoing County Executive Joe Parisi, who proposed the additional funding in the 2024 Dane County budget. According to Stedman, the $200,000 from the county will operate like a “matching funds grant” for cities in the Madison metro area who want to partner with Madison to use CARES.
“In other words,” Stedman said, “if it was going to cost Monona ‘X’ dollars to contract with CARES for 2024, the county would match that ‘X’ dollars.” The pricing models for Madison’s surrounding communities are still being figured out.
Whatever the cost, “it’ll be an addition to services,” Stedman said. “We don’t want to water down the services that Madison is currently getting.” In 2023, the city approved funding to keep a third CARES team on the streets during the week rather than just two. The new team should be operational by the end of 2024.
The approved 2024 county budget also included $400,000 for additional 911 crisis counselors. Per Stedman, there is currently one “mental health professional in the 911 center that can triage calls more appropriately.” The new county funding will bring that number up to five. About 15% of 911 calls that are sent to CARES end up being managed on the phone “because there’s people that call that don’t want anybody to come see them.” More crisis counselors in the 911 center means more time for CARES teams to physically go out on calls.
The model used by Madison’s CARES teams is not unique. In planning the expansion of CARES, Stedman looked at mental health crisis teams in Denver and San Francisco that are run out of the fire department, like in Madison. Looking forward, Stedman emphasized the need for a 24/7 mental health triage center in Dane County.
“That’s kind of always been the elephant in the room with us. If a person in Madison gets put into an emergency psych detention, they get driven all the way to Winnebago. At two in the morning, right now, if CARES was in service, the only place they could take someone is to the Emergency Room.”
Dane County included $10 million in funding for a 24/7 mental health crisis triage center in its 2022 budget. Earlier this year it was announced that the facility would be built in the existing Huber Detention Center; the search is on for a partner organization to help run the center once construction is complete.
But until that facility is open, Stedman said, “CARES doesn’t have a lot of incentive to be in service overnight.” Ideally, “we have 24/7 service throughout the city and eventually throughout the county. That’s the long-term vision.”