Lost Patients: Presenting The Fifth Branch – A Detailed Summary

Introduction In the episode titled "Presenting: The Fifth Branch," part of the six-part docuseries Lost Patients by KUOW News and Information and Seattle Times, reporter Will James delves into the intricate and often flawed mental healthcare system in America. This episode focuses on Durham, North Carolina's innovative approach to handling mental health crises by disentangling mental health care from traditional policing through the establishment of a new public safety branch known as HART (Holistic Empathetic Assistance Response Team).

The Intersection of Mental Health and Policing The episode opens with Will James highlighting the problematic overlap between mental health care systems and law enforcement. He states, “Police here in Seattle responded to nearly 10,000 scenes of people in crisis last year” (00:00), emphasizing how the intertwining of these systems often leads to tragic outcomes, including interactions with police that result in violence or incarceration rather than healing.

Durham's Innovative Response: The Fifth Branch Durham presents a radical solution by creating the Community Safety Department, a fifth branch of public safety aimed specifically at responding to mental health crises with unarmed professionals. Ryan Smith, the director of Durham's Community Safety Department, explains the framework: “Put a mental health worker inside 911 who will resolve some calls over the phone. Deploy teams of unarmed social workers, EMTs, and people with lived experience to respond to nonviolent calls involving mental illness and homelessness” (09:48).

Challenges in Implementation Introducing this new branch was met with significant resistance from the existing police force. Police Chief Patrice Andrews recounts her own experiences, stating, “There were times where I knew that some of the force that I saw and participated in was excessive. It was very hard to call that out” (14:13). The episode details the skepticism and fear among officers, many of whom were concerned about safety and job security, with quotes like, “I'm like, this is going to be a disaster” (10:41) and “What did we do? We're good cops. We didn't do anything wrong” (21:15).

Building Trust and Overcoming Skepticism Despite initial pushback, success stories began to emerge, demonstrating the efficacy of HART. A pivotal moment described in the episode involves a barricaded man in 2022. Police Chief Andrews opted to involve Ryan Smith and the HART team instead of deploying a SWAT team. Abena Bediako, a social worker with HART, successfully de-escalated the situation without the use of force, leading to the man's peaceful hospitalization (26:31). This incident was a turning point, shifting the perception of HART within the police force and the community.

National Context and Broader Implications The episode situates Durham's experience within a national movement, noting that cities like Denver, Albuquerque, Houston, Louisville, and New York are implementing similar alternative crisis response programs. Kristi Thompson from the Marshall Project adds, “One thing that they said was really important is that the messenger really matters here” (30:36), highlighting the importance of having law enforcement advocate for these programs to gain wider acceptance.

Legal and Future Considerations Legal challenges loom on the horizon, with ongoing lawsuits arguing that continued reliance on armed police for mental health crises violates the Americans with Disabilities Act (34:17). This legal pressure may accelerate the adoption of alternative response programs across the country.

Conclusion "Presenting: The Fifth Branch" offers a comprehensive look at Durham's pioneering efforts to reform mental health crisis response by creating a specialized, unarmed public safety branch. Through real-life testimonials, data-driven results, and the overcoming of institutional resistance, the episode illustrates both the potential and the challenges of transforming mental healthcare in America. As Durham's HART continues to respond to over 15,911 calls, it serves as a model for other cities striving to balance safety with compassionate care.

Notable Quotes with Timestamps

• Will James (00:00): “Mental healthcare in America is a maze — by design.”

• Ryan Smith (10:38): “If what we're really doing is about sending the most appropriate response, then I want that to be available for as many people in as many moments as possible.”

• Patrice Andrews (13:33): “Law enforcement was an extension of an oppressive government. I mean, just in a nutshell.”

• Abena Bediako (22:02): “We needed to build confidence that we could do this and not get someone killed.”

• Ryan Smith (27:51): “Abina said, well, he's not a danger to himself. He is intoxicated. Let's give him a moment. Let's check back in with him.”

• Ryan Smith (28:20): “When I'm wrong, I'm the first one to raise my hand and say, you know what? I was wrong. These people are going to help you. They're going to make your job and your lives on this job easier.”

Final Thoughts The episode effectively captures the complexities of overhauling entrenched public safety systems, highlighting the interplay between policy, on-the-ground realities, and human empathy. Lost Patients not only chronicles Durham's journey but also serves as a beacon for other cities aiming to create safer and more supportive environments for individuals experiencing mental health crises.