Across W.Va., Localities Look For New Ways To Help People In Crisis

This story originally aired in the July 6, 2025 episode of Inside Appalachia.

This story includes discussion of suicide and substance use disorder. If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988. There is also an online chat at 988lifeline.org.

In Huntington, West Virginia, Cabell County’s quick response team, or QRT, meets in the upper floor of an Emergency Medical Services building five days a week. Huntington is a small city of 45,000 people on the western edge of West Virginia. 

On a weekday last fall, four team members small-talked and joked around. The tone seemed light, especially given what the quick response team does: checking-in on folks who’ve recently had an overdose, or who are at high risk for one, in a city that’s known nationally for its struggles with opioids.

“I think what brought it to the forefront probably is 2016 we had an incident where we had about 28 overdoses in about a four-or five-hour period, and that made international news,” Connie Priddy, a registered nurse with Cabell County EMS and program coordinator for the quick response team, said.

Priddy said EMTs saved all the folks they encountered that day, but a local doctor soon realized that none of the individuals who overdosed were referred for follow-up resources or treatment. Without support, they could lapse back into substance use disorder, potentially encountering law enforcement and ending up in jail or the emergency room. 

“[We] finally realized we had a really huge gap, and we weren’t going to arrest our way out of the problem,” Priddy said. “So we were looking for a different way to do things.

They used an idea that came from Ohio that seemed to be getting results — a quick response team, consisting of first responders, health officials and a peer specialist who has experienced mental health or substance abuse challenges. They take a proactive approach and often are called to respond for emergency calls involving people with substance use disorder or experiencing mental health challenges. Cabell County applied to create its own quick response team and received a three-year grant from the U.S. Department of Justice. In 2017, the Cabell County QRT launched. 

The first year, they saw a 40% reduction in overdose calls — 700 fewer calls than the year before. But, there was a learning curve.

“Even in 2017, I think we had in our mind what we thought was a stereotypical client,” Priddy said. “And we quickly realized that we could go into an area that somebody might be living in an abandoned house with a dirt floor, and then the next minute, we’re going into a million-dollar home. So, I think we really sort of quickly got away from stereotyping.” 

Those sorts of lessons are important stepping stones to improving response. West Virginia faces a steep challenge when it comes to addressing behavioral health issues. In a 2023 survey, 38 percent of West Virginians reported symptoms of anxiety or depression, about six points higher than for the U.S. as a whole, according to KFF, formerly known as the Kaiser Family Foundation. The state’s drug overdose death rate was also nearly three times higher than the national average in 2021. 

Those higher rates of mental health challenges and substance use disorder have strained first responders across the state, who already have limited resources. Most of the time, the people responding [to crisis calls] are law enforcement officers, firefighters and emergency medical technicians, who aren’t always trained to deal with these kinds of problems. So people tend to end up in jail, or they cycle in and out of crisis. 

Programs like the quick response team and crisis intervention teams are intended to train first responders to respond more efficiently and empathetically and to divert more folks away from the criminal justice system, toward treatment. Quick response teams (QRT) focus more on substance use disorder and connecting people with treatment, while crisis intervention teams (CIT) aim more at mental health challenges and training first responders on de-escalation and directing individuals toward resources. They’ve shown enough promise that both models have been replicated throughout the state, but they still have trouble attracting sustainable funding.

Both programs use peer support specialists, who are team members with lived experience who are in recovery from substance use disorder or mental health challenges.

“In recovery, every path is different, but we have one common thread: We have disease that wants to kill us,” Sue Howland, Cabell County QRT’s peer specialist, who has lived experience with substance use disorder, said. “I’ve walked through hell twice. I don’t want to go back. I’m having too much fun living, okay? So basically, it is for me to show an individual that you can live a life without being dominated by ‘King Addiction.’”

An Innovative Approach To Meeting Behavioral Health Challenges

Howland went through treatment in 2011 and was later hired by the mental health treatment center. She was chosen to be part of the first quick response team, along with paramedic Larresca Barker. Barker said from the start, the Huntington community welcomed the team, which hasn’t been the case everywhere.

“I think we anticipated there being some kind of backlash, but we really didn’t get that,” Barker said. “I think people were very open to the idea of this team. Parents, the clients themselves, spouses are like, ‘No, please come in. We need to talk about this.’ That made our job so much easier, when we weren’t facing scrutiny or anger, right? We were never met with that.”

As the Cabell County quick response team made its rounds, it received a call to check on a woman who walked into one of Huntington’s EMS stations. She’d been shooed from an abandoned house by police. She had a port in her neck from recent medical treatment, and the EMS crew administered Narcan out of concern. She seemed confused and asked to be dropped off at a low barrier shelter for unhoused people. Barker and the team agreed to transport her there. 

Shelters for unhoused people play an important role in Huntington. The city’s poverty rate is about 27%, more than 10 percentage points higher than the West Virginia rate and 16 points higher than the national average. An annual count found that the number of unhoused people in the area was on the rise. 

“I’m convinced more and more that addiction is a symptom of mental health or other things,” Mitch Webb, executive director of the Huntington City Mission, a local homeless shelter, said. “The number of people who have co-occurring dual diagnoses, substance use disorder, and mental health disorders — that seems to have grown.”

Research backs him up, with government studies tracking a growing number of people who reported symptoms of anxiety or depression, as well as substance use. Other researchers see the trend as well. 

Webb said the quick response team has become a vital partner to the city mission. Twice a month, QRT responders set up a booth at the shelter to do everything from linking people to services to dressing wounds. 

People like Fiasili Fitisemanu-Bartram, who is better known by her nickname “Sili” says the QRT team members have made a difference in people’s lives.

“I think I was probably in and out of addiction almost 21 years, in and out of prison for 17,” Sili said.

Sili said Sue Howland and Larresca Barker went out of their way to check on her during that time.

“I can remember when QRT started,” she said. “I can remember Larresca riding around in this big hunk of junk and seeing me walking down the street, either on my way to get some drugs or just having gotten some — trying to get my fix, jumping out of moving cars, chasing me down the street because she’d been looking for me. ‘Are you okay? Where have you been? I haven’t seen you’ … She was adamant to try to get me some help.”

In 2022 Sili was arrested and asked to be put into a rehab program. After several months, she came out and got an apartment, and a few months after that she got a job at the Huntington City Mission — the same place she was a client for so many years.

Getting People To Treatment Instead Of Jail

On the other side of West Virginia in Princeton, a small city of about 5,595 in the southern coalfields, similar work is underway. More than 1 in 5 of the 5,500 people there live in poverty, a significantly higher percentage than the state and national average.

On a mild September day, a McDowell County sheriff’s deputy and a mental health worker approached a blonde man with caution. The man wore bright orange inmate pants as he paced in front of a house. The deputy and mental health worker introduced themselves and asked his name.

“Just take me to jail, OK?!” he shouted as he saw the deputy.

The interaction was intense, but it was a roleplay, not a real-life situation. In the weeklong training at the Princeton Rescue Squad’s Karen Preservati Center, first responders develop and practice skills to use when they interact with people in crisis. 

The class teaches the so-called “four plays” of crisis intervention: Introduce yourself, get the person’s name, express what you see, hear or have been told and summarize the situation. They visit local care facilities and develop skills around de-escalation, trauma-informed care, crisis stabilization and working with children and veterans, among others. 

In this case, the deputy and mental health worker used the four plays to convince the agitated man to let them help him get a meal and some clothes and find a place to stay.

The group works with responders from different agencies in McDowell, Mercer and Wyoming counties. Those counties have some of the highest poverty rates in the U.S. and rates of overdoses that exceed the state average. Trainer Aaron Beeman said responders across southern West Virginia have seen a growing number of people experiencing mental health and substance use challenges.

“Every call is different,” Beeman, who works for the Princeton Fire Department and is part of the Southern West Virginia Crisis Intervention Team (CIT), said. “We pay attention on every call that we’re going on, and there’s some basic medical calls that we’ve ran, and realize there’s something else going on here. They’re calling for this, but that’s not really what’s going on. After talking to them and dealing with them, you’ll find out that they’ve got an underlying mental illness.”

Identifying and addressing that underlying mental illness is a novel approach, one that’s working. But not everyone embraced it from the start — including Beeman. He admits some of his resistance stemmed from feeling overwhelmed by the sheer volume of calls West Virginia first responders received. Beeman and his colleagues just wanted to get the job done — and move on to the next one.

“We all were those people who wanted to get in, get out,” Beeman said. “Didn’t care what we said, didn’t care what we treated. You were doing drugs. You made that choice. Live with it, or don’t.”

Beginning in 2021, something changed. That’s when Candace Nelson was named to coordinate the CIT program for Southern Highlands Community Mental Health Center in Princeton. Nelson, Southern Highlands’ chief clinical officer for community programs, spent a lot of time taking food to fire departments, emergency medical service providers and law enforcement agencies, trying to get them interested in learning a new approach for crisis response.

“I beat the streets constantly, just knocking on doors,” Nelson said. “They didn’t always open the door, but they always took my stuff, so I felt like I was inching in.”

One of those places was the Princeton Fire Department, where Beeman worked.

“She’d show up with food, [and] we’d open the door, grab the food, shut the door, and lock her out,” Beeman said. 

But roughly three years ago, something changed: a Princeton City firefighter died by suicide and “word got back to Candace.” 

“That was the first night when she come to the door, she was allowed into our station,” Beeman said. “That’s where the bond started with her.”

Beeman and Princeton firefighters and first responders signed up for CIT training. Some were skeptical of going through CIT training or felt silly doing roleplay. Yet, when they applied what they learned in the training, they started seeing a difference.

“We’re getting these guys and gals to voluntarily want to go to rehab and treatment to find the underlying cause,” Beeman said. “And a lot of them are telling us it’s [because] ‘Hey, they treated me like a person.’”

Overcoming Institutional Resistance

A key component of most crisis response teams is a peer support specialist, someone who’s been there before and understands what it’s like to be in crisis. That’s true of the team here in southern West Virginia. 

“I’m in recovery myself,” said Katie Slaughter, the Princeton CIT peer support specialist. “I have almost 14 years clean. I started out with Southern Highlands in the substance use disorder part of the system.”

Slaughter works on both the crisis intervention team and the region’s quick response team, which means she regularly works with people dealing with substance use disorder and mental health challenges. And the crisis response programs work, she said. Not every first responder buys in, though.

“A lot of people think this is more of a ‘hug a thug’ type thing for officers, and it’s not,” Slaughter said. “We’re not trying to soften them up [or] tell them not to do their job.”

Slaughter and other trainers use the term often. “Hug a thug” is a dismissive term for CIT — the idea that showing empathy and looking for a nonviolent resolution to a situation, is essentially a way of coddling criminals. 

Experts like West Virginia University professor and former paramedic Joy Hutchinson say there’s evidence showing the CIT approach works. But the people tasked with using it need to buy into it.

“I think CIT training is a wonderful thing,” Hutchinson said. “[But] we have to train those who are responding first to recognize that this is needed, these resources.”

The training directly addresses stigma and awareness of mental health issues. And in West Virginia, the culture shift is starting to happen. 

Anthony Epperson, chief field deputy for the McDowell County Sheriff’s Office, said he applied for a position with CIT, and his colleagues were skeptical. He was too, until the first week of classes.

“We were suspecting as a department that this was just all about drugs and users,” Epperson said. “But after I’m in the class, I find that it’s more about people in crisis, and you get a broader spectrum.”

Soon after completing the class, Epperson was called to assist with an attempted suicide. The woman in crisis needed to get to a hospital and was refusing to go. He and a fellow trooper decided to use the four plays and “a light switch just kicked on.” She voluntarily chose to go in the ambulance.

In April 2024, Epperson was called to a cemetery where a woman was threatening to kill herself, a call he said “changed my life and my outlook on CIT altogether.”

“Without CIT and the training that I received through CIT, I’m not sure how that call would have turned out that day,” Epperson said. “It was high stress and quite unnerving at certain points. Finally, all the adrenaline just dumps when the person relinquishes the gun and lays it down.”

Successful outcomes are not just anecdotal. Research shows CIT works, too. It significantly reduces the number of arrests of people with serious mental illnesses because they’re diverted to receive treatment instead. It also reduces stigma and prejudice toward people with mental illness and makes officers more likely to identify and help people who need psychiatric care. 

Studies of CIT in Memphis, Tennessee, and Albuquerque, New Mexico showed the training reduced officer injuries and SWAT team intervention. CIT even reduced how much time officers spent on mental disturbance calls — which allowed them to spend more time in the community instead. 

Research also shows that CIT programs save money over time. The National Alliance on Mental Illness (NAMI) reports the cost of jailing a person for a year in Detroit is three times more than the cost of community-based mental health treatment. Another study found that mental health crisis intervention programs resulted in a return of $2.16 for every dollar invested. 

Some West Virginia policymakers are starting to pay attention.

“When we talk about CIT, it’s just adding a tool to our first responders’ tool belt,” Hollis Lewis, a West Virginia delegate representing Kanawha County and the West Virginia CIT Project Director, said. “It doesn’t usurp any policies or procedures that they have in place … we have a big problem here [in West Virginia], so we have to be trained and more conscious in how to deal with that.”

Mercer County Commissioner Greg Puckett is also an advocate of bringing CIT and QRT to southern West Virginia.

“When you look at where we are as a society, we’ve got to be able to take care of those when there happens to be that crisis, and you’ve got to figure out where to get the resources and the best available assistance,” Puckett said.

The Funding Conundrum

The QRT and CIT programs in West Virginia were funded from the start by a patchwork of grants. The grant funding allowed these programs to get established and prove the approach works.  But the initial funding for both programs has now run out, and program officials like Connie Priddy and Candace Nelson have had to re-apply. 

They’ve had some success. The Cabell County QRT received an award in December from the West Virginia First Foundation. That fund was established to distribute money from the state’s settlements with opioid manufacturers and distributors.

“It’s important to have a program like a quick response team in a community to make sure they can meet the person where they’re at and lift them up to get them into those services when needed,” Dr. Matthew Christiansen, who sits on the West Virginia First Foundation’s board and is active in addiction treatment, said.

Christiansen, who also serves as the director of the West Virginia Office of Drug Control Policy, said the First Foundation recognized the value of crisis intervention programs and awarded grants to several CIT programs around the state.

“One of the things that was really important to us as a board in our discussions was the role of law enforcement in the addiction response and the importance of supporting them,” Christiansen said. “We wanted to be able to give them some tools and some resources to be able to address the issue in a way that they really felt like was making a difference. ”

But he acknowledges grant funding only goes so far and “for many of these programs, it really is feast or famine.” 

“We need to be looking to the future about how we create a narrative of sustainability and a model that we can rely on that will help these programs continue in perpetuity for as long as they’re needed,” Christiansen said.

While attitudes about substance abuse and mental health are starting to shift, Christiansen said state policymakers should consider funding these programs as a standard part of their budget process. So far, they haven’t allocated any state funding, which puts the burden on local governments instead. 

“The departments don’t have the money, and that’s where the problems come in,” WVU Professor Hutchinson said. 

Mercer County commissioner Greg Puckett said he’d be willing to support the programs but lacks the revenue.

“These programs, they’re extraordinarily effective. They just are. It’s evidence proven that they are effective programs,” Puckett said. “But if you want to fix the problem you’ve got to put the money into that investment. And right now all I hear is tax cuts.”

In mid-April, West Virginia lawmakers voted to approve a state budget for fiscal year 2026. It did not include any direct funding for quick response teams or crisis intervention team programs. 

“I’m a Republican. I’m a very fiscally conservative person. But I can tell you that if you don’t figure out a way to put it in, you’re going to lose tax revenue anyway,” Puckett said.

West Virginia Public Broadcasting is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center and newsrooms in select states across the country.