Need for better awareness, training and intervention on sex trafficking in health system

Victims' agency and needs, independent of their desire to exit trafficking, should be the focus of health care services for individuals who have been sexually exploited, concludes a new study by researchers with McGill University's Ingram School of Nursing (ISoN).

"Unfortunately, we found a lack of awareness on the part of health care professionals and the inability to recognize the signs and symptoms of sex trafficking. This represents a lost opportunity to provide appropriate support, resources and services," says Johane Lorvinsky, RN, MSc(A), one of the study's co-authors and a former graduate student at the ISoN.

Now published in PLOS ONE, the study was conducted in Montreal, Quebec, in conjunction with the directors of "Les Survivantes," a unit within the Service de police de la Ville de Montréal (SPVM) that raises awareness of trafficking while supporting and educating service providers who interact with sex-trafficked individuals.

"This is a very hard-to-reach population," explains Ms. Lorvinsky. With the assistance of Les Survivantes, the researchers contacted 12 sex trafficking survivors who had left their abusers. Of these, seven participated in in-depth interviews that explored their experiences with the Quebec health care system. The goal of the study was to inform future education programs for health care professionals tailored to the complex needs of this underserved population.

Sex traffickers use force to coerce their victims to perform commercial sex acts. "The problem is largely hidden but experts believe that is far more prevalent than the 1,700 police-reported human trafficking cases in Canada from 2009–2018, of which sex trafficking is the largest subset," says Ms. Lorvinsky.

Sex trafficking not recognized by health professionals

Sexually exploited individuals often experience acute injuries, sexually transmitted infections, untreated anxiety and depression and post-traumatic stress symptoms. Fear of their trafficker, low self-esteem and feelings of shame often prevent victims from disclosing the abuse to health care professionals.

"At the same time, health care professionals often do not suspect these patients may be trapped in situations of sexual exploitation," says Ms. Lorvinsky. Visual cues included marks of physical abuse (e.g., cigarette burns, bruises) and/or sexual abuse, and dress code (e.g., "stripper clothes"). Behavioral clues were more subtle and included being anxious, stressed, fearful, pressed, and constantly texting, while contextual cues included stories inconsistent with injuries.

"Individually, these signs may be insufficient to indicate trafficking, but in combination, they ought to raise alarm," explains Ms. Lorvinsky.

Training in universities and workplace recommended

Study participants also noted that the attitudes of health care professionals played a key role in building relationships of trust, which are essential for disclosure of abuse.

"Care was perceived as more impersonal, hasty and perfunctory in hospitals and private walk-in clinics. By contrast, in settings where health care professionals had higher exposure to marginalized groups, such as community care centers and sexual health clinics, they provided non-judgmental, holistic care. Yet, even in these more positive environments, study participants reported that health care professionals who may have suspected abuse or trafficking did not act on their suspicions," says Ms. Lorvinsky.

Complicating matters further, in some cases, sex-trafficked individuals lacked self-awareness of their situation. Once they were able to define their situation as one of sexual exploitation and felt ready to exit sex trafficking, they had no idea how to access resources that could help them to safely leave their abusers. Given these challenges, based on the accounts of study participants, the authors recommend a multifaceted approach for health care providers that includes:

• Identifying personal biases and misconceptions about sex trafficking
• Training on sex trafficking in university curriculums and in the workplace
• Routinely querying psychosocial well-being and assessing for signs of abuse and trafficking
• Developing screening tools to identify victims of sex trafficking
• Creating a catalog of resources to meet the complex needs of survivors
• Establish a network of health care professionals trained in anti-trafficking responses
• Raising public consciousness of sex trafficking through awareness campaigns

"There is definitely a need for more evidence-based research to inform protocol and care delivery for this extremely vulnerable population," concludes Ms. Lorvinsky. Accordingly, the authors suggest that future research should be geared towards the creation and validation of screening tools to identify trafficked individuals as well as best practice intervention guidelines.

More information: Johane Lorvinsky et al, Sex trafficking survivors' experiences with the healthcare system during exploitation: A qualitative study, PLOS ONE (2023). DOI: 10.1371/journal.pone.0290067

https://medicalxpress.com/news/2023-08-awareness-intervention-sex-trafficking-health.html

Avoid cannabis during adolescence, pregnancy and while driving

Researchers recommend avoiding cannabis during adolescence and early adulthood, in people prone to or with mental health disorders, in pregnancy, and before and while driving, based on an in-depth evidence review published by The BMJ today.

However, they say cannabidiol (one active compound in cannabis) is effective in people with epilepsy, and cannabis based medicines can help people with multiple sclerosis, chronic pain, inflammatory bowel disease, and in palliative care.

Their recommendations are based on an "umbrella review" of 101 meta-analyses on cannabis and health. Umbrella reviews synthesize previous meta-analyses and provide a high-level summary of evidence on a particular topic.

According to the Global Burden of Disease 2019 study, around 24 million people worldwide have cannabis use disorder (being unable to quit cannabis despite it causing health and social problems). It's more common among men and in high income countries.

An increasing number of studies have examined the effects of cannabinoids on health and other outcomes, but most findings are observational and prone to bias, making it difficult to draw firm conclusions.

To address this, an international team of researchers set out to assess the credibility and certainty of over 500 associations reported between cannabis and health in 50 meta-analyses of observational studies and 51 meta-analyses of randomized controlled trials, pooling data from hundreds of individual studies.

The studies were published from 2002 to 2022 and looked at the effects of different combinations of cannabis, cannabinoids, and cannabis based medicines on health.

The researchers graded the evidence as high, moderate, low, or critically low certainty in randomized trials—and as convincing, highly suggestive, suggestive, weak, or not significant in observational studies, based on quantitative criteria.

Based on at least suggestive level evidence in observational studies and moderate certainty evidence in trials, the researchers found an increased risk of psychosis associated with cannabinoids in the general population.

Specifically, cannabis use was associated with psychosis in adolescents (when brain development is still taking place), and with psychosis relapse in people with a psychotic disorder. In other words, use of cannabis when no psychotic disorder has occurred increases the risk of its onset, and using cannabis after its onset, worsens clinical outcomes.

Based on weak to suggestive observational evidence and high to moderate certainty trial evidence, the researchers also found an association between cannabis and general psychiatric symptoms, including depression and mania, as well as detrimental effects on memory, verbal and visual recall.

They note that these associations are of particular concern given that the age pattern of cannabis use disorders coincides with the peak age at onset of mental health disorders, from around mid-teens to early 20s, and at that age adolescents and young adults are still in education.

Across different populations, weak to convincing level observational evidence suggested a link between cannabis use and motor vehicle accidents. And in pregnant women, there was also convincing observational level evidence for a link between cannabis use and risk of having a small, low birth weight baby.

Cannabidiol was, however, beneficial in reducing seizures in certain types of epilepsy, while cannabis-based medicines were beneficial for pain and muscle stiffness (spasticity) in multiple sclerosis, as well as for chronic pain in various conditions, and in palliative care, yet not without adverse events.

This umbrella review is the first to pool observational and interventional studies on the effects of cannabinoids on humans, but the researchers note that most outcomes associated with cannabinoid use are supported by weak evidence, have low to very low certainty, or are not significant.

They also point to other limitations, such as differences in the cannabis content of products, the fact that not all individuals will experience the same effects of cannabis on their mental health and cognition, and that randomized trials might not be representative of the real-world population.

Nevertheless, they say law and public health policy makers and researchers "should consider this evidence synthesis when making policy decisions on cannabinoids use regulation, and when planning a future epidemiological or experimental research agenda."

Future guidelines are needed to translate current findings into clinical practice, while involving stakeholders, they add.

More information: Balancing risks and benefits of cannabis use: umbrella review of meta-analyses of randomised controlled trials and observational studies, The BMJ (2023). DOI: 10.1136/bmj-2022-072348

https://medicalxpress.com/news/2023-08-cannabis-adolescence-pregnancy-experts.html

Scientists reverse Alzheimer's plaque formation in animal models by boosting key ion channel

Losing the activity of a key ion channel in the brain may contribute to the buildup of a devastating and toxic protein responsible for the clumps of plaque that accumulate in Alzheimer's disease, a team of neurobiologists in China has found.

Stunningly, this team has also shown—at least in animal-model studies—that this protein, a key hallmark of Alzheimer's, can be diminished in the living brain by manipulating the ion channel.

The suspect protein is amyloid-beta, which becomes pervasive in the brain tissue of patients with Alzheimer's disease. Toxic, gooey amyloid-β accumulates in wads between neurons and disrupts the function of these vital brain cells. The ion channel is known simply as TRPM7, and it may contribute to the buildup of toxic amyloid-β when the channel itself ceases to function properly, according to scientists at State Key Laboratory of Medical Neurobiology, Fudan University in Shanghai.

"Toxic aggregation of amyloid-β in neurons is implicated in Alzheimer's disease pathology," asserted lead author Shimeng Zhang, reporting in the journal Science Signaling. Zhang is part of a large team conducting ongoing research into the activity of the TRPM7 ion channel at the lab in Shanghai.

The TRPM7 channel studied by Zhang and colleagues is a special pore in the membrane of neurons, which allows the passage of charged ions from the outer cellular environment into the inner sanctum of the cell. The TRPM7 channel is involved in the uptake of divalent cations, such as Zn2+, Mg2+ and Ca2+ . The ion channel, therefore, helps shape critical cellular activities, such as excitability, plasticity and metabolism.

But TRPM7 is a dual-function protein that is both an ion channel and a kinase. As difficult as it may be to imagine, this complex constituent in the neuronal membrane is also an enzyme—a kinase—that catalyzes the transfer of high-energy phosphate groups from potent ATP molecules to fuel activities involving TRPM7. Malfunctioning TRPM7 ion channels have been linked not just to Alzheimer's disease but various other neurodegenerative diseases, studies have shown.

In a portion of the team's study that examined human brain tissue, Zhang and colleagues found that the amount of TRPM7 was substantially low in postmortem brain samples from patients with Alzheimer's disease and in two different mouse models of amyloid-β-induced pathology.

Zhang and colleagues confirmed in their research that losing the activity of ion channel TRPM7 may contribute to the buildup of toxic amyloid proteins in Alzheimer's disease. Their findings may also provide a mechanistic link between the loss of TRPM7 and amyloid pathology in patients afflicted with the mind-robbing condition.

The Shanghai scientists not only revealed in their research that TRPM7 declines in Alzheimer's disease, the team also conducted a series of experiments with mouse models and showed that diminished amounts of TRPM7 in cell membranes resulted in the accumulation of amyloid-β.

Keenly aware that TRPM7 is a dual-functioning protein (an ion channel and a kinase), the team then asked a deceptively simple question: What if we boost the amount of full length TRPM7—ion channel plus kinase—in one group of animals and provide the other group with an abundance of the kinase portion of the molecule?

In a group of aged mice that were bred for amyloid-β presence in their brain tissue, the scientists increased the amount of full length TRPM7 in these animals, overexpressing it substantially. In that experiment, the collaborative team found that by boosting the amount of the full length TRPM7 molecules, they were able to restore synapse formation and cognitive function in the mice. The kinase portion of the molecule is known as M7CK.

Then, in younger animals the kinase portion alone was introduced and overexpressed. And when M7CK was tested in this cohort, the kinase directly activated a cascade of activities. For example, the protease, MMP14, promoted amyloid-β degradation and clearance. The kinase actually helped sweep destructive amyloid-β out of the brains of these animals. Indeed, the team—at least in the lab—had found a way to restore synaptic activity and cognitive function in one group of mice and the elimination of toxic amyloid-β in the other.

"We found that the kinase activity of TRPM7 is important to stimulate the degradation of amyloid-β," Zhang reported. "TRPM7 expression was decreased in hippocampal tissue samples from patients with Alzheimer's disease and two mouse models of AD. In cultures of hippocampal neurons from mice, overexpression of full-length TRPM7 or of its functional kinase domain M7CK prevented synapse loss induced by exogenous Aβ."

Overexpression of M7CK maintained cognitive function in presymptomatic young mice and restored synapse formation and cognitive function in aged mice. Further studies revealed that M7CK directly activated the enzyme MMP14, which promoted the degradation and clearance of amyloid-β.

As promising as the new research seems, scientists worldwide have yet to definitively say whether amyloid plaques are a cause of the disease. Although clearly toxic to the brain, the plaque formations may occur in the aftermath of a subtler series of deleterious events that have yet to be discovered.

Additionally, another protein, known simply as tau, forms insoluble stringy filaments in the brain that accumulate as neurofibrillary tangles. Just as some scientists have proposed that plaques are a possible cause of the disease, others have argued in favor of tau.

Ultimately, their synergism may also tell a deeper story about Alzheimer's genesis. Together the amyloid plaques and tau's neurofibrillary tangles create the hallmark plaques and tangles of the disease.

Alzheimer's also has been linked to a number of different gene variants, but most cases occur "sporadically," which means the disorder cannot be traced to a specific cause. And whether genetic or sporadic, sticky amyloid plaques are a defining characteristic of the disorder for which there is no cure. In the U.S. alone, total health care costs for the disorder run $355 billion annually, data from the Alzheimer's Association show.

Unless a cure is found, the disorder is expected to overwhelm global health care systems by 2050 because of the inexorable aging of populations, according to the World Health Organization.

"Our results show that [Alzheimer's disease] pathology is associated with a reduction in TRPM7 expression and that maintaining normal expression of its kinase domain is sufficient to reduce amyloid-β accumulation, protect synaptic density and prevent or reverse memory deficits," Zhang concluded.

More information: Shimeng Zhang et al, TRPM7 kinase activity induces amyloid-β degradation to reverse synaptic and cognitive deficits in mouse models of Alzheimer's disease, Science Signaling (2023). DOI: 10.1126/scisignal.ade6325

https://medicalxpress.com/news/2023-08-scientists-reverse-alzheimer-plaque-formation.html

Early action to control cardiovascular risk factors preserves brain metabolism

 Cardiovascular disease and dementia frequently occur together in elderly people. Nevertheless, few longitudinal studies have examined how atherosclerosis and its associated risk factors affect brain health from middle age.

Now, a new study by scientists at the Centro Nacional de Investigaciones Cardiovasculares (CNIC) in Madrid provides new data on this relationship; the results confirm the importance of controlling traditional cardiovascular risk factors, such as hypertension, cholesterol, diabetes, smoking, and a sedentary lifestyle, not only to preserve cardiovascular health, but also to prevent Alzheimer's disease and other dementias.

Published in The Lancet Healthy Longevity, the CNIC study shows that atherosclerosis—the accumulation of fatty deposits in the arteries—and its associated risk factors, in addition to being the main cause of cardiovascular disease, are also implicated in the cerebral alterations typically found in Alzheimer's disease, the most frequent cause of dementia.

According to CNIC General Director Dr. Valentín Fuster, an author on the study, the new findings are important because they open up the possibility of treating a modifiable disorder (cardiovascular disease) to prevent the development of a disease for which there is currently no curative treatment (dementia). "The sooner we act to control cardiovascular risk factors, the better it is for our brain health," said Dr. Fuster.

"Everybody knows that a healthy lifestyle and controlling cardiovascular risk factors are important for preventing a heart attack," continued Dr. Fuster. "Nevertheless, the additional information linking the same risk factors to a decline in brain health could further increase awareness of the need to acquire healthy habits from the earliest life stages."

In 2021, CNIC scientists discovered that the presence of cardiovascular risk factors and subclinical (presymptomatic) atherosclerosis in the carotid arteries (the arteries that supply the brain) was associated with lower glucose metabolism in the brains of apparently healthy 50-year-old participants in the PESA-CNIC-Santander study. Glucose metabolism in the brain is considered an indicator of brain health.

The PESA-CNIC-Santander study, directed by Dr. Fuster, is a prospective study that includes more than 4000 asymptomatic middle-aged participants who have been exhaustively assessed for the presence and progression of subclinical atherosclerosis since 2010.

Dr. Fuster's team, led by Drs. Marta Cortés Canteli and Juan Domingo Gispert, have continued to monitor the cerebral health of these participants over five years. Their research shows that individuals who maintained a high cardiovascular risk throughout this period had a more pronounced reduction in cerebral glucose metabolism, detected using imaging techniques such as positron emission tomography (PET).

"In participants with a sustained high cardiovascular risk, the decline in cerebral metabolism was three times greater than in participants who maintained a low cardiovascular risk," commented Catarina Tristão-Pereira, first author on the study and INPhINIT fellow.

Glucose is the main energy source for neurons and other brain cells. "If there is a sustained decline in cerebral glucose consumption over several years, this may limit the brain ability to withstand neurodegenerative or cerebrovascular diseases in the future," explained Dr. Gispert, an expert in neuroimaging at the CNIC and Barcelonaβeta Research Center.

Through a collaboration with Drs Henrik Zetterberg and Kaj Blennow, world experts in the identification of new blood biomarkers at the University of Gothenburg in Sweden, the CNIC team discovered that the individuals showing this metabolic decline already show signs of neuronal injury. "This is a particularly important finding because neuronal death is irreversible," said Dr. Cortés Canteli, a neuroscientist at the CNIC and a Miguel Servet fellow at the Fundación Jiménez Díaz Health Research Institute.

The CNIC team also discovered that the progression of subclinical atherosclerosis in the carotid arteries over five years is linked to a metabolic decline in brain regions vulnerable to Alzheimer's disease, in addition to the effect of cardiovascular risk factors. "These results provide yet another demonstration that the detection of subclinical atherosclerosis with imaging techniques provides highly relevant information," said Dr. Fuster, who is the principal investigator on the PESA study.

"The interaction between the brain and the heart is a fascinating topic, and with this study we have seen that this relationship begins much earlier than was thought."

The scientists conclude that in light of these results, "carotid screening has great potential to identify individuals at risk of cerebral alterations and cognitive decline in the future." In the published article they write, "this work could have important implications for clinical practice since it supports the implementation of primary cardiovascular prevention strategies early in life as a valuable approach for a healthy cerebral longevity."

"Although we still don't know what impact this decline in cerebral metabolism has on cognitive function, the detection of neuronal injury in these individuals shows that the earlier we start to control cardiovascular risk factors, the better it will be for our brain," concluded Dr. Cortés Canteli.

More information: Valentín Fuster et al, Longitudinal interplay between subclinical atherosclerosis, cardiovascular risk factors and cerebral glucose metabolism in midlife: results from the PESA prospective cohort study, The Lancet Healthy Longevity (2023).

https://medicalxpress.com/news/2023-08-early-action-cardiovascular-factors-brain.html

More eyedrops recalled as FDA warns of ‘life-threatening infection’

 Dr. Berne’s Whole Health is voluntarily recalling a selection of its eyedrops for fear they may be contaminated by bacteria and fungi.

The recall, which was shared last week by the Food and Drug Administration, includes the company’s MSM Drops 5% and 15% solutions; Dr. Berne’s Organic Castor Oil Eye Drops; and Dr. Berne’s MSM Mist 15% Solution.

An FDA analysis found one batch (lot 6786) of Dr. Berne’s MSM Drops 5% Solution showed bacterial and fungal contamination.

Out of an abundance of caution, Dr. Berne’s is recalling all of the other lots of the 5% and 15% strengths of MSM Solution and the other products.

The FDA noted that using contaminated eyedrops could lead to “minor to serious” infections that could potentially affect vision and even “progress to a life-threatening infection.”

The FDA said Saturday that Dr. Berne’s has received two reports of adverse events related to the recall.

Consumers, distributors and retailers that have any of the recalled products should stop using them and return the products to Sun Star Organics, 988 N. Main St., Orange, California 92867.

The Post reached out to Dr. Berne’s for comment.

This is not the first time eyedrops have been recalled this year.

In January, the Centers for Disease Control and Prevention urged doctors and patients to stop using EzriCare Artificial Tears, as they had been linked to at least 55 infections in 12 states.

This is not the first time eyedrops have been recalled this year.

Getty Images/iStockphoto

At the time, the product was blamed for cases of permanent vision loss, hospitalizations and one death.

“CDC recommends that clinicians and patients immediately discontinue the use of EzriCare Artificial Tears until the epidemiological investigation and laboratory analyses are complete,” read the January CDC statement.

By March, the CDC and FDA had identified 68 patients in 16 states who had been infected with a rare strain of bacteria after using the product.

Four people even had to have an eyeball surgically removed, while eight infections caused permanent vision loss.

Using contaminated eyedrops could lead to infection.

FDA
Florida grandmother Clara Oliva claims she was declared legally blind after her right eye was surgically removed following use of EzriCare Artificial Tears.

“My client is horribly injured and now legally blind. I am currently investigating others similarly injured by this recalled product,” Oliva’s attorney, Natasha Cortes, wrote in an email to Law&Crime in March.

“These companies must be held accountable for the devastating consequences their product has caused Ms. Oliva and other consumers.”

https://nypost.com/2023/08/30/more-eye-drops-recalled-as-fda-warns-of-life-threatening-infection/

Interstitial Lung Disease + Pulmonary Hypertension = Poor Outcomes in Systemic Sclerosis

 Systemic sclerosis patients with both interstitial lung disease and pulmonary hypertension had worse survival than those without both conditions, based on data from more than 3,000 individuals.

Pulmonary complications are now the most common causes of death in adults with systemic sclerosis (SSc), but the impact of patient characteristics and risk factors such as interstitial lung disease (ILD) and pulmonary hypertension (PH) on SSc outcomes remains unclear, wrote Pia Moinzadeh, MD, of University Hospital Cologne (Germany) and colleagues.

Although the role of ILD and PH in different SSc subtypes has been studied, larger studies of the effects of ILD and combining ILD and PH on outcomes are needed, since survival rates can change over time with new classification criteria, diagnostic tools, and improved therapies, they said.

In a study published in the journal Chest, the researchers reviewed data from 3,257 adults aged 18 years and older with SSc over a mean follow-up of 3.45 years. Participants were part of the German Network for Systemic Sclerosis (DNSS) that included 25 clinical centers in Germany. The participants were divided into SSc subsets: 54.2% with limited cutaneous SSc (lcSSc), 31.4% with diffuse cutaneous SSc (dcSSc), and 14.4% SSc overlapping syndromes.

The baseline prevalence of ILD was 34.5%, including 200 patients with ILD-PH and 923 with ILD but without PH. The baseline prevalence of PH without ILD was 4.5%. ILD was defined as SSc associated when other causes were excluded. PH was defined as an increase in mean arterial pressure of at least 25 mm Hg at rest, and also was defined by an estimated right ventricular systolic pressure greater than 35 mm Hg based on echocardiography.

By the end of the study period, 47.6% of SSc patients had ILD, 15.2% had ILD-PH, and 6.5% had pulmonary arterial hypertension (PAH). Of the SSc patients with ILD, 57.3% had dcSSc; the prevalence of PAH was not significantly different between the SSc subtypes. Patients with dcSSc were more likely to develop ILD-PH (52.2%) and ILD without PH (52.1%); patients with lcSSc were more likely to have PAH (64.9%) or no pulmonary involvement (64.1%).

“For all subsets, a significant increase in the frequency of SSc-ILD was observed during follow-ups,” the researchers noted.

Overall survival at 5 years was worst for patients with both ILD and PH (79.1%). Five-year OS for patients with PAH was 85.0%. OS at 5 years was significantly better for patients with ILD without PH (92.8%) and those with no pulmonary involvement (96.4%), compared with the ILD and PH patients (P < 0.001).

In a multivariate analysis, the risk of death was more than five times higher for patients with ILD-PH, compared with the reference group of patients without pulmonary involvement (hazard ratio, 5.3). Factors associated with reduced risk of death included female sex (HR, 0.3), higher body mass index (HR, 0.9), and higher diffusing capacity of the lung for carbon monoxide (HR, 0.98).

The findings were limited by several factors including the incomplete data for patients enrolled early in the registry, lack of complete radiology data, and the inability to determine whether the association between pulmonary involvement and survival was related to ILD or to pulmonary vascular disease, the researchers noted.

However, the results suggest that a combination of ILD and PH is the main predictor of death in patients with SSc and ILD, although the overall survival for SSc patients with and without pulmonary involvement has improved in recent decades thanks to improved therapies, multidisciplinary care, and greater attention to the disease worldwide, they concluded.

The study received no outside funding. Dr. Moinzadeh disclosed lecture fees from Boehringer Ingelheim.

https://www.medscape.com/s/viewarticle/995984

Many big US cities now answer mental health crisis calls with civilian teams — not police

 Christian Glass was a geology geek, a painter and a young man beset by a mental health crisis when he called 911 for help getting his car unstuck in a Colorado mountain town last year.

When sheriff’s deputies arrived, he refused to get out of the car after saying that supernatural beings were after him, body camera video shows. The officers shouted, threatened and coaxed. Glass made heart shapes with his hands and prayed: “Dear Lord, please, don’t let them break the window.”

They did, and the 22-year-old grabbed a small knife. Then he was hit with bean bag rounds, stun gun charges and, ultimately, bullets that killed him and led to a murder charge against one deputy and a criminally negligent homicide charge against another.

As part of a $19 million settlement this spring with Glass’ parents, Colorado’s Clear Creek County this month joined a growing roster of U.S. communities that respond to nonviolent mental health crises with clinicians and EMTs or paramedics, instead of police.

The initiatives have spread rapidly in recent years, particularly among the nation’s biggest cities.

Data gathered by The Associated Press show at least 14 of the 20 most populous U.S. cities are hosting or starting such programs, sometimes called civilian, alternative or non-police response teams. They span from New York and Los Angeles to Columbus, Ohio, and Houston, and boast annual budgets that together topped $123 million as of June, The AP found. Funding sources vary.

“If someone is experiencing a mental health crisis, law enforcement is not what they need,” said Tamara Lynn of the National De-Escalation Training Center, a private group that trains police to handle such situations.

There’s no aggregate, comprehensive data yet on the programs’ effects. Their scope varies considerably. So does their public reception.

In Denver, just an hour’s drive from where Glass was killed, a program called STAR answered 5,700 calls last year and is often cited as a national model. Its funding has totaled $7 million since 2021.

In New York, a more than $40 million-a-year program dubbed B-HEARD answered about 3,500 calls last year, and mental health advocates criticize it as anemic.

Representatives from some other cities were frank about challenges — staffing shortages, acclimating 911 dispatchers to sending out unarmed civilians, and more — at a conference in Washington, D.C., this spring.

Still, officials in places including New York see no-police teams as an important shift in how they address people in crisis.

“We really think that every single B-HEARD response is just a better way that we, the city, are providing care to people,” said Laquisha Grant of the New York Mayor’s Office of Community Mental Health.

Federal data is incomplete, but various studies and statistics show that mentally ill people make up a substantial proportion of those killed by police. Often, the dead are people of color, though Glass was not.

The alternative approach dates back decades but gained new impetus from calls for wide-ranging police reform after the 2020 killing of George Floyd in Minneapolis. There also were specific pleas for better responses to psychiatric crisis after such tragedies as the death of Daniel Prude that year in Rochester, New York. Prude was just out of a psychiatric hospital and running naked through snowy streets when he was suffocated by police who had been called to help him. He was Black, as was Floyd.

Reports of mental distress made up about 1% of police calls in a 2022 study involving nine police agencies; there’s no nationwide statistic. A long-established civilian response program in Eugene, Oregon, says it diverts 3% to 8% of calls from police. The Vera Institute of Justice, a police reform advocacy group, suggests alternative teams could handle 19% if homelessness, intoxication and some other troubles were included.

In Denver, STAR teams arrive in vans stuffed with everything from medical gear to blankets to Cheez-Its. In one recent instance, they spent three hours — more time than police could likely have spent -- with a Denver newcomer who was living on the streets. The team helped him get a Colorado ID voucher, groceries, and medications and took him to a shelter.

“It’s really about meeting the needs of the community and making sure we are sending the right experts, so we can actually solve the problem,” says Carleigh Sailon, a former STAR manager who now works elsewhere.

STAR responded to 44% of calls deemed eligible last year, said Evan Thompkin, a STAR program specialist.

A Stanford University study found that petty crime reports fell by a third and violent crime stayed steady in areas that STAR served in its earliest phase. Throughout the program’s three years, police have never been called for backup due to safety concerns but have helped direct traffic, Thompkin said.

Some observers wonder if safety worries will grow as non-police programs do. While there’s an appeal to the idea of pulling cops out of psychiatric crisis calls, “the challenge is identifying those calls,” said Stephen Eide, a senior fellow specializing in mental health issues at the conservative Manhattan Institute think tank.

In New York, dispatchers must gauge the potentially life-or-death risk of “imminent harm” while deciphering sometimes frantic 911 calls that often come from bystanders or relatives, not the person in crisis.

Officials say B-HEARD answered 53% of eligible calls in the last six months of 2022, the most recent data available. But that was 16% of all the mental health crisis calls within the program’s limited territory.

Combined, staffers answered about 2% of the 171,000 such calls citywide throughout last year.

“Very unimpressive,” says Ruth Lowenkron, an attorney involved in a federal lawsuit that seeks changes in B-HEARD.

Grant says the city is exploring whether more calls could qualify. Meanwhile, officials note that B-HEARD’s social workers and EMTs resolve about half of calls by talking to people or taking them to social service or community health centers, rather than the hospitals where armed officers have traditionally brought people in crisis. Plans call for extending B-HEARD citywide.

Grant credits the program with “providing people with more options and letting people know that they can stay safely in their homes, in their communities, with the connection to the right resources.”

John Barrett, however, wanted to go to a hospital to get some physical and mental health problems checked out one June day. He asked 911 for an ambulance, but police came, he said. Then two other people showed up unannounced, in bulletproof vests and face masks.

“They totally escalated the situation for me,” recalled Barrett, 45, a former door technician. “Between them and the police being there, I was just totally terrified.”

He said he learned only by asking that they were with B-HEARD. (Teams can be summoned by on-scene police, and staffers are allowed, but not required, to wear ballistic vests.)

Barrett said the two performed medical tasks such as taking his blood pressure, and eventually a social worker appeared in plain clothes and sought to talk with him, but he wasn’t interested. An ambulance ultimately took him to a hospital.

The city mental health office said it couldn’t discuss any individual responses.

Barrett said he went home from the hospital the next day, still shaken by the response to his call for help.

“I’m saving money for an Uber next time,” he said.

https://apnews.com/article/mental-health-crisis-911-police-alternative-civilian-responders-ca97971200c485e36aa456c04d217547