PM Magazine, May 2025: Mental Health

MENTAL HEALTH

Emily Lewis

Deputy County Administrator

Charlotte County, Florida, USA

FEATURES

12

Revolutionizing Crisis Intervention

The urgent need for mobile crisis response teams in behavioral health emergencies.

Daniel R. Gerard

18

Leaders in Action: Mental Health Solutions in Local Government

Exploring effective strategies for addressing workplace burnout and promoting mental health.

Justin Battles, Mark Crawley, and Brenda Orchard

24

Breaking the Isolation Through the Power of Peer Support

How Compass Peer Groups is transforming leadership development in local government.

Matt Fulton and Craig Rapp

28

How Durham, North Carolina, Got Police Onboard with Unarmed Crisis Response

One of the most respected alternative response programs in the country, Durham sends unarmed mental health workers to 911 calls involving mental illness, addiction, and suicidal thoughts.

Ryan Levi 34

Reconnecting Physical Health to Mental Health

What the mental health discourse is often missing.

Michael Huling

38

Meeting the Drug Overdose Problem Where (and When) It’s At

A data-driven guide for local governments.

Kim Michelle Lersch, PhD 42

Strengthening Fiscal Resilience in Local Governments

Lessons from the COVID-19 pandemic.

Theodore Arapis, PhD & Vaswati Chatterjee, PhD

DEPARTMENTS

2 Executive Director’s Corner Empowering Communities with Tools for Tackling Incivility and Mental Health

4 Ethics Matter!

An ICMA Code of Ethics Retrospective of the Past 12 Years

8 Letter to the Editor Pioneering Earlier Aspirations for Women in Local Government Management

10 Assistants and Deputies Keeping Morale Afloat Amid Rising Public Hostility

46 Women in Leadership From Ambition to Achievement: Career Growth Tips for Women

48 Senior Advisors

Communication, Self-Care, and Relationship Building

50 Mental Health

How to Restore Hope in Uncertain Times

51 Professional Services Directory

International City/County Management Association 18

Empowering Communities with Tools for Tackling Incivility and Mental Health

The rise of incivility and the increasing concern about the state of mental health is top of mind for our members.

BY JULIA D. NOVAK, ICMA-CM

JULIA D. NOVAK, ICMA-CM, is CEO/executive director of ICMA.

I’ve often thought that government is at its best when it is behind the scenes—the water comes out of the tap and is clean and safe, the trash is picked up, emergency services respond, etc. One of the original “values” of reform that professional management touted was offering communities was stability. While policy changes happen at the federal level and “trickle down” to the state and then local level, your residents feel the impact first and they come to you. When the world is feeling uncertain, it raises anxiety, and that has an effect

International City/County Management Association

icma.org

May 2025

Public Management (PM) (USPS: 449-300) is published monthly by ICMA (the International City/County Management Association) at 777 North Capitol Street. N.E., Washington, D.C. 20002-4201. Periodicals postage paid at Washington, D.C., and at additional mailing offices. The opinions expressed in the magazine are those of the authors and do not necessarily reflect the views of ICMA.

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Creating and Supporting Thriving Communities

ICMA’s vision is to be the leading association of local government professionals dedicated to creating and supporting thriving communities throughout the world. It does this by working with its more than 13,000 members to identify and speed the adoption of leading local government practices and improve the lives of residents. ICMA offers membership, professional development programs, research, publications, data and information, technical assistance, and training to thousands of city, town, and county chief administrative officers, their staffs, and other organizations throughout the world.

Public Management (PM) aims to inspire innovation, inform decision making, connect leading-edge thinking to everyday challenges, and serve ICMA members and local governments in creating and sustaining thriving communities throughout the world.

on how people interact with one another. For you, it can mean that the tone of public meetings is increasingly toxic.

The rise of incivility and the increasing concern about the state of mental health in our country is top of mind for members. This month’s PM offers a number of resources, as well as practical solutions that your colleagues are working through in their organizations. On April 22, I participated in an important conversation,

“Addressing the Rise of Incivility: A Town Hall Event,” sponsored by ICMA, the National League of Cities, National

PRESIDENT

Tanya Ange*

County Administrator Washington County, Oregon

PRESIDENT-ELECT

Michael Land*

City Manager Coppell, Texas

PAST PRESIDENT

Lon Pluckhahn*

City Manager

Vancouver, Washington

VICE PRESIDENTS

International Region

Colin Beheydt

City Manager Bruges, Belgium

Doug Gilchrist

City Manager

Kelowna, British Columbia, Canada

Lungile Dlamini

Chief Executive Officer

Municipal Council of Manzini, Eswatini

Midwest Region

Michael Sable*

City Manager Maplewood, Minnesota

Jeffrey Weckbach

Township Administrator Colerain Township, Ohio

Cynthia Steinhauser*

Deputy City Administrator Rochester, Minnesota

Mountain Plains Region

Dave Slezickey*

City Manager The Village, Oklahoma

Pamela Davis

Assistant City Manager Boulder, Colorado

Sereniah Breland

City Manager Pflugerville, Texas

Northeast Region

Dennis Enslinger

Deputy City Manager Gaithersburg, Maryland

Steve Bartha*

Town Manager Danvers, Massachusetts

Brandon Ford

Assistant Township Manager

Lower Merion Township, Pennsylvania

Civic League, American Public Health Association, and American Psychological Association. C-SPAN decided to air it live (bit.ly/rise-ofincivility) and more than 1,300 people tuned in. That number reinforced for me that this is a topic of concern for many of you.

We know our members need tools and resources to deal with incivility and to navigate some of the mental health issues that may be underlying some of the incivility. We have been working with the National Civic League on a new training series to help you reimagine your community meetings. You can find more information and register for this program at bit.ly/BetterPublicMeetings or by scanning the QR code on this page.

We have also created a resource page on the topic of civility with some tools and ideas that came from the Town Hall event. You can find them at icma.org/topics/civility.

As you read this month’s articles, I hope you will identify some ways you can focus on the well-being of your own organization— and of course, that starts by taking care of yourself!

Southeast Region

Jorge Gonzalez*

Village Manager Village of Bal Harbour, Florida

Eric Stuckey

City Administrator Franklin, Tennessee

Chelsea Jackson

Deputy City Manager Douglasville, Georgia

West Coast Region

Jessi Bon

City Manager

Mercer Island, Washington

Nat Rojanasathira*

Assistant City Manager Monterey, California

Elisa Cox*

Assistant City Manager

Rancho Cucamonga, California

*ICMA-CM

** ICMA Credentialed Manager Candidate

ICMA CEO/ Julia D. Novak, ICMA-CM Executive Director

Managing Director, Lynne Scott lscott@icma.org

Brand Management, Marketing, and Outreach

Senior Managing Editor Kerry Hansen khansen@icma.org

Senior Editor Kathleen Karas kkaras@icma.org

Graphics Manager Delia Jones djones@icma.org

Design & Production picantecreative.com

An ICMA Code of Ethics Retrospective of the Past 12 Years

Membership votes on potential revisions to Tenets 8 and 10 of the Code of Ethics this month as this review cycle concludes.

BY JESSICA COWLES

As the membership votes by ballot this month on potential revisions to Tenet 8 (professional development) and Tenet 10 (job interference), we look back on how the ICMA’s Code of Ethics has evolved through the review effort with membership since 2013.

Twelve years ago, the ICMA Executive Board approved the plan put forth by the Committee on Professional Conduct (CPC) to engage the membership in a structured review of the Code to ensure its continued relevance for all working in service to a local government. The tenets express the values of the profession while the guidelines assist members in understanding their ethical obligations as outlined in the tenet.

COWLES is director of ethics at ICMA (jcowles@icma.org).

engagement is crucial in this effort so in-person and virtual meetings, as well as online surveys, provided feedback. The following is detailed information about the revisions:

ICMA’s Constitution requires members to vote by ballot to change the language of the tenets in the Code. As background, the board has the authority to revise guidelines to the tenets, and this usually occurs at the CPC’s recommendation.

Accomplishments in the Review Cycle

Through this defined process, membership reviewed Tenets 1, 2, 3, 4, 5, 6, 7, 9, 11, and 12, and/or their respective guidelines. Member

2013: The CPC launched the formal review process beginning with Tenet 7 expressing the profession’s ethical obligation to be politically neutral. Tenet 7 was first because based on 10-year trend data, political activity was the greatest source of member inquiries and ethics violations (excluding illegal activity). Based on feedback, the Board retained the existing language of Tenet 7 but modified the guidelines on elections of the governing body, running for office, elections, elections relating to the Form of Government, presentation of issues and added a new personal advocacy of issues guideline.

2014: In conversations with the membership, the overwhelming feedback was Tenet 12 on public trust used archaic language and seemed to present two disconnected principles. The old language “Seek no favor; believe that personal aggrandizement or profit secured by confidential information or by misuse of public time is dishonest” was replaced with “Public office is a public trust. A member shall not leverage his or her position for personal gain or benefit.” Of members voting, 94% approved this revised language.

JESSICA

2017: Tenet 3, last revised in 1976, is one of two tenets applicable to all ICMA members (the other is Tenet 1 on the values of professional local government management). In reviewing Tenet 3 with its commitment to honesty and integrity, the focus was to redraft the language to ensure relevancy to a membership that was substantially broader and more diverse than in 1976. The 1976 language was: “Be dedicated to the highest ideals of honor and integrity in all public and personal relationships in order that the member may merit the respect and confidence of the elected officials, or other officials and employees, and of the public.”

Of members voting, 94% approved revisions to Tenet 3: “Demonstrate by word and action the highest standards of ethical conduct and integrity in all public, professional, and personal relationships in order that the member may merit the trust and respect of the elected and appointed officials, employees, and the public.”

The commitment to integrity was retained and became more action oriented; a new guideline on personal relationships in the workplace was added; and the existing guideline under Tenet 12, which addressed personal relationships that create conflicts of interest, was expanded to further explain what constitutes a conflict of interest.

2018: Tenet 4 on the principle of public service was first added to the Code in 1952 as: “The city manager keeps the community informed on municipal affairs. He emphasizes friendly and courteous service to the public. He recognizes that the chief function of the local government at all times is to serve the best interests of all the people on a non-partisan basis.”

It was revised in 1972 to read, “Recognize that the chief function of local government at all times is to serve the best interests of all of the people.” Member feedback provided a consensus on simplifying the tenet language to “Serve the best interests of the people.” Of those who voted, 84% approved this amendment and shortly thereafter the Board adopted changes to the guidelines on inclusivity and diversity, as well as moved the length of service guideline to Tenet 3, since it related more to the professional commitment to integrity.

2019: Tenets 1 and 2 express the principles and commitment to professional management and democratic local government. They had not been substantively revised since their addition to the Code in 1969.

Tenet 1 language was “Be dedicated to the concepts of effective and democratic local government and believe that professional general management is essential to the achievement of this objective by responsible elected officials.” Tenet 2 language was “Affirm the dignity and worth of the services rendered by government and maintain a constructive, creative, and practical attitude toward urban problems and a deep sense of his social responsibility as a trusted public servant.”

Voting members adopted revisions (82% for Tenet 1 and 88% for Tenet 2) to maintain the original intent through the following streamlined language: Tenet 1. We believe professional management is essential to efficient and democratic local government by elected officials.

Tenet 2. Affirm the dignity and worth of local government services and maintain a deep sense of social responsibility as a trusted public servant.

Following membership approval of the tenet changes in mid-2020, the Board approved the revision to the Tenet 2 guideline on advice to officials of other local governments to explicitly state the reason for providing this notification to a colleague. It now states: “When members advise and respond to inquiries from elected or appointed officials of other local governments, they should inform the administrators of those communities in order to uphold local government professionalism.”

2020: Tenets 5 and 6 were last revised in 1972 and were reviewed together because they both addressed aspects of the policy recommendation and decisionmaking process and focused on a member’s role in implementing a governing body’s decisions.

Tenet 5 language was “Recognize that elected representatives of the people are entitled to the credit for the establishment of municipal policies, credit or blame for policy execution rests with the member.”

Tenet 6 language was “Make it his duty continually to improve his ability and his usefulness and to develop the competence of his associates in the use of management techniques.”

The changes included the addition of providing technical and professional advice about policy options to elected officials and made the language specific about the member’s role in collaborating with elected officials to set goals for the community and organization. Members voting approved the revisions (87% for Tenet 5 and 91% for Tenet 6) as follows:

Tenet 5. Submit policy proposals to elected officials; provide them with facts, and technical and professional advice about policy options; and collaborate with them in setting goals for the community and organization.

Tenet 6. Recognize that elected representatives are accountable to their community for the decisions they make; members are responsible for implementing those decisions.

Tenet 5’s conflicting roles guideline when serving in two roles was updated and moved to Tenet 3, where it is now aligned with the existing guidelines on conflicts of interest. The revision to Tenet 6 better reflected that the decisions elected officials make are not limited only to policy adoption, elected officials are accountable to the people for those decisions, and members remain responsible for implementing those decisions.

2023: At the board’s directive to ensure the Code reflects the profession’s longstanding values to advance the needs of all community members, Tenets 1, 4, 9, and 11 were reviewed together and amended, as well as their associated guidelines.

Tenet 1: The first principle of the Code establishes the commitment to

ICMA’s Constitution requires members to vote by ballot to change the language of the tenets in the Code of Ethics.

professional management and democratic local government. The National Academy of Public Administration and the American Society for Public Administration regard equity, effectiveness, and efficiency as the three pillars of public administration. Of the voting membership, 86% approved revising the existing language as: “We believe professional management is essential to effective, efficient, equitable, and democratic local government.”

Tenet 4: Of the voting membership, 85% approved a minor language revision to “Serve the best interests of all community members.” In the Tenet 4 guideline discussion, members recommended (1) broadening the consideration of effects or outcome of decisions on all community members and (2) serving the interests of the community requires assessing the impact of policies, programs, and services. The guidelines encourage members to be proactive in proposing solutions to eliminate disparities. Of the members who responded to the survey, 75% supported the addition of a new guideline to promote equity. The board approved the guidelines: Effects of Decisions. Members should inform the appropriate elected or appointed official(s) of a decision’s anticipated effects on community members.

Promote Equity. Members should ensure fairness and impartiality in accessing programs and services and in the enforcement of laws and regulations. Members should assess and propose solutions to strive to eliminate disparities.

Tenet 9: The principle of communications and community engagement had not been reviewed since it was adopted in 1972. That language read: “Keep the community informed on municipal affairs, emphasize friendly and courteous service to the public, and

recognize that the chief function of local government at all times is to serve the best interests of all the people.”

The revisions made the language consistent with current public engagement practices in local government. It also reinforced that constructive engagement is essential in supporting equity. The language retains the phrase “keep the community informed on local government affairs” to provide clarity on the ethical obligation to do so.

Of the voting membership, 84% approved revised language for Tenet 9: “Keep the community informed on local government affairs. Encourage and facilitate active engagement and constructive communication between community members and all local government officials.”

The actions encouraged in Tenet 4’s inclusion guideline were more central to engagement than to inclusion, so the title was updated and moved to Tenet 9. The objective of the new guideline was to encourage members to promote the public’s active engagement in governance. Of the members who responded to the survey, 86% supported this effort. The board approved revised language and moved it to Tenet 9: Engagement. Members should ensure community members can actively engage with their local government as well as eliminate barriers and support involvement of the community in the governance process.

Tenet 11: This principle focused on merit-based personnel decisions and remained largely unchanged since its adoption in 1938: “The city manager handles all matters of personnel on the basis of merit. Political, religious, and racial considerations carry no weight in appointments, salary increases, promotions, and discipline in the municipal service.”

Of the survey responses, 89% supported the proposal to emphasize the principles of fairness and impartiality in personnel and to remove the term “merit.” Eightysix percent of the membership voting approved revised language for Tenet 11: “Manage all personnel matters with fairness and impartiality.”

The initial feedback from members noted there were two distinct actions combined in the “equal opportunity” guideline. Therefore, the proposal outlined in the survey offered language for two guidelines. The CPC ultimately recommended deleting the guideline on non-discrimination, finding it to be repetitive of the principle outlined in the tenet. Of the survey respondents, 84% supported the changes to this guideline to ensure impartiality at all levels of the organization and the board approved revised language:

Diversity and Inclusion. It is the member’s responsibility to recruit, hire, promote, retain, train, and support a diverse workforce at all levels of the organization.

What’s Next?

The election ballot is open for membership to vote on potential revisions to Tenet 8 (professional development) and Tenet 10 (job interference) of the Code of Ethics in May concluding this review cycle. In 2024, ICMA facilitated in-person discussions at six state association meetings and ICMA’s two Local Government Reimagined Conferences, engaging with more than 600 members who provided comments and suggested revisions. ICMA offered a survey for those who could not attend those sessions; 128 responded and offered 602 written comments. The CPC drafted revised language and surveyed membership again in March.

Tenet 8: Current language: “Make it a duty continually to improve the member’s professional ability and to develop the competence of associates in the use of management techniques.”

The first statement of an emphasis on professional development appeared in the Code’s 1952 version, “The city manager considers it his duty continually to improve

his ability and his usefulness and to develop the competence of his associates in the use of management techniques.” That principle was restated three times with the last revision reflecting the current language in 1976. From 1969: “Make it his duty continually to improve his ability and his usefulness and to develop the competence of his associates in the use of management techniques.” From 1972: “Make it his duty continually to improve his ability and to develop the competence of his associates in the use of management techniques.” In 1995, two guidelines were added on selfassessment and professional development. Survey language: “Continually improve professional capabilities while fostering growth and development through ethical leadership and effective management practices.”

Of those voting, 647 members (83.48%) approved of the proposed changes. Written comments said the language should stress the importance of the ethical obligation members have to develop the capabilities of staff in the organization and others. Members had an appreciation of moving beyond technical competence to embrace ethical leadership and management practices, and said the revisions were improved, inclusive, and modernized.

The CPC then further refined the language to include that members have the obligation to support others in their professional development efforts: “Continually improve professional capabilities and those of others while fostering growth and development through ethical leadership and effective management practices.”

Tenet 10: Current language: “Resist any encroachment on professional responsibilities, believing the member should be free to carry out official policies without interference, and handle each problem without discrimination on the basis of principle and justice.”

The principle was first included in the Code’s 1938 version: “The city manager, in order to preserve his integrity as a professional administrator, resists any encroachment of his control of personnel, insists on the exercise of his own judgment in accomplishing council policies, and deals frankly with the council as a unit

rather than secretly with its individual members.” It has been amended over the years with the most recent version adopted in 1995.

From 1952: “The city manager, in order to preserve his integrity as a professional administrator, resists any encroachment on his responsibility for personnel, believes he should be free to carry out council policies without interference, and deals frankly with the council as a unit rather than with its individual members.” From 1969: “Resist any encroachment on his responsibilities, believing he should be free to carry out official policies without interference.” From 1972: “Resist any encroachment on his responsibilities, believing he should be free to carry out official policies without interference, and handle each problem without discrimination on the basis of principle and justice.” In 1995, a guideline was added on information sharing. Survey language: “Uphold and defend the integrity of the profession and the Council-Manager form of government by carrying out official duties, policies, and processes with a commitment to equitable public service.”

Of those voting, 483 members (62.32%) approved of the proposed changes. In the written comments there was an emphasis on the importance of supporting good governance and a member’s responsibility to carry out their duties to that end. Specifically, there were concerns that the language was not strong enough since members frequently use this with their governing bodies, that the use of the term “equitable,” and that naming the council-manager form is limiting, since not all members work in this form. Based on that feedback, the CPC further refined the language: “Oppose efforts to interfere with professional responsibilities by consistently executing official duties, policies, and processes with an unwavering commitment to unbiased public service.”

Respondents to the previous survey were given another opportunity to share their thoughts on the latest revisions where 70% approved of them. If membership approves the revised tenet language in the ballot open now, the board will consider changes to the tenet’s associated guidelines in summer 2025.

Pioneering Earlier Aspirations for Women in Local Government Management

A long-time ICMA member recalls the challenges for women in the profession in the 1960s.

The splendid March 2025 issue of Public Management introducing Julia Novak as the association’s CEO/executive director includes an important, well-informed article by her and Jan Perkins, “Fifty Years of Aspirations for Women in Public Administration.”

I would like to share a story that further demonstrates changed understandings since some 60+ years ago. In the early 1960s, Charldean Newell, who a few decades later became the author/editor of ICMA’s famous greenbook, The Effective Local Government Manager, was a student in the city management program at North Texas State University in Denton, near her hometown of Fort Worth. Blessed to be her professor, in hopes of arranging an internship for Charldean, I made an appointment with Perry Cookingham, whom I knew from his years in Kansas

BY CHESTER A. (CHET) NEWLAND

CHESTER A. (CHET)

NEWLAND, a long-time city manager and academic, has been an ICMA member since 1967 and an ICMA Honorary Member since 1980.

City, Missouri, before he became Fort Worth’s city manager. Perry was often referred to back then as the dean among professional city managers.

Following my explanation of Charldean Newell’s outstanding merits, Perry told me no, that his Fort Worth city council would not allow him to have a woman intern, thinking that “women have no place in city management and never will.”

Charldean Newell’s efforts then turned to admission to doctoral study at the University of Texas at Austin, although such graduate study was generally barred to women at the time. Charldean succeeded in overcoming barriers and completing her PhD with distinction. Dr. Newell then returned to the North Texas faculty, where she became a leading author, teacher, and advisor in the advancement of public administration broadly, especially including local government management and ICMA’s leadership of the field. She was instrumental in the development of various ICMA educational programs and the ICMA Voluntary Credentialing Program.

Fifty Years of Aspirations for Women in Public Administration

Inclusiveness of gender, racial, and social diversity became an aspiration for enlightened civilization in the 1960s. It broadened slowly via such exemplars as Charldean Newell and Jan Perkins, and now Julia Novak at ICMA. It is central to other aspirations in search for reasonableness and human dignity, broadly understood under Constitutional rule of law. While these values are endangered in today’s historically troubled times for responsible civic culture, politics, and professional public administration, ICMA continues to strengthen them.

Charldean Newell

Calendar of Events

Better Public Meetings Online Training Series

May 27–June 17

bit.ly/BetterPublicMeetings

Regain control and promote civility in your public meetings with this four-part workshop from the National Civic League and ICMA.

UPCOMING EVENTS

Who Moved My Government? Navigating Change in Public Administration

May 6 | Free webinar

The Modern Finance Office Is Built, Not Inherited: Your Blueprint for High-Performance

May 6 | Free webinar

How to Achieve Your Financial Goals through Student Debt Savings and Forgiveness

May 8 | Free webinar

Misinformation Management: Protecting Public Trust

May 8 | Free webinar

Managing Public Relations with your Elected Officials

May 13 | Webinar

Resilience Reimagined: Building Unbreakable Communities, Teams, and Organizations

May 14 | Webinar

2025 IIMC Annual Conference

May 18 | Conference

National Economic Mobility and Opportunity Conference

May 21–23 | Baltimore, Maryland | Registration is Free

New Approaches to Funding, Implementation, and Data Transparency for Building Modernization

May 22 | Free webinar

51st CAMA Conference and Annual General Meeting

May 26–28 | Global Event

Ethics 101

2025 NASPAA

Regional Conference

May 26–28 | Global Event

Better Public Meetings

May 27–June 17 | Online Training Series

Asking Fire and EMS Chiefs the Right Questions

May 28 | Webinar

A Budgeting Guide for Local Government 3-Part Series (Spring 2025)

May 29–June 12 | Online Training

The Inclusion Summit | CivicPride

June 4 | Virtual Event

ICMA Innovation Bootcamp

June 3–27 | Online Training

Enjoy a 25% discount through June 30! Use code ETHICS25. bit.ly/Ethics_101

Ensure your staff has a proper grounding in your organization’s values and can deal with ethical issues that arise on the job.

For a full listing of events and details, visit icma.org/events. Shop all courses at learning.icma.org.

Keeping Morale Afloat Amid Rising Public Hostility

How local government leaders can have grace under pressure

In the heart of every thriving community is a local government workforce committed to keeping the wheels turning—from public safety and sanitation to parks, planning, and community services. But in today’s increasingly polarized and impatient society, many local public servants are facing a disheartening trend: rising incivility from the very residents they serve. For deputy and assistant county or city managers, this new reality demands more than strategic planning and operational oversight. It requires emotional intelligence, innovative leadership, and a relentless commitment to uplifting employee morale—even when the community feels unappreciative or downright antagonistic.

The Challenge of Serving with a Smile

Across the country, reports of local government employees facing verbal abuse, threats, and social media harassment are on the rise. Front desk clerks, utility workers, code enforcement officers, and even librarians are increasingly bearing the brunt of resident frustration. While some of the

LEWIS

BY EMILY LEWIS

discontent may stem from pandemic-era service disruptions, economic pressures, or divisive national politics, its impacts are being felt acutely at the local level.

“Residents used to come in with questions. Now they come in with cameras, accusations, and demands,” said one longtime city hall receptionist.

This growing hostility erodes morale, contributes to burnout, and makes it harder for local governments to recruit and retain top talent. For deputy and assistant managers, the stakes are high: maintaining a resilient, engaged workforce in a toxic external climate is not just about staff well-being—it’s essential to organizational performance and public trust.

Walking the Line Between Empathy and Accountability

Deputy and assistant managers occupy a unique leadership space. While the county or city manager may be focused on high-level strategy and board relations, their deputies often work closest with department heads and frontline employees. This proximity makes them the first line of

EMILY

is deputy county administrator of the Charlotte County Board of County Commissioners of Charlotte County, Florida, USA.

defense against low morale and the primary architects of internal culture.

One of the most effective strategies these leaders employ is acknowledgment and validation. Employees want to feel seen, especially when dealing with rude or disrespectful behavior. A well-timed visit to a department under stress, a handwritten thank-you note, or a public recognition at a team meeting can reinforce that leadership sees their struggles and appreciates their effort.

But managing morale also means holding the line on service standards and professionalism. We can’t mirror the behavior we’re seeing from the public. Our credibility comes from staying calm, helpful, and solution-oriented—even when residents don’t.

A Charlotte County Success Story: Addressing Mental Health Proactively

In Charlotte County, Florida, we recognized that employee morale could not be addressed without a serious commitment to supporting the mental health of our almost 1,500 employees.

Faced with growing stress among our staff after the pandemic and multiple catastrophic hurricanes, our administration formed an internal mental health task force to investigate the sources of burnout, anxiety, and frustration among employees. This wasn’t a token committee—it was a cross-departmental effort involving HR, risk management, and employee representatives aimed at creating tangible, long-term solutions.

After a thorough internal review and listening sessions with staff, the task force delivered a set of actionable recommendations. Among the most impactful changes were:

• Bringing in dedicated mental health providers for county staff, ensuring timely and confidential access to counseling.

• Expanding employee assistance program (EAP) offerings with a focus on traumainformed care and ongoing mental health education.

• Dedicated and intentional focus on mental health first aid training for staff and management teams.

In today’s increasingly polarized and impatient society, many local public servants are facing a disheartening trend: rising incivility from the very residents they serve.

in de-escalation training and customer service in crisis workshops for employees. These trainings, often led by former law enforcement or mental health professionals, equip staff with techniques to stay calm, set boundaries, and resolve conflicts without escalating tension.

As deputy and assistant managers oversee implementation of these programs, they’re sending a clear message: “We’re preparing you, supporting you, and standing with you.”

Fostering Pride and Purpose

• Launching wellness campaigns and workshops that addressed stress management, workplace resilience, and emotional regulation techniques.

• Establishing peer-support channels and employee wellness champions across departments.

These initiatives have already begun to shift the internal culture. Employees have reported feeling more supported, more heard, and better equipped to cope with difficult interactions and job stressors. It’s a clear demonstration that investing in people—not just policies—pays off.

Creating a Culture of Psychological Safety

Beyond individual recognition and programmatic solutions, leaders are fostering environments where employees feel safe expressing concerns without fear of retaliation. Regular “pulse checks,” town hall-style meetings, and anonymous feedback mechanisms help management stay attuned to emerging morale issues before they metastasize into larger problems.

Transparency also plays a critical role. When employees understand the “why” behind tough decisions—such as staffing shortages, budget cuts, or changes in service delivery—they are more likely to stay engaged. Assistant managers who openly communicate challenges, budget realities, and policy shifts can build trust even when news isn’t always positive.

Training for Tougher Times

Recognizing the shift in public behavior, many local governments are investing

At its core, morale is driven by a sense of purpose. Many local government employees are drawn to public service because they want to make a difference. Reinvigorating that sense of mission is a powerful antidote to external negativity.

Deputy and assistant managers are finding creative ways to reconnect staff with their community impact—through storytelling campaigns, behind-the-scenes videos, service spotlights, and employeeled community projects. When a solid waste team sees a thank-you video from a neighborhood, or when a permit technician is highlighted for helping a small business open its doors, the work becomes more than a task—it becomes a calling.

Leading by Example

Perhaps most importantly, deputy and assistant managers serve as emotional barometers for the organization. When they remain steady, empathetic, and missiondriven in the face of adversity, their teams are more likely to follow suit. Their willingness to engage directly with both the public and their staff, to listen deeply and act decisively, models the very values they seek to instill.

In a time when civility feels increasingly scarce, the role of local government leaders has never been more challenging—or more vital. For deputy and assistant managers across the globe, the mission is clear: protect the dignity of the workforce, foster resilience in the face of rising hostility, and remind every employee that their work matters.

Charlotte County’s approach shows that real change is possible. With intention, empathy, and action, local governments can create a workplace where employees not only survive but thrive—no matter how turbulent the outside world becomes.

REVOLUTIONIZING CRISIS INTERVENTION

The

urgent need

for mobile crisis response teams in behavioral health emergencies

BY DANIEL R. GERARD

“No man is an island entire of itself; every man is a piece of the continent, a part of the main; if a clod be washed away by the sea, Europe is the less… any man’s death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls; it tolls for thee.”

—Meditation XVII, Devotions upon Emergent Occasions, John Donne

The definition of a behavioral health crisis is “the experience of stress, emotional or behavioral symptoms, difficulties with substance use, or a traumatic event that compromises or has the ability to negatively impact an individual’s ability to function within their current family or caregiver environment, living situation, school, workplace, or community, as defined by the individual experiencing the crisis or by a parent, caregiver, guardian, or designee of the individual as appropriate.”1

The need for mobile crisis response teams in the United States has become increasingly apparent. Highprofile incidents across the United States underscore the inadequacy of traditional law enforcement responses to behavioral health crises. Such crises often involve disruptions in mental or emotional stability requiring immediate intervention to prevent severe health deterioration. In the United States, the numbers are staggering:

1. One in five adults experiences a mental illness during their lifetime.

2. Over 12 million people have serious thoughts of suicide annually.

3. Nearly a quarter of those shot by police from 2015 to 2020 had a mental health condition.

4. Two million individuals with serious mental illnesses are incarcerated annually. These figures highlight the urgent need for communitybased mobile crisis response teams that address behavioral health emergencies without relying solely on police intervention. Behavioral health incidents are complex scenarios that require a multi-disciplinary approach in order to achieve a measure of resolution.

Traditional singleagency approaches, such as law enforcement or EMS responding alone, may not fully address the complexities of behavioral health crises, often leading to unnecessary hospitalizations, incarceration, or escalation.

A multi-disciplinary mobile crisis response— incorporating behavioral health practitioners, paramedics or EMTs, peer support specialists, and social workers—ensures a more comprehensive approach that prioritizes de-escalation, medical assessment, and

Government health spending on mental health remains below 2% globally, leaving many communities unprepared to handle the growing demand for services.

to say that law enforcement does not have a role in these types of responses, but what that role embodies needs to be carefully considered.

The immediacy surrounding the need for mobile crisis response teams has been exacerbated by the COVID-19 pandemic, amplifying global mental health challenges. The World Health Organization reports a 13% rise in mental health conditions and substance use disorders over the last decade, with depression now one of the leading causes of disability. Despite these statistics, government health spending on mental health remains below 2% globally, leaving many communities unprepared to handle the growing demand for services.

connection to appropriate resources. By integrating expertise from different fields, these teams can reduce the risk of injury, improve patient outcomes, and divert individuals from the criminal justice system or emergency departments when more appropriate communitybased care is available. This collaborative model enhances situational awareness, ensures trauma-informed care, and builds public trust in crisis response systems. This is not

Community Resources and Challenges

A needs assessment is a fundamental tool for public health. Successful programs begin with a community needs assessment to identify gaps in behavioral health resources. A community needs assessment for a crisis mobile response team is a systematic evaluation designed to identify the specific behavioral health needs and service gaps within a particular community. This

assessment should evaluate existing support, such as law enforcement, emergency departments, and outpatient services, while considering new approaches like telehealth for rural or underserved areas.

Determining the appropriate structure for mobile crisis response services requires careful consideration of community size, population demographics, and available local resources. Larger urban areas (urbanized areas with a population of 50,000 or more or urban clusters with at least 2,500 but fewer than 50,000 people) may have the capacity to establish comprehensive, multidisciplinary teams that operate 24/7, integrating behavioral health practitioners, medical personnel, and social workers.

In contrast, smaller or rural communities (where rural areas comprise open country and settlements with fewer than 2,000 housing units and 5,000 residents) might face challenges such as limited funding and workforce shortages, making it more practical to implement alternative models like telehealth services or contracted mobile crisis units.

For instance, the Medi-Cal Mobile Crisis Services Benefit in California emphasizes rapid, community-based interventions tailored to the specific needs and resources of each locality, highlighting the importance of flexibility in service design.

By aligning crisis response models with community size and leveraging available resources, whether through in-person teams or telehealth solutions, municipalities can enhance the quality and accessibility of mental health crisis care.

This assessment gathers data from diverse stakeholders, including residents, healthcare providers, law enforcement, and community organizations, to understand the challenges faced during mental health crises. Key focus areas include:

• Identifying high-risk populations.

• Types of crises most frequently encountered.

• Barriers to accessing care.

• Preferences for culturally appropriate, timely, and effective interventions.

• How many people have a substance use/addiction problem that needs to be addressed.

The findings inform the development and deployment of tailored services, such as crisis de-escalation, immediate mental health support, linkage to ongoing care, and addressing social determinants

of health to ensure equitable access to comprehensive care. The mobile crisis response team is designed to not only get the care to a client that they need in the moment, but also to connect them with continued care beyond what the mobile crisis response team provides to hopefully prevent further incidents.

Mobile crisis teams often include diverse professionals: emergency medical technicians (EMTs), paramedics, licensed clinical social workers (LCSWs), and behavioral health technicians. These teams must be equipped to provide immediate, compassionate care, often spending two to six hours per response. Staffing models vary, with some communities favoring co-responder models that include law enforcement as part of the initial response or only when necessary.

Deciding the Best Path Forward

Any governmental entity must conduct a needs assessment, taking into consideration what services you need to provide and respond to in your community. What are you currently doing, what should you be doing, what does the population you want to provide care for look like?

You need to take a deep dive into what you have in place. Who is already providing this care and response in the community? What role does law enforcement provide in these types of responses? Who are the hospitals, psychiatric receiving facilities, and outpatient behavioral health services who would care for these clients from the field? What educational programs for social workers exist in your community or

region? Do you have a 9-8-8 system in place or do these calls normally go through your 9-1-1 system? Is there an opportunity to partner with other communities to provide this response?

Once you answer these questions and you have your list, you will essentially have the stakeholders who will help devise your system of care. The police will always be part of any plan you devise, whether or not they are part of the crisis mobile team. Is your 9-8-8 service going to be part of your 9-1-1 center, a government entity or are you going to contract that out to a private concern? If you contract it out how will 9-8-8 interface with 9-1-1?

What is your team going to look like? Will paramedics from the EMS side of the house be working with

social workers? Do the social workers work for your city or will they be a contracted service? If you lack social services in your community, will a telehealth option work for your response team to access when they arrive on scene? Are the paramedics coming from a third-service EMS agency, the fire department, or a contracted ambulance provider for your community? Will you use a behavioral health or psychiatric technician as part of your team? Is there a community not-for-profit organization looking to operate in this space and develop your team? Will you contract out the entire response team all together?

In reality, depending on the number of requests for care you currently receive, contracting out for service may be the best logical progression or providing service in conjunction with other communities in a joint partnership as a better solution. You may have one community that has the ability to provide 9-8-8 service, while two other communities have the capabilities and capacities to field a multi-disciplinary team of paramedics, social workers, and if inclined law enforcement for 3 or 4 different towns.

Training and Education

Current EMS and law enforcement training programs are inadequate for behavioral health emergencies. EMTs typically receive only 2-4 hours of classroom instruction for caring for a patient with a behavioral health outburst or mental health emergency, while law enforcement training often

Comprehensive training is essential to equip responders with skills in de-escalation, patient assessment, and mental health stabilization.

in the past may require law enforcement assistance for a burglary or a car accident. These instances are stressful for anyone, but the law enforcement response and encounter with someone with a mental health diagnosis may either be routine or catastrophic, depending on the training of police officers.

lacks clinical interaction. Comprehensive training is essential to equip responders with skills in de-escalation, patient assessment, and mental health stabilization.

Training for law enforcement is important. If they are part of your team, the initial and ongoing training is essential to service delivery success. If they are going to provide support for the team—for instance if an encounter turns violent and someone needs to be restrained—the training that they have will reduce the chances that an incident will have a poor outcome.

Some models of response have eschewed law enforcement participation for a multitude of reasons. While each community is different, law enforcement still needs a robust training component. Think about it like this: someone with a mental health diagnosis or a history of behavioral outbursts

Ongoing education and joint training across disciplines can help bridge the gap between EMS, law enforcement, and behavioral health professionals, ensuring coordinated, effective responses. It will greatly reduce the likelihood of a disastrous outcome. Can you leverage current providers in your community to help devise training outlines and curriculums? Is there a school of social work at the community college or university level that you may use in this endeavor?

Building a System of Care

Systems of care improve the quality of care and reduce death and disability associated with clients who are experiencing a mental health crisis or a behavioral outburst. A robust crisis care system must include:

1. 24/7 regional crisis call centers (e.g., 9-8-8) for real-time support.

2. Mobile crisis teams staffed to respond immediately.

3. Crisis receiving and stabilization centers for short-term care and referrals.

4. Inpatient and outpatient behavioral/mental health services to provide long-term support. How these components are provided in any community

is strictly dependent on the stakeholders available to participate in the system. For instance, your mobile crisis team may utilize a licensed clinical social worker, but they may be only available via a telehealth option once the unit is on scene. Your crisis receiving center and your outpatient

Key Terms

behavioral health service may be at the same facility or it may be in different facilities in different towns.

There are some communities that do not have a facility that is a standalone psychiatric emergency receiving facility. Transporting these patients to a local emergency department is

Patient or Client: An individual needing care, as determined by caregivers, public safety agencies, or direct self-reporting. This person may be categorized as a patient—someone with a medical problem that may appear as a mental health issue, or a client— a person experiencing a mental health crisis or behavioral health outburst.

Mobile Crisis Teams: Mobile crisis teams have the capability to reach any person in the service area in his or her home, workplace, or any other community-based location of the individual in crisis in a timely manner. They are designed to assess and address a wide range of needs. Clients/patients may require immediate transport for a medical and/ or psychiatric evaluation; others might need food, shelter, or medication, basic necessities that can prevent escalation into full-blown crises. Some may require referral and follow up with a behavioral health specialist for continued care after de-escalation and assessment.

Mental Health Crisis: A significant disruption in a person’s thoughts, feelings, or behaviors, leading to an inability to cope with everyday life or an increased risk of harm to oneself or others. Such crises may stem from acute or chronic mental health conditions, substance use disorders, or situational stressors, and require urgent outpatient or hospital treatment.

Behavioral Outburst: A behavioral outburst is defined as a sudden and intense reaction characterized by impulsive or disruptive actions that are often situational and may not indicate an underlying mental health disorder. These outbursts can occur due to frustration, anger, or environmental triggers and are typically short-lived. Typically, they do not result in hospitalization, but will necessitate de-escalation, a safety plan, and may require same-day or next-day follow-up with a mental health professional.

the only option, but they need to be part of the planning since they may lack the resources to be the dedicated center for care. Some individuals may present in crisis but actually have a metabolic or endocrine disorder that makes this a medical response requiring medical screening. What is the process and how will this be carried out needs to be identified and understood by all stakeholders. Meetings need to occur not only with the people in charge of the emergency department and your psychiatric receiving center (if one exists), but hospital leadership needs to be part of the conversation as well. These services require a considerable amount of commitment from your hospital and they need to be on board.

Key operational components include seamless communication between 9-1-1 and 9-8-8 systems, dedicated resources for mobile teams, and comprehensive safety planning for patients. Communities must also establish clear protocols for data collection and quality assurance to measure program effectiveness.

Basic measures of effectiveness include:

• The number of requests managed by your department.

• Whether the number of requests are increasing or decreasing (both of which can be viewed through a prism of success).

• The number of repeat clients versus unique events or new clients.

• Client access of services/referrals. (This would require outside stakeholder feedback.)

• Client and stakeholder satisfaction surveys.

Conclusion

Mobile crisis response teams are essential for bridging the gaps in behavioral healthcare. By investing in resources, training, and a coordinated system of care, local governments can reduce unnecessary incarcerations, prevent tragic outcomes, and ensure that individuals in crisis receive timely, ompassionate support.

ENDNOTE

1 Substance Abuse and Mental Health Services Administration. (2025). National behavioral health crisis care: Model behavioral health crisis services definitions. U.S. Department of Health & Human Services. Retrieved February 3, 2025, from (https://www.samhsa.gov/mental-health/ national-behavioral-health-crisis-care) REFERENCES

1. Medi-Cal Mobile Crisis Services Benefit, https://www.dhcs.ca.gov/Documents/ Mobile-Crisis-FAQ.pdf

2. National Association on Mental Illness, https://www.nami.org/about-mentalillness/mental-health-by-the-numbers/ 3. Oregon Laws 2021 Chap. 628, https:// www.oregonlegislature.gov/bills_laws/ lawsstatutes/2021orlaw0628.pdf

4. Washington Post Fatal Force Database, https://www.washingtonpost.com/ graphics/investigations/police-shootingsdatabase/

5. SAMHSA. National Guidelines for Behavioral Health Crisis Care Best Practice Toolkit, https://www.samhsa.gov/sites/ default/files/national-guidelines-forbehavioral-health-crisis-care-02242020.pdf

6. United States Census Bureau, https:// www.census.gov/newsroom/blogs/ random-samplings/2022/12/redefiningurban-areas-following-2020-census.html

7. United States Census Bureau, https:// www.census.gov/programs-surveys/ geography/guidance/geo-areas/ urban-rural.html

DANIEL R. GERARD, MS, RN, NRP, is a paramedic and registered nurse with over 40 years of experience, and the EMS coordinator for a Northern California fire department. He is currently a fellow at the Christian Regenhard Cener for Emergency Response Studies at John Jay College of Criminal Justice and the past president of the International Association of EMS Chiefs.

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We advance our communities by promoting equity in the workplace, actively supporting our local neighborhoods, and contributing to a sustainable environment. Learn more about our commitment to service at www.missionsq.org/service.

We’re proud to partner with you in strengthening our communities.

Leaders in Action: Mental Health Solutions in Local Government

Exploring effective strategies for addressing workplace burnout and promoting mental health.

This special section of our May 2025 mental health issue of PM Magazine takes a deep dive into mental health as it relates to workplace burnout and other potential work-related stressors. Review three cases from three local government professionals across the world as they uncover what has worked for them and their organizations in recognizing and combatting workplace burnout, and how they are prioritizing mental health throughout their organizations and communities.

Justin Battles Assistant City Manager Mustang, Oklahoma, USA

For Justin Battles, assistant city manager of Mustang, Oklahoma, USA, he addresses workplace burnout by prioritizing work-life balance, encouraging boundary setting in the workplace, fostering an environment of open communication, and providing access to mental health resources.

A key way that Battles has helped connect his community with mental health services is through partnering with Cope Notes, which provides daily mental health support to subscribers through SMS messages. Read more about the city of Mustang’s partnership with Cope Notes in the box on the following page.

Combatting Workplace Burnout

Over my career, I have learned to take advantage of restorative times, finding places that allow me to recharge. Dr. Brian Little of Harvard University calls this a restorative niche. Outdoor recreation and my family provide this in my life. Being fully present during these times is critical to renewing my energy and passion for public service. Setting realistic goals and expectations and learning to say

“no” when necessary, allows balance. Additionally, seeking support from colleagues or mental health professionals provides a valuable outlet for expressing concerns and seeking guidance. Being my best self allows me to serve the public and my organization in the best way possible.

Prioritization of Mental Health for Employees, Colleagues, and Community

I prioritize mental health by advocating for a workplace culture that values work-life balance and employee well-being. This includes promoting open communication, support networks, and access to mental health and wellness resources. Creating a supportive and inclusive environment can foster a sense of belonging and community among employees, reducing feelings of burnout.

Local government is vital in bridging the gap between mental health services and our community. Public entities may not provide all services, but working with local nonprofit, religious, or wellness groups can connect residents with the necessary services. Meeting with these groups regularly allows for a more seamless transition when recommending services and resources to the public. Easy access to these services is critical to having successful programs.

The Power of Cope Notes

The city of Mustang continually seeks ways to support mental health and overall well-being among its employees. Understanding that mental health plays a crucial role in an individual’s success and happiness, the city has implemented various initiatives to support and uplift its workforce. One of those programs that has seen success is the utilization of Cope Notes. Leadership was looking for something that would impact staff daily and we found that in Cope Notes. Cope Notes is a text-based mental health support system that sends positive and inspirational messages to individuals’ phones daily. They began by educating staff on the importance of mental health and the benefits of utilizing Cope Notes. Staff members were encouraged to sign up for the program, and individualized support was provided throughout the process. When Mustang launched the initiative in 2022, only 41% of full-time employees signed up. Today, 69% use the program.

The success of Cope Notes for city staff has been evident in its positive effect on their mental health. Staff members have reported enjoying the positive daily messages and have noted an improvement in openly discussing their overall well-being. The daily messages have helped to boost morale and create a more positive work environment. Often, staff can be overheard sharing with others the messages they received through Cope Notes and the impact it has on them.

Finding mental health solutions that transform the daily grind of working in local government and providing employees with support allows them to flourish. Encouraging, thought-provoking text messages help staff reframe stress, reset their mindset, and build emotional resilience, making it easier to navigate high-pressure situations and maintain patience and positivity when interacting with the public. Proactively supporting mental well-being can empower employees to show up as their best selves, even on the toughest days.

Learn more by viewing his ICMA Member Spotlight at youtube.com/watch?v=N9ifNiGiSlw

Key Lessons Learned

I have learned that work-life balance must be a priority. To be the best version of myself, I must ensure that I maintain my well-being. Public service can be a thankless job, but I know my “why.” It is a passion for serving the public and leaving a bright future for those who inherit it. Everyone’s journey may differ, and it is crucial to learn what works best for them. Ultimately, it is about presenting our best self to those we serve.

Mark Crawley

Retired Chief Executive Officer Carpentaria Shire Council, Queensland, Australia

Mark Crawley and other local leaders in Queensland, Australia, needed to take extra care and consideration of mental health in the workplace, considering Queensland’s implementation of a code of practice in 2022 dedicated to managing the risks of psychological hazards at work. With this extra layer of obligation to protect the mental health and well-being of their employees, Crawley took a deep dive into what psychological hazards were present within his organization and used that as the catalyst to create more meaningful organization-wide change to protect the psychological safety of his employees. Through establishing a realistic and effective system around taking personal time off, partnering with an Australian-based mental health brand to create a conversation-starting line of uniforms for his employees, designating specially trained Mental Health First Aiders throughout staff, and more, Crawley offers a unique approach to addressing workplace burnout and overall employee well-being.

Codification of Mental Health and Well-being

Prioritization in Queensland, Australia

Mental health has become as important, if not slightly more important, than our own physical health and well-being now in the workplace. As leaders of our organizations, we are now charged with

City Hall in Mustang, Oklahoma, USA

the additional responsibility to consider and look after the mental health and well-being of our employees, and ourselves.

In Queensland, Australia, the government issued a code of practice titled “Managing the Risks of Psychosocial Hazards at Work” with an effective date of April 1, 2023. Additionally, Safe Work Australia released a similar code of practice, and both are approved code under current legislation.

Under the Queensland Code, a psychosocial hazard is defined as a hazard that arises from, or relates to, the design or management of work, a work environment, plant at a workplace, or workplace interactions and behaviors and may cause psychological harm, whether or not the hazard may also cause physical harm. In severe cases, exposure to psychosocial hazards can lead to death by suicide.

Psychosocial hazards can create harm through a worker’s experience of a frequent, prolonged, and/or severe stress response, where stress is defined as a person’s psychological response (e.g. anxiety, tension) and physiological response (e.g. release of stress

hormones, cardiovascular response) to work demands or threats. Workers are likely to be exposed to a combination of psychosocial hazards; some hazards may always be present, while others only occasionally. Common psychosocial hazards that arise from, or are related to, work may include:

• High and/or low job demands.

• Low job control.

• Poor support.

• Low role clarity.

• Poor organizational change management.

• Low reward and recognition.

• Poor organizational justice.

• Poor workplace relationships including interpersonal conflict.

• Remote or isolated work.

• Poor environmental conditions.

• Traumatic events.

• Violence and aggression.

• Bullying.

• Harassment including sexual harassment.

We identified that some of these were present in our organization when reviewing the staff surveys from previous years provided by our employees. This was the catalyst for further effort in relation to managing the mental health and well-being of our staff, as well as their physical health and well-being.

Combatting Workplace Burnout

Following the 2008 Queensland council amalgamations, we were going through a major change management process bringing three separate councils together at Isaac Regional Council. During that time as the chief executive officer of the newly amalgamated council and having identified that I needed to be looking after myself and take a break from work, I implemented a process where I could take a two-week holiday every six months to ensure I was away from the office and the demands on my time, allowing for a mind clear and a body destress.

We arranged for a relief/acting CEO for the two-week period, and at the handover they were provided with the CEO’s mobile phone, CEO’s laptop, keys to the CEO’s car and residence, and

Staff members of Carpentaria Shire, Queensland, Australia

we left for a break away from the pressures of work. This worked extremely well, and I was able to relax and enjoy the time away with family. I knew the organization was in good hands, and after letting others know what had been implemented, some other colleagues decided to give it a try.

Prioritization of Mental Health for Employees, Colleagues, and Community

At the time of the introduction of the Code of Practice in 2023, I was working as the Carpentaria Shire Council CEO, and decided it was time to put serious effort into prioritizing employee mental health and well-being. Some of the feedback from staff surveys had touched on the psychosocial hazards listed in the code of practice. So we set about ensuring we had the appropriate HR policies and procedures in place, and these were reviewed by HR lawyers to ensure they were appropriate for the new legislation and the health and well-being of our staff.

We also partnered with TradeMutt, a local company, to develop new staff uniforms around the brand’s mental health initiative. which centers around conversation-starting funky shirts. To learn more, a previous PM article from May 2024 outlines this initiative in greater detail.1

We also selected several senior executives, managers, and others from various departments to undertake a mental health first aid course and become accredited “mental health first aiders.” They all agreed to take on this additional responsibility for the benefit of the organization, and to a certain extent for family, friends, and the community.

Councils across the state have implemented some great programs for the health and well-being of their staff, from barbecues and sausage sizzles on Mental Health Day and other initiatives during Mental Health Month. I was recently at the McKinlay Shire Council and the mayor mentioned that the council had recently provided free gym and pool membership for all staff, and there are similar initiatives popping up across Australia.

Local government is such a great place to work and develop a career, the councils often have their employees’ health and wellbeing front of mind and in general are working to be employers of choice, not just to stand out, but to offer an environment where you can really enjoy a career as a public servant.

Brenda Orchard Chief Administrative Officer Lennox and Addington County, Napanee, Ontario, Canada

Brenda Orchard, chief administrative officer, Lennox and Addington County, Napanee, Ontario, Canada, has engaged in a multi-pronged approach to combatting workplace burnout

and prioritizing mental health in her organization. Through a combination of work/life balance prioritization, peer support initiatives, trainings and programs that both directly and indirectly support mental health, and more, Orchard is tackling workplace burnout and enhancing the mental health of her organization through various angles. Orchard also takes a deep dive on the role of social media incivility as it relates to the mental health of her employees, and how her organization has worked to address this issue and support employees through social media difficulties.

Combatting Workplace Burnout and Supporting Employee Engagement

Work/Life Balance: Whether it’s through flexible hours, telework, job sharing, or a reduced work schedule, we are committed to finding solutions that accommodate the diverse needs of our staff while ensuring the operational needs of the county are met. This approach reflects our belief in the value of a supportive, adaptable work environment that prioritizes the well-being of our employees, understanding that optimal work conditions vary among individuals and tasks.

Health and Wellness Activities: Our active and engaged Employee Health and Wellness Committee takes the lead in organizing a variety of events and initiatives designed not only for our staff but their families as well. The approach is threefold: we aim to raise awareness about health and wellness and the resources available, create a supportive environment that promotes health and wellness programs for our employees and their families, and offer opportunities to cultivate and maintain healthier lifestyles. Popular events, such as baseball each month in the summer, golf tournaments, family pumpkin carving, chili cook-offs, and step challenges, are just a few examples of how we bring our commitment to life, fostering a community that values well-being.

Peer Support: Lennox and Addington proudly support our employees through challenging times with a specialized team of staff from various departments trained to offer peer-based individual and/or group support. This initiative is designed to assist employees who may encounter work-related trauma, professional crises, or stressful events in either their work or personal lives. Ensuring confidentiality and timeliness, this program reflects our commitment to the mental and emotional well-being of our staff. It was launched with a campaign titled, “It’s OK To Not Be OK.”

Employee Assistance Program: We prioritize the wellbeing of our employees and their families through a valuable partnership with FSEAP, our dedicated ally in workplace health. FSEAP grants our staff and their family members complimentary access to professional and confidential counseling, coaching, and consulting services and monthly workshops open to all staff. These resources are designed to support individuals in managing personal, family, or work-related challenges, enhancing their resilience and overall well-being.

Working Minds Mental Health Training: We are proud to highlight our investment in mental health through the Working Minds program, with two staff members certified as trainers by the Mental Health Commission of Canada. This initiative is pivotal in

shaping a workplace culture that supports mental health awareness and assistance for both employees and managers. The program services to reduce stigma and discrimination, and provide strategies to build a more resilient workplace.

Prioritization of Mental Health for Employees, Colleagues, and Community

I think that when it comes to supporting my staff’s mental well-being, actions speak louder than words. When people are vulnerable, they need to see a tangible sign that you care. That is what we strive to do with the programs I’ve mentioned. It can also be demonstrated in individual ways.

Two years ago, someone very close to me had a serious episode of depression following a medication change. I have never felt so helpless and worried. There was nothing I could do to make a difference. At work, I have a staff person who had previously selfidentified as having anxiety and depression challenges. I saw her in my building and invited her to come to my office. I briefly explained what was happening with the person close to me who was suffering from depression, and told her, “I can’t help my person, but I can help you. I know that your anxiety might sometimes torment you with thoughts of inadequacy or fear for your job. I want you to know that you are great at your job. We value you and appreciate you. And we have your back. If you need support or someone to talk to, you can talk to me. I understand.” Well, she cried, I cried, and we hugged. Compassion and understanding are not just words; they have to become actions.

With regard to our community, counties in Ontario are responsible for social service delivery, which includes welfare payments, childcare funding, and social housing /homelessness. We also operate 911 and community paramedicine. Staff in both of these departments actively support our most vulnerable residents on a daily basis. Mental health challenges are often a root cause of many health and housing issues in our community. On the

proactive side, our staff participates in community working groups aimed at supporting the most vulnerable residents directly as well as nonprofit organizations that do similar work.

Mental Health Impacts of Social Media Incivility

Incivility on social media is at the heart of much of the mental stress experienced by our council and staff. Keyboard warriors armed with misinformation and ill-will can confuse the public, detract from healthy debate, pivot discussions from important topics to trivial ones, stifle growth and community pride, and affect the mental health and well-being of the public, staff, and council. It is a serious concern that requires proactive and reactive strategies to protect our democratic processes and our people.

On the proactive side, our organization:

• Provides media/communications training to our elected officials. We urge elected officials to “take the cue, not the bait.” For example, if a local Facebook group repeatedly taunts a councilor or the municipality and puts out misinformation on a topic, we take the cue and note that perhaps we need to do a better job of communicating the facts on this particular issue on our own social media. We do not encourage the council or staff to take the bait and engage in an argument on the group’s social media platform. It only serves to confuse and detract from disseminating the facts. Moreover, it can put an elected official at risk of breaching a code of conduct if a heated conversation gets out of control. We encourage councilors to refer people to the municipality’s corporate sites.

• We limit the pages on our social media platforms that have comments enabled. We only allow comments for posts that are expressly looking for public feedback. For example, a terminated employee began trolling our job ad postings on Facebook and making comments about the employer. We now disable comments on such posts. This not only keeps the focus on our content, but it also protects the mental health of our staff who might be targeted by unwarranted comments.

• When we anticipate that an issue might be controversial, we proactively prepare speaking points for council so that they can quote facts and protect themselves from saying too much or something off-side.

• We purposely prepare social media content at a level that can be understood by a majority of residents. There is no benefit in talking over someone’s head.

On the reactive side, we:

• Try to be timely in our efforts to “take the cue” and respond on our social media with information and facts on a topic that has been picked up by trolls.

• Remind council that the loudest voice isn’t necessarily representative of the majority.

• We also look for signs of stress in our staff. The reality is that you may recognize it in someone before they see it in themselves. For example: A few years ago, one of my directors was being tormented by a former employee. The online bullying went well beyond anything we could have imagined, which included her photo and terrible, untrue accusations that she was doing illegal

Lennox and Addington County Courthouse, Napanee, Ontario, Canada

things and putting residents’ lives at risk. Along with HR and even our council, I provided support and encouragement, but I noticed that my director started wearing her hair differently (so she wouldn’t look like the picture that the bully was using online) and wouldn’t go shopping in town for fear of running into the bully. She became distracted and just not herself. The social media barrage from the bully went on for more than six months. We put a safety plan in place and paid for the director to get personal legal advice. It was distressing to learn that as municipal leaders our ability to protect ourselves through a defamation lawsuit is pretty much nonexistent, as the bully can assert that we are public figures. We also paid for crisis communications advice from a reputable firm. I contacted the police twice and eventually the bully was arrested, jailed overnight, and charged with criminal harassment. It took a number of months for the director to begin to feel like herself again. She is an amazing leader in our organization, and I am so proud of how the council stood by our staff with unwavering support. This director knows just how supportive her employer is, and it makes such a big difference in employee engagement, not only for this director, but also for the rest of our leadership team. We have each other’s backs in our organization.

While the stress of social media incivility is very much a negative, it is also an opportunity to circle the wagons and protect staff, showing them that their employer is committed to their well-being.

ICMA Mental Health Resources

In addition to the best practices used by these local government professionals, ICMA has curated helpful resources and content that is tailored to mental health as it applies to the local government space. Visit icma.org/topics/mental-health for more information.

ICMA’s Partner in Supporting Mental Health

If you’re looking for an impactful mental health tool that works and can be easily integrated into your organization or community as a whole, ICMA has partnered with Cope Notes to help ICMA members in creating affordable and convenient mental health support for their communities.

Cope Notes is an SMS service that delivers unique, handcrafted messages from mental health professionals that are proven to support, emphasize, and encourage recipients. This unique and helpful tool connects individuals with anonymous, easy-to-use support on a daily basis, prioritizing prevention by investing in resilience and positive health outcomes to curb crises before they arise.

To inquire about Cope Notes for your organization or community, visit icma.org/copenotes.

ENDNOTE

1 https://icma.org/articles/pm-magazine/mental-health-conversationstarter-remote-australia

Breaking the Isolation Through thePower of Peer Support

How Compass Peer Groups is transforming leadership development in local government.

BY MATT FULTON AND CRAIG RAPP

Who do you call when the going gets tough? How are you going to mentally and emotionally survive in this increasingly disruptive local government environment?

During my long city management career, I persevered mostly alone through the challenging times. That is, until the opportunity arose to join a small group of trusted friends and colleagues in an intentionally supportive environment where we could share our professional and personal stories and collaborate on expanding our leadership skills.

Over the past two years as ICMA Midwest regional director, I have been greatly impacted by the number of stories from local government leaders struggling to find joy in their work because of their political and disruptive climates. They are searching for meaningful and ongoing support to help navigate rough waters and

provide reaffirmation on the critical role they have as a leader in local government.

This article is intended to share information about the peer support group I found in Minnesota. It has continued to grow and is a very successful example of what can be achieved on this important topic. I sat down with Craig Rapp, co-founder of Compass Peer Groups, to discuss how this innovative organization is addressing the critical needs of local government leaders through facilitated peer support and professional development.

Matt Fulton: Craig, Compass Peer Groups has been operating for over a decade now. What prompted you and Dr. James Lynn to start this organization?

Craig Rapp: The genesis of Compass Peer Groups came from our collective experience in local government and organizational development. I spent years as a city manager and then as director of consulting for ICMA, while Jim brought his experience as a psychologist and organizational consultant who coached CEOs. We recognized a shared outlook on leadership, education, and supporting emotionally healthy executives.

suspected: leaders needed a space to connect with others who truly understand their world.

The peer group model has been in the corporate world for decades. Why do you think it took longer to establish in local government?

The catalyst was an ICMA member survey in 2007 that identified peer support and leadership development as the top two needs of local government leaders. Concurrently, I had been delivering an ICMA workshop, “Managing in Difficult Political Environments,” based on my experiences being fired and under duress in a city with a celebrity mayor. We had already been discussing the concept of local government peer groups. The survey and reactions to my workshop confirmed what we

My educated guess is that the corporate sector has long recognized the value/ROI of peer support and is willing (and able) to pay thousands of dollars annually to get it.

Local governments typically have greater budget constraints, a culture that sometimes values self-sufficiency over collaboration, and a lack of programs tailored to the unique challenges of public service. At Compass, our pricing is accessible while ensuring high-quality facilitation and content designed for local government leaders.

The question that inspired us was simple yet profound: “When

was the last time you admitted you were overwhelmed or shared a personal problem with your peers?” Local government executives face unique challenges—navigating political landscapes, managing public scrutiny, balancing community needs with limited resources—most often in isolation.

You and Dr. Lynn both have backgrounds in quality improvement methodologies. How has that influenced your approach?

Jim and I are Baldrige Quality and Lean Six Sigma proponents. In fact, we developed ICMA workshops on both subjects as far back as 20 years ago. This background

The most profound benefit of peer support groups is breaking the isolation that so many local government leaders experience. It may be cliché, but we truly believe it when we say, “It’s lonely at the top.”

shaped the structuring of Compass Peer Groups, and the focus of our early content. We operate on a simple model: forum, framework, and facilitation.

• Forum is the peer group itself.

• Framework provides structure for our discussions, covering essential leadership areas from governance and strategy to operations and personal development.

• Facilitation ensures conversations remain safe, productive, and focused. This systematic approach means we’re not just providing networking opportunities— we’re creating a comprehensive development experience that builds on itself over time.

Can you walk us through what the program looks like in practice? What exactly do members experience?

Absolutely. Our approach centers on monthly three-hour sessions. These sessions bring together 10 to 12 CAOs/senior executives in a confidential, structured environment facilitated by professionals with decades of local government experience.

Each session is divided into two parts: half the time is dedicated to facilitated peer support, where members discuss current challenges, share experiences, and provide mutual guidance. The remaining time focuses on professional development, exploring specific management concepts, best practices, or emerging trends relevant to local government leadership. One caveat is that we will dispense with the leadership topic and devote the entire session to support and member problem-solving if the need presents itself.

Beyond the monthly meetings, members are provided a private Microsoft Teams site to engage in secure messaging and chat with their peers. Our reference library contains professional development resources specific to local government, and members receive a Personality/Style Assessment and help developing personal growth plans.

Your organization has grown substantially since that first meeting in December 2011. Can you share some numbers that illustrate this growth?

We started with just two groups in 2011–2012, and today we serve 100 active members across multiple cohorts—61 city managers across six groups, 27 assistant city managers across three groups, and 12 in one department head group. Over our history, we’ve had 141 members participate and facilitated discussions on over 100 different leadership topics.

How do you determine what leadership topics to focus on in any given year?

Our topic selection reflects perennial leadership challenges and emerging issues. Looking at our calendar from 2016 through 2024, you’ll see we’ve addressed such topics as work-life balance, managing in difficult political environments, race equity, COVID-19 response, and polarized communities. The topics emerge from three sources: member input about their most pressing challenges, my assessment of emerging trends in local government, and feedback

from our annual retreats. The ability to be responsive to current issues while maintaining focus on leadership and personal growth principles is a strength of our model.

I understand that participation in Compass Peer Groups counts toward ICMA credentialing requirements. How did you structure the program to align with these professional standards?

We’ve deliberately structured our program to align with ICMA’s credentialing requirements, which means participation counts toward maintaining professional certification. This was important because we wanted to ensure that the time executives invest with us contributes to their professional development.

In your experience, what have been the most significant benefits for members of Compass Peer Groups?

The most profound benefit is breaking the isolation that so many local government leaders experience. It may be cliché, but we truly believe it when we say, “It’s lonely at the top.” This resonates deeply with our members.

We’ve seen CAOs struggling with burnout find new strategies and accountability through their peer group. Others have successfully navigated politically charged situations by workshopping approaches with colleagues who have faced similar challenges. And many have formed lasting professional relationships that extend well beyond our formal sessions.

One of the most powerful questions we ask is, “Where do you go for answers and support?” Before joining Compass, many CAOs had no good answer to that question. Now they do.

One final question: What would you say to a local government leader who’s on the fence about joining a peer group?

I go back to the previous question—“Where do you go for answers and support?”— but just as importantly I ask, “When was the last time you claimed your brilliance?”

Many public service leaders are so focused on solving problems that they rarely acknowledge their successes or leverage their strengths. What they receive through Compass is transformative: a confidential forum where they can admit challenges, share innovations, and receive honest feedback; structured professional development aligned with ICMA credentialing requirements; and perhaps most importantly, a group of peers who have “walked in their shoes” and understand the unique pressures of local government leadership.

In a profession where leadership decisions impact entire communities, the value of guided peer learning cannot be overstated. Our peer groups help leaders create more balanced, effective, and fulfilled lives while becoming better equipped to serve their communities.

MATT FULTON is ICMA Midwest regional director and a former city manager.

CRAIG RAPP is founder and president of Compass Peer Groups and the Rapp Consulting Group.

THANK YOU TO OUR STRATEGIC PARTNER

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ICMA is the leading organization for change makers, those committed to creating and sustaining thriving communities throughout the world — and seeking the right solutions to make it happen.

How Durham, North Carolina, Got Police Onboard with Unarmed Crisis Response

BY RYAN LEVI

One of the most respected alternative response programs in the country, Durham sends unarmed mental health workers to 911 calls involving mental illness, addiction, and suicidal thoughts.

Police in America shot and killed at least 2,053 people between 2015 and 2024 who were in the middle of a mental health crisis.1 That’s 20% of all killings by police in the last decade. Those numbers are helping to fuel a movement. Instead of sending armed police to most 911 calls, cities like Denver, Albuquerque, Houston, Louisville, and New York— more than 100 jurisdictions, all told—now send unarmed

mental health workers to respond to 911 calls that involve mental illness, addiction, or suicidal thoughts.2

As a reporter and producer for Tradeoffs, a national nonprofit news organization covering health policy, I spent more than a year reporting on these “alternative crisis response programs” to understand what early adopters have learned that may help other communities. We partnered with The Marshall Project, a

Ryan Levi/Tradeoffs

Angela Hollowell/Tradeoffs

nonprofit news organization covering criminal justice, to produce a three-part podcast series called The Fifth Branch.3 The series focused on one of the most respected programs in the country: Durham, North Carolina’s Community Safety Department4 and its Holistic Empathetic Assistance Response Team, known locally as HEART.

For decades, Durham had four branches of public safety—911, police, fire, and EMS. Ryan Smith, who was tapped to lead HEART in 2021, saw his job as creating a fifth branch.

“Your house is on fire, we send fire. You’re having cardiac arrest, we send EMS. There are shots fired, there is violent crime or criminal activity, we need to send law enforcement,” Smith said. “But people call 911 for a whole bunch of other reasons. And most of those reasons, because we haven’t had another branch to sort them into, have gone to law enforcement.”

Tradeoffs watched HEART in action as its teams of social workers, EMTs, and peer support specialists responded to 911 calls. And we talked

Protests led Wanda Page, Durham’s city manager at the time, to launch an independent review of her city’s 911 data, which found that violent crime represented less than 2% of all calls.

extensively with Durham city leaders, first responders, and program critics, as well as to the residents who had called HEART in a crisis.

Our reporting focused on some of the biggest questions that Durham—and any community interested in the alternative response approach—has to answer: How do you get buy-in to launch a new public safety branch?

Is an unarmed response safe? How big should a program like HEART be?

Birth of Durham’s Fifth Branch

Durham, like many cities, erupted in protests in the summer of 2020, after the police killings of George Floyd and others. These protests led Wanda Page, Durham’s city manager at the time, to launch an independent review of her city’s 911 data, which found that violent crime represented less than 2% of all calls. Trespassing, verbal disturbances, and mental health crisis calls made up much of the rest.

“That research let us know that the majority of the time when folks are calling 911 … it is just a neighbor or a resident that needs assistance,” Page said in a documentary about HEART’s early days.5

To respond to certain nonviolent calls, city leaders earmarked $2.8 million in June 2021 to create the Community Safety Department. “We still need policing to help protect our community. But it is unfair to expect them to address every single issue our residents experience,” Page

told residents shortly before the department launched.

The new HEART team spent six months researching “unarmed response,” an approach that dates back to the 1980s. Their counterparts in early adopter cities like Denver, Albuquerque, and San Francisco shared lessons learned and data proving this work could be done safely for people in crisis and for the people responding to those calls.

Smith presented the research to the city council in January 2022 and proposed a four-part program:

1. A mental health worker inside 911 who can resolve calls over the phone.

2. Unarmed teams of social workers, EMTs, and peer support specialists to respond to nonviolent calls that involve mental illness and homelessness.

3. Pairing a mental health worker and police officer for crisis calls that involve the threat of violence.

4. Teams that connect people to longer-term support after a crisis call.

Smith believes Durham’s model is the most comprehensive in the

Ryan Levi/Tradeoffs

nation. “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,” Smith said.

The city council greenlighted Smith’s proposal, giving him six months to build the city’s fifth branch of emergency response.

Resistance from Police Smith had a problem: Police officers felt attacked. Durham police sergeant Dan Leeder said many officers saw HEART as an outgrowth of the “defund the police” protests.

“Nothing is ever 100%, but it was darn close [in the police department] that this was a bad idea,” Leeder said. “There was a lot of trepidation about what this is going to mean for us, how this is going to affect what we’ve been doing for years.” Most of the officers’ concerns came down to fear: fear for their jobs, fear for residents, fear for the safety of the new responders.

Ryan Smith didn’t need police to like HEART. With backing from city manager Page and the city council, HEART was happening. But Smith believed that getting cops’ support would give his fledgling department its best chance of success. “The inability to get law enforcement buy-in can lead to programs like ours being much smaller than they need to be,” Smith said. Luckily, he had an important ally in Durham police chief Patrice Andrews. The city hired Andrews a few months after forming the Community Safety Department, in part, because of her support for alternative response. A quarter century as a cop—most of them in Durham—had given the new chief an intimate understanding of how difficult it can be for police officers to respond to

people with mental illness.

She remembers early in her career responding to a call from a woman who insisted someone had broken into her home. It quickly became clear after Andrews arrived on scene that there were no intruders.

“She’d point to a lamp and she’d say, ‘They’re behind the lamp.’ And so we’d go over there and say, ‘You can’t be here,’” Andrews said.

Andrews and her partner hoped humoring the woman, and being patient with her would mollify her concerns.

But the woman continued to call 911. “We kept saying, ‘You can’t call us anymore for this.

We’ve told the people to get out of your home, and they’re out. You can’t call us anymore. Don’t call us anymore.’”

The calls kept coming. “We didn’t know what to do. We didn’t have the professional knowledge on how to work with someone clearly going through a moment of crisis,” Andrews said. Eventually, Andrews and her partner arrested the woman for abuse of 911 and brought her to jail.

“It felt so wrong,” Andrews said of the arrest. “I knew right from

Police officers felt attacked. Most of the officers’ concerns came down to fear: fear for their jobs, fear for residents, fear for the safety of the new responders.

wrong, but I didn’t necessarily know how to change a system that had seemingly always done it the wrong way and had gotten away with it.”

To Andrews, HEART represented a way to change a system that too often failed people in the middle of a mental health crisis. Adding a new crisis response team, Andrews hoped, would also allow her officers to focus their efforts on what they did best— fight crime. “We can do both,” Andrews said. “We can have a

wonderful professional police department. We can also have amazing public safety partners in HEART.”

How to Convince the Cops

“We can do both” became a rallying cry for Andrews and Smith. From their very first meeting, the pair agreed that HEART should be presented as a complement to good police work. “We’re not replacing you,” Andrews told officers. “You still have work that you need to do as a law enforcement officer.”

Durham’s current city manager, Bo Ferguson, echoed those sentiments. “It was always critically important for me that this not be perceived as something that we were taking away from the police department,” said Ferguson, who directly oversaw HEART and the police department as the deputy city manager for public safety until taking over as city manager in early 2025.

Smith and his team met regularly with the police department. Andrews even invited Smith to answer patrol officers’ questions and address

Ryan Levi/Tradeoffs

their concerns. Smith, as he did with the city council, presented officers with data that unarmed response could be done safely.

Smith’s campaign to win hearts and minds extended to community activists and 911, where front-line call-takers also questioned whether unarmed mental health workers should respond to crisis calls. “Every single one of our calls touches 911,” Smith said. “If this is about sending the right response, we need [911 workers] to feel really confident.”

HEART formally launched on June 28, 2022. During those early days, skeptical officers would swoop in and respond to calls meant for HEART. Others would ignore orders and engage before social workers arrived.

Sgt. Dan Leeder listened on the police radio as the new teams fanned out across the city responding to homeless people panhandling, to potential suicides, and to parents past their breaking point. He expected to hear the social workers screaming for police support. He guessed wrong. “I’ll hear these calls come out, the HEART team responding to

help them do their own jobs better. HEART estimates their responders saved Durham police officers more than 5,500 hours in the program’s first two years, leaving the shorthanded department better able to respond to violent calls. Cops have even asked HEART to take over calls more than 450 times.

said they felt safe 99% of the time.6 Other cities report their responders can do this work safely, too.7,8,9

it, and the call’s been handled,” he said. “Whatever it is they’re doing, they’re doing it right.”

Police support for the program has grown, according to an independent study. Initially, just 37% of officers thought HEART would be helpful on mental health calls; that number had risen to 67% last year.

Andrews said officers have started to come around to the idea that HEART can

Seeing HEART’s work has transformed Sgt. Dan Leeder from a strident critic into one of the program’s biggest supporters. “When I’m wrong, I’m the first one to raise my hand and say, you know what? I was wrong,” Leeder said. “These people are going to help you. They’re going to make your job and your lives on this job easier.”

Unarmed Responders Feel Safe, Too

After every 911 call, HEART responders have to tell their bosses whether they felt safe. In nearly 25,000 calls answered as of March 24, 2025, HEART responders

This high rate is by design. Durham sends HEART to calls like trespassing, wellness checks, and intoxication, which city data show rarely end in violence for police. To mitigate the risks that exist with this work, HEART responds with a police officer to any call with a threat of violence. HEART also provides their responders with police radios to call for backup if necessary.

“Is there a level of risk in this job? There is,” said David Prater, one of the department’s unarmed responders. “Do I consider it an acceptable risk? I do.” Prater’s boss, Ryan Smith, said it’s important to acknowledge the risks involved in unarmed response, but adds that society has deemed those risks acceptable for firefighters and EMTs. As with the other branches of public safety, it’s worth putting HEART’s first

Angela Hollowell/Tradeoffs

Ryan Levi/Tradeoffs

responders in harm’s way, Smith argues, if that lowers the risk that someone in crisis is hurt by the police.

“I think that’s part of what being a public servant is,” Smith said. “I think government at its best is shifting burden and risk away from those that we serve to those who are signed up to be public servants.”

“Help Is on the Way.”

Yolanda is a 38-year-old Durham resident with depression, PTSD, and bipolar disorder. (We’ve agreed to not use Yolanda’s last name to protect her family’s privacy.)

She has called 911 many times when her two teenage daughters’ mental health issues have escalated into yelling, punching doors, and suicide threats. Yolanda said those phone calls are always a last resort.

“I fear[ed] that an officer was going to show up and be having a bad day and decide that today’s the day that I’m going to use my badge to be able to do whatever it is that I want to do, and nobody’s going to be able to do anything about it because I have a badge,” she said.

Since HEART launched, Yolanda feels much safer

calling 911. HEART units have responded several times, de-escalating the situation and offering Yolanda and her daughters coping tools to help them prevent future fights. “When you ask for the HEART team and they say help is on the way, to me that is the biggest sigh of relief that I could possibly take during an altercation,” Yolanda said.

In a 2023 survey of Durham residents, 57% said they were more likely to call 911 thanks to HEART.10 In the 2024 survey, more residents were satisfied with HEART than with any other public safety unit in the city.11

It’s unclear if physical safety has improved. Researchers in Durham and a handful of other cities are studying whether unarmed responses reduce arrests, police use of force, and involuntary hospitalizations.

Anecdotally, Chief Andrews believes that working with HEART has improved how her officers do their job—a sentiment shared by many officers we interviewed. Andrews recalls a particular call where a man was dancing on top of a squad car in downtown Durham. Before HEART, Andrews said, the man would’ve been handcuffed

and taken to jail. Instead, her officers spoke with the man and then called HEART. “I was so damn proud of how those officers just allowed this man to just have his space,” Andrews said. “He wasn’t hurting himself. He wasn’t hurting the officers. HEART provides us the opportunity to be a part of a different face of public safety.”

HEART’s Biggest Challenge: Connecting People to Care After the 911 Call

HEART, in many ways, has

exceeded expectations. The program has established and maintained deep support from elected leaders, law enforcement, and the community. It’s proven that unarmed mental health workers can safely respond to 911 calls that used to be answered by the police.

The challenge is what happens after HEART responds to a 911 call. Right now, the team refers residents to its Care Navigation unit. Staffed by social workers and peers with similar lived experience, navigators are responsible for connecting people to longer-term care such as housing, therapy, or addiction treatment.

“I knew that [part] would be hard,” said Ryan Smith. “I knew that it would be messy. But that it would be the hardest thing that we do? That’s the thing that surprised me.” Smith knew when he designed the program they would encounter people with problems bigger than anything social workers

Angela Hollowell/Tradeoffs

could solve out of a van. But he wanted to avoid his department sliding into delivering longterm care, so he limited Care Navigation to 30 days.

“We’re not there to provide all the services,” he said. “We’re there to try to make the most of our sometimes underfunded, fragmented system of support.”

Yet in these first three years, HEART’s efforts have regularly failed to adequately address people’s long-term problems in a month. HEART has connected just 20% of people to follow-up care.

Part of the problem is structural, Smith said. Housing and mental health services are hard to come by in Durham. Programs across the country face similar challenges.

Absent a more robust social safety net, certain individuals cycle in and out of HEART’s care. John Warasila, a real estate developer in Durham, sees HEART as well-meaning, but is upset with the program as a handful of homeless or mentally ill people continue to present problems on city streets. “[HEART] will tell us, ‘We’re working on it.’ They tell us this list of things they’re

doing,” Warasilla said. “At the end of the day, it’s not resolved. So at a certain point you’re like, I appreciate all the effort that’s going into this, but this is not functioning as a solution.”

Smith has met with Warasilla and other frustrated members of the business community.

HEART now directs its care navigators to contact people as soon as possible. The department is also gathering data to inform city leaders what additional services could more meaningfully help people.

“It is a larger system-wide failure and HEART is put in a position that is a very difficult one without appropriate resources,” Smith said. “We’re continuing to take seriously the concerns of [business owners]. It is a long road that we’re not shying away from.”

City Manager Wary of Mission Creep, but Wants HEART to Grow HEART’s inability to connect people to follow-up care has on occasion led the department to expand its role beyond first responder and care connector. HEART helped stand up an emergency cold weather shelter

police no longer have the call volume that justifies a certain level of staffing, naturally, we’ll have a conversation about whether or not we need as many officers,” Ferguson said. “We haven’t seen that yet.”

Police chief Patrice Andrews also wants HEART to grow. But she, Ferguson, and Ryan Smith agree there’s a danger to pitting police against HEART. Andrews said cutting her budget would be difficult at a time when the city continues to grow and demand for police is only increasing.

during one of the coldest weekends of 2024, for example. The department also has piloted a program that provides intensive ongoing support to a handful of people with significant needs.

Durham city manager Bo Ferguson appreciates that certain cases require HEART to provide what looks like more traditional social services, but he said the department must keep sight of its core function— responding to 911 calls. “I’m comfortable acknowledging the line is fuzzy and the line can move and has moved because we’re such a young program. We’re still learning how to operate in this space,” Ferguson said.

Ferguson is eager for HEART to expand operations to run 24/7. Having at least one unarmed unit on all day would push the program’s annual budget from $5 million to $6.5 million. Ferguson knows some elected officials and community advocates would like to see police funding diverted to beef up HEART.

“If the growth of alternative response takes a certain amount of workload off of police, and

She believes Durham—and any city doing this work—must balance responding to crisis and responding to lawlessness. “You need a level of law enforcement, but you also need that side of public safety that really is all about taking care of our populations of people that are most vulnerable,” she said. “We can do both.”

ENDNOTES

1 https://www.washingtonpost.com/ graphics/investigations/police-shootingsdatabase/

2 https://drive.google.com/file/ d/18KBgQGeuiSfc3Ue1fYM1uZCCOBHOqe5/view

3 https://tradeoffs.org/projects/ thefifthbranch/

4 https://www.durhamnc.gov/4576/ Community-Safety

5 https://www.rti.org/announcements/ new-documentary-highlights-communitycentered-crisis-response-programdurham-nc

6 https://tinyurl.com/6c9fnt8s

7 https://www.eugene-or.gov/ DocumentCenter/View/66051/ CAHOOTS-program-analysis-2021-update

8 https://www.axios.com/local/denver/ 2023/05/03/denver-star-set-to-expandamid-tension-over-its-future

9 https://www.cabq.gov/acs/documents/ acs-quarterly-report-fy24-q2-final.pdf

10 https://www.durhamnc.gov/ ArchiveCenter/ViewFile/Item/6810

11 https://www.durhamnc.gov/ ArchiveCenter/ViewFile/Item/7196

RYAN LEVI is a reporter and producer for Tradeoffs (tradeoffs.org).

Angela Hollowell/Tradeoffs

RECONNECTING PHYSICAL HEALTH TO MENTAL HEALTH

What the mental health discourse is often missing

BY MICHAEL HULING

Few topics have penetrated social life in recent years as much as mental health, whether in the workplace, schools, public policy, or casual conversations with friends and family. It’s a subject that hits close to home for those who have struggled with their own mental health or have seen firsthand what the implications of mental illness can be for others.

Research from Gallup found that depression diagnoses and treatment rose significantly between 2015 and 2023, and across virtually every demographic.1 According to the Centers for Disease Control (CDC), the age-adjusted suicide rate increased by 30% between 2002 and 2022, with the most extreme increases being among children and young adults.2 In 2022, suicide was the eleventh leading cause of death for all ages in the United States, but was the

second leading cause of death for people ages 10–14 and 20–34, and the third leading cause for people ages 15–19. The trends are similar for deaths due to drugs and alcohol, the abuse of which is strongly associated with mental illness. As depression, anxiety, drug addiction, and suicide rates continue to rise, so too does the number of people who are affected by our collective mental health crisis. A 2018 survey published by the American Psychological Association found that 59% of Americans know someone with a mental health disorder, indicating a general awareness of the prevalence of mental illness.3 In the same study, 87% of respondents said that having a mental health disorder is nothing to be ashamed of, while 86% thought the term mental illness carries a stigma. It seems peculiar that such a large percentage of respondents simultaneously believes that suffering from a mental illness is not shameful— and should presumably be destigmatized—but is also unfairly stigmatized. If the

vast majority of us agrees that mental health shouldn’t be stigmatized, then why is there the widespread perception that it is? Why does the mental health epidemic persist despite our normalization of discussing and experiencing mental illness?

I ask these questions because I think they speak to the imprecision of our mental health discourse, which often seems more interested in endlessly highlighting the problems without making much progress on potential solutions—as though destigmatizing mental health was in itself a solution to mental illness. What I’m contending is that we can do better than simply spreading awareness, encouraging empathy, and destigmatizing mental health, all of which may be necessary, but are far from sufficient. There are other, more tangible solutions that are not receiving the attention they should, particularly in schools, workplaces, and mental health institutions. A crucial example, and the focus of this article, is physical health, which I

believe is inseparable from mental health.

The Relationship Between Physical and Mental Health

The fact that there is such a strong relationship between physical and mental health makes sense when you understand the interconnections of our various bodily systems. While we may distinguish the functions of our respiratory system, digestive system, immune system, and so forth, these are mutually dependent systems. The Utah Education Network offers a succinct summary: “Each of our body systems are interconnected and dependent on each other. Our heart, which is part of our circulatory system, does not beat unless our brain, which is part of our nervous system, tells it to. Our skeletal system is dependent on our digestive system for increase in size and strength. Our muscular system needs our respiratory and circulatory systems to supply energy in the form of oxygen and nutrients. It takes all the systems for human growth and development.”4

The interdependence of our organs is certainly not neck-down, as the brain is the most interconnected organ of all, playing a pivotal role in most major bodily functions. In 2015, a study was published in the National Library of Medicine, which examined network physiology, meaning the dynamic interactions between human organ systems.5 The researchers studied how diverse physiological systems in humans dynamically interact and collectively behave to produce distinct physiological states and functions. The findings are both extensive and fascinating, with two conclusions that are particularly relevant. First, the authors discovered that in its communication with the brain, “each organ has

its own frequency profile, representing the relative strength of brain-organ links mediated through the different frequency bands.” Second, they concluded that this organ network behavior is universal, since it is “observed for every healthy subject in the database we analyzed, and thus points to a new previously unknown regulatory mechanism that underlies the dynamics of organ interactions.”

So, what does all of this mean and why does it matter? In simple terms, our organ systems, including our brain, are highly interactive and dependent on each other to function properly. This strongly supports the notion that physiological and psychological health are inextricably linked, which entails that physical and mental health are as well. If this were the case, then we would also expect to find a strong relationship between diet, exercise, and mental health. As it turns out, we do have robust evidence showing exactly that.

The 2021 Move for Mental Health Report, published by the John W. Brick Foundation for Mental Health, analyzed over 1,000 studies across 30 years, finding an overwhelming consensus that exercise significantly improves mental

health. According to the report, 89% of all published peer-reviewed research between 1990 and 2022 found a positive, statistically significant relationship between exercise/physical activity and mental wellness.6 Numerous forms of exercise were cited in the research, including aerobic exercise, resistance training, team sports, and yoga, all of which demonstrated considerable benefits. A key reason is that exercise positively impacts our various bodily systems that affect mental health, providing the mechanistic pathway for exercise’s secondary influence on mental health.

“Physical health is clearly intertwined with mental health in a bidirectional fashion. Scientific evidence shows that changes in thinking patterns and behaviors affect neurological, endocrine, and immune systems,” the report adds. “Research overwhelmingly supports a beneficial role for exercise and increased physical activity for addressing mental health issues, particularly depression and anxiety.” While the authors acknowledge that specific clinical recommendations are dependent on individual patients and their needs, they

find that holistic treatment approaches that are inclusive of diet and exercise are “rarely included in prevention and treatment of mental illness, and mental health care providers are not well trained in their evidence-base or clinical utility.” This mismatch between the scientific literature and the clinical application of the evidence seems to be a major barrier to improving mental health treatment and outcomes. There is abundant evidence for the relationship between diet and mental wellness as well, and much like exercise, the emphasis should be much greater given the weight of evidence. Most people understand that some foods have been found to positively influence mood, but are less likely to understand the deeper connection between the brain and gut microbiome. The emergent field of nutritional psychiatry is investigating precisely these mechanisms, with a growing body of research indicating that the microbiome modulates brain neuroplasticity through multiple biological pathways, including the synthesis of neurotransmitters and enzymes that facilitate healthy brain function.7 More broadly, we

know that proper nutrition is crucial for every bodily system, from our immune system to our nervous system. Malnutrition and excessive consumption of ultra-processed foods have been closely linked to cognitive decline and dysfunction in areas of the brain such as the hippocampus and amygdala.

A 2017 study published in the National Library of Medicine found that diets high in fat and added sugar significantly alter the bacterial composition of the gut microbiome, negatively influencing cognitive function via the gut-brain axis.8 A 2024 study examined the implications of this relationship between processed foods and mental health, finding that diets with high amounts of ultraprocessed foods are associated with a 48% increased risk of anxiety and a 22% increased risk of depression.9 While much debate remains on what constitutes the ideal diet, the consensus of the nutritional literature is that ultra-processed foods should be minimized, while natural, whole foods are the staple of a healthy diet. The importance of diet and exercise should seem obvious, and yet, rarely penetrates the mental health discourse and is largely absent from mental health interventions, which is

a disservice to those suffering from mental illness. None of this is to suggest that physical health and mental illness are mutually exclusive, of course, as one can be physically fit and still struggle with mental health. My argument is that physiological and psychological health are so intertwined that it simply doesn’t make sense to treat them otherwise. The mechanics of our bodily systems are complex, to say the least, and there is plenty more research to be done on how these systems and mechanisms interact. However, given the compelling evidence for the intimate relationship between diet, exercise, and mental wellness, it’s alarming that our social discourse and many of our institutions seem to be ignorant—if not outright dismissive—of the importance of targeting physical health as part of our broader approach to the mental health crisis. It’s long overdue for us to take the evidence seriously and examine ways that we can encourage healthy lifestyles in schools, workplaces, and other institutions. Not as a replacement or alternative to mental health resources, but as a complement to them to facilitate a more holistic approach to health and well-being.

Promoting Physical Health in Our Institutions

With all of the science and evidence showing that physical health is instrumental to mental health, the challenge remains of finding ways to incorporate this knowledge into our institutions and practices. A necessary first step is to require that mental health professionals are educated on the importance

of diet and exercise as part of a mental health protocol. Some universities are beginning to offer degrees and programs that focus on this comprehensive approach to health. Bastyr University, for example, has a dual-degree master’s program that allows students to simultaneously study nutrition, counseling psychology, and the relationship between the two.10 More programs like this, or even the inclusion of courses on nutrition and exercise science in clinical psychology programs, would go a long way to ensuring that mental health professionals are receiving thorough education and training, and that patients are given proper guidance to improve their health.

Downstream of this revamped institutional training of those working in the mental health field is rethinking how we promote mental health in our schools and workplaces. It has become common for schools to have several counselors on staff, and for employers to offer employee assistance programs that typically connect employees with counselors. These are great options, of course, and we should encourage students and employees struggling with their mental health to utilize these resources. However, if the counselors we are referring people to are inadequately trained on the relationship between diet, exercise, and mental health, then they are less likely to provide the comprehensive, evidencebased advice that is needed. While schools and workplaces should continue offering—and improving—these resources, it would also be beneficial to encourage physical health in other ways.

For schools, this could mean increasing recess and free play opportunities for students, along with providing more nutritious food options. California’s Farm to School program, launched in 2021, allocates funding for schools to purchase fresh food from local farms while also giving students hands-on learning opportunities.11 The program, which should be a model for other states, aims to provide nutritious food options for students, support local economies, and improve the nutritional literacy of students and school staff members.

For employers, offering gym memberships or stipends for employees may also help facilitate a healthy workplace. Additionally, where feasible, employers should consider providing healthy food options through cafeterias, vending machines, or meal delivery services. The provision of such diet and exercise-related benefits may be attractive to prospective employees, while also increasing workplace productivity.12 While not all employees will take advantage of these benefits, we shouldn’t dismiss the utility of promoting nutrition and exercise in creating a culture that values physical health as an integral component of mental health. Whatever the details may look like in practice, our schools, workplaces, and mental health programs will benefit immensely from promoting the physical health of students, employees, and patients alike. Ultimately, our goal should be to ensure that people have the opportunities and resources necessary to flourish, and a crucial component of flourishing is being in good health, both physical and

mental. While the promotion of physical health may not be a magical panacea to the mental health epidemic, it is an evidence-based approach that warrants much more attention if we truly want to help those suffering from mental illness. Prioritizing diet and exercise may seem banal to those who desire sexier solutions, but if it’s positive outcomes we want, then it’s evidence we need— and the evidence is overwhelming.

ENDNOTES AND RESOURCES

1 https://news.gallup.com/poll/505745/ depression-rates-reach-new-highs.aspx

2 https://www.cdc.gov/nchs/products/ databriefs/db509.htm

3 https://www.apa.org/news/press/ releases/2019/05/mental-health-survey

4 https://www.uen.org/themepark/ systems/human.shtml

5 https://pmc.ncbi.nlm.nih.gov/articles/ PMC4640580/

6 https://www.johnwbrickfoundation. org/wp-content/uploads/2022/08/ MYMH_Executive-Summary.pdf?eType =ActivityDefinitionInstance&eId=7ea195 ea-386b-4f48-9da6-b946a749c7e4

7 https://www.nmi.health/wp-content/ uploads/2022/05/1-Felice-JackaSupplement-3-Research-compressed.pdf

8 https://pmc.ncbi.nlm.nih.gov/articles/ PMC5277010/

9 https://www.bmj.com/content/384/ bmj-2023-077310

10 https://bastyr edu/academics/nutrition /masters/ms-nutrition-clinical-psycholog y#: :text=MSN%2FMACP%20students %20put%20scientific,clinical%20supervis ors%20on%20Bastyr’s%20faculty

11 https://www gov ca gov/about/first-par tner/ca-for-all-kids/cafarm2school/#: :te xt=Through%20farm%20to%20school%2 0programs,achievement%2C%20health% 2C%20and%20wellbeing

12 https://ph byu edu/poor-employee-hea lth-means-slacking-on-the-job-business-lo sses?uclick id=cb0ee305-8d5d-4f6b-8a0 3-2b44df74f338

MICHAEL HULING is a senior county planner in Clark County, Nevada, and an advisory council member at the Davenport Institute for Public Engagement and Civic Leadership.

Meeting the Drug Overdose Problem Where (And When) It’s At A data-driven guide for local governments

BY KIM MICHELLE LERSCH, PhD

The opioid crisis continues to pose significant challenges for local governments, stretching public safety resources, overwhelming emergency responders, and devastating families and communities. The Centers for Disease Control and Prevention (CDC) reports that more than 110,000 people died from overdoses in 2023. However, the number of non-fatal overdoses is far higher, leading to increased demands on 911 call centers, emergency medical services (EMS), police, fire departments, and public health agencies.

Municipalities need more than just additional funding to combat this crisis effectively—they need targeted, data-driven interventions. The good news is that local governments already have access to much of the data they need to respond strategically. Publicly available datasets—such as 911 calls for service, EMS dispatch records, and emergency room data—can be leveraged to identify overdose hotspots, recognize time-based patterns, and deploy resources more effectively.

This article presents a blueprint for local decision-makers to integrate spatiotemporal data analysis into their overdose response strategy. Using 911 call data from Detroit, Michigan, USA, as a case study, this approach demonstrates how cities can move from a reactive crisis response to proactive, evidence-based intervention strategies—ultimately saving lives and reducing the burden on first responders.

Step 1: Identifying the Patterns — Where and When Overdoses Occur

Analyzing overdose data can reveal critical patterns that help local leaders make informed policy decisions. When evaluating 7,102 overdose-related 911 calls in Detroit in 2022, several clear trends emerged.

Overdoses follow predictable daily and weekly cycles. Overdoses peak in the evening hours (8:00 p.m. to 11:59 p.m.), with the lowest call volumes occurring in the morning. The

highest number of overdoses occur on weekends (Friday to Sunday), aligning with increased social activity and potential recreational substance use.

Hotspots exist. Overdoses cluster in certain areas. Incidents were not randomly distributed but heavily concentrated in a 7-square-mile hotspot in Detroit’s downtown entertainment district, where nightlife venues, restaurants, retail establishments, and hotels are prevalent. These findings suggest that placing overdose prevention resources in these areas—particularly during high-risk times—could have a significant impact.

Seasonal trends were evident. Summer brings a surge in overdoses. Calls increased steadily from January through August, peaking in the summer months before declining in the fall. This seasonal pattern suggests that local governments should ramp up public awareness campaigns and harm reduction efforts in the months leading up to peak overdose periods.

Overdoses are predictable. Understanding when and where overdoses occur allows for strategic interventions rather than blanket, resource-heavy responses.

Why This Matters for Local Governments

Overdoses are predictable. Understanding when and where overdoses occur allows for strategic interventions rather than blanket, resource-heavy responses. While the city of Detroit covers around 139 square miles, many areas experience very few overdoses.

Data should drive policy. Instead of spreading prevention efforts thin, municipalities can concentrate their efforts in known high-risk areas at peak times. By focusing efforts on spatiotemporal clusters, such as the 7-square-mile hotspot in the evening hours, only 5% of the city land area is targeted in a relatively small time window.

Community partnerships are critical. Neighborhoods with high rates of drug addiction and overdose may experience overall lower quality of life. Community development efforts may be stifled as businesses and investors may be less likely to invest in these areas. It is crucial to engage local businesses, social service organizations, and first responders in efforts to target the overdose crisis.

Step 2: Turning Data into Action — Practical Strategies for Local Governments

Once a city has identified overdose patterns, leaders can implement targeted solutions that increase the availability of life-saving interventions and reduce the burden on emergency responders. Expand Narcan access where and when overdoses happen. Naloxone (Narcan) is a proven, life-saving tool that can reverse opioid overdoses in minutes—but only if it is available at the right places and times. As a strategy, cities should deploy Narcan vending machines or establish distribution sites at bars, restaurants, transit hubs, libraries, and 24-hour businesses in overdose hotspots. Wayne County, Michigan, has deployed 100 Narcan vending machines across high-risk locations, providing free, easy access to overdose reversal medication.

Train local businesses and community members to respond. Empowering community members to intervene can significantly reduce overdose fatalities. Train bar and restaurant staff, hotel workers, and transit employees to recognize overdoses and administer Narcan, CPR, and other life saving measures.

Deploy mobile crisis units during peak overdose hours. First responders—particularly police and EMS—are stretched thin responding to overdose calls. One strategy is to implement non-police crisis response teams that operate during peak overdose times (weekends and evenings). These teams, staffed with medical professionals and peer recovery specialists, can provide immediate

Wayne County, Michigan, has deployed 100 Narcan vending machines across high-risk locations, providing free, easy access to overdose reversal medication.

care and connect individuals to treatment. Cities like Denver, Colorado, and Eugene, Oregon, have successfully launched mobile crisis response teams that de-escalate drug-related emergencies without police involvement.

Use 911 data to predict and prevent future overdoses. Predictive analytics can help anticipate where and when overdoses are likely to occur. Law enforcement, public health departments, and social services should map overdose calls in real time to proactively deploy harm reduction teams before spikes occur.

Some police departments have successfully used heat maps and machine learning to anticipate drug-related emergencies and target interventions accordingly.

Engage local stakeholders in data-driven decision making. Open data fosters collaboration between government agencies, businesses, and community groups. As one strategy, municipalities should create publicly accessible overdose dashboards where decision-makers and community partners can track trends and coordinate responses.

Step 3: Securing Funding to Support Data-Driven Overdose Prevention

Funding is a key challenge for cities implementing overdose prevention initiatives. However, several state, federal, and private funding sources can support these efforts.

Federal grants. CDC, SAMHSA, and HRSA offer funding for opioid intervention programs. The Bureau of Justice Assistance (BJA) provides grants for alternative emergency response models.

State and local funding. Many states have received opioid settlement funds from lawsuits against pharmaceutical companies, which can be directed toward harm reduction efforts.

Private foundations and public-private partnerships. Organizations like the Robert Wood Johnson Foundation and Bloomberg Philanthropies fund innovative local government initiatives in public health.

Local governments should actively seek out funding opportunities and collaborate with private businesses and nonprofits to sustain overdose prevention initiatives.

Conclusion: A Data-Driven Approach to Saving Lives

The opioid crisis is an ongoing challenge for municipalities across the country, but local governments are not powerless. By using datadriven strategies, cities and counties can:

• Identify and target high-risk overdose locations.

• Ensure life-saving resources like Narcan are in the right places at the right times.

• Leverage partnerships with businesses, community groups, and public agencies.

• Reduce the burden on first responders while improving public health outcomes.

With strategic, data-informed decision-making, municipalities can proactively combat the overdose epidemic—saving lives, supporting communities, and making local governments more effective in public health response. The time to act is now.

KIM MICHELLE LERSCH, PhD, is a professor in the School of Information at University of South Florida.

THRIVE IN LOCAL GOVERNMENT 2025 COACHING PROGRAM

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Strengthening Fiscal Resilience in Local Government

LESSONS FROM THE COVID-19 PANDEMIC

BY THEODORE ARAPIS, PhD AND VASWATI CHATTERJEE, PhD

The COVID-19 pandemic presented unprecedented fiscal challenges to local governments, transforming budgeting into a complex problem for adept problemsolvers.1 Municipal leaders were tasked with addressing increased demands for public services amid substantial revenue losses, all while striving to maintain balanced budgets. The pandemic disrupted traditional revenue streams, heightened healthcare and social service needs, and imposed new financial burdens, necessitating swift and effective decision-making by governments.

To better understand these challenges, we conducted the Pandemic Management Survey (PMS) in spring 2021.2,3,4 This survey was distributed among municipal executives across Pennsylvania local governments, yielding 93 responses. The survey focused on the following themes:

1. Preparedness for natural, technological, and health-related disasters.

2. Risk perception among local government managers regarding public health, economic, and budgetary impacts of the pandemic.

3. Fiscal strategies adopted to address budgetary disruptions.

4. Approaches to community engagement and communication during the crisis.

5. Actions taken to mitigate the socioeconomic impacts of COVID-19 on vulnerable populations.

By capturing detailed financial and operational information, the survey provided critical insights into how municipalities navigated fiscal disruptions and maintained essential services. This article builds on these findings, outlining the cutback management strategies employed during the crisis, the factors that influenced these decisions, and actionable recommendations for future fiscal resilience.

Local Budget Policies

During the pandemic, local governments deployed a variety of strategies to maintain balanced budgets amidst economic uncertainties and fiscal stress. As has been common in past crises,

municipalities employed cutback management strategies to minimize budget gaps. These strategies fell into three general categories: expenditure reductions, revenue enhancements, and productivity measures. Each approach reflected the unique challenges and opportunities faced by municipalities as they worked to address fiscal pressures.

Expenditure Cuts

According to our survey, expenditure reductions were the most commonly used strategy, adopted by 70% of municipalities. These actions focused on limiting spending in areas deemed less critical during the crisis. Key measures included:

Postponing capital projects: Delaying infrastructure and maintenance investments to free up immediate funds. Hiring freezes, furloughs, or layoffs: Reducing personnel costs by freezing

recruitment, temporarily reducing staff hours, or terminating personnel.

Benefit reductions: Scaling back employee benefits to lower ongoing expenses.

Revenue Enhancements

Revenue-raising measures were the second most popular strategy, implemented by 63% of municipalities, providing a crucial supplement to local budgets. These strategies aimed to increase available resources to support essential services. Common actions included:

Applying for federal aid: Leveraging programs like the CARES Act to secure additional funding.

Borrowing: Issuing bonds or securing loans to cover immediate budget shortfalls.

Productivity Measures

Productivity improvements were the least utilized strategy, with only 12% of municipalities adopting these measures. However,

they represented innovative approaches to maintaining service delivery while reducing costs. Strategies included: Reorganizing, consolidating, or closing departments: Reorganizing, consolidating, or closing administrative units to streamline operations. Reducing hours of operation: Adjusting service hours to lower operating costs. Municipalities’ cutback management strategies during the pandemic were shaped by various factors. Expenditure reductions were most commonly observed in municipalities where managers had high confidence in their jurisdiction’s preparedness. Conversely, revenue enhancements were more prevalent in communities with active resident engagement, whose input supported initiatives like applying for federal aid and pursuing borrowing options. Lastly, productivity measures were predominantly favored by council-manager

Figure 1. Cutback Management Strategies

Expenditure Cuts

Productivity Gains Revenue Raising

governments, where professional management facilitated the implementation of efficiency-driven approaches.

Factors Influencing Fiscal Strategies

The survey uncovered key factors that influenced municipalities’ choice of specific cutback management strategies during the pandemic. Insights from our regression analysis, featured in the recent study, “Analyzing Cutback Management Strategies Amidst the COVID-19 Pandemic: Insights from Pennsylvania Municipalities,” published in Public Money and Management, elucidate the reasons behind the adoption of particular approaches by municipalities.

Expenditure Cuts

Expenditure reductions during the pandemic were significantly influenced by managerial perceptions and fiscal stress indicators. Municipalities where managers had strong confidence in their jurisdiction’s ability to handle a disease outbreak were more likely to prioritize expenditure cuts rather than seeking revenue enhancements or productivity gains. This suggests that managers confident in their existing resources to manage a health crisis saw less need for additional support, leading them to favor expenditure cuts to close budget gaps. Moreover, municipalities that experienced notable revenue declines from 2019 to 2020 were also more inclined to adopt expenditure reductions, highlighting the urgency of budget adjustments under fiscal stress.

Our analysis found that concerns over sharp revenue changes increased the likelihood of expenditure cuts. In times of rising fiscal stress, managers tended to opt for more immediate and significant measures like cuts over milder tactics such as delays or resource stretching. However, results indicated that managers concerned about healthcare resource availability or school reopening were less likely to reduce expenditures, prioritizing community needs instead. While prior studies often link severe fiscal challenges to budget-reduction strategies, during the pandemic, amid escalating public health concerns and increased service demands, managers were less inclined to reduce expenditures.

Revenue Enhancements

Revenue-raising strategies were more prevalent in municipalities that prioritized community engagement. By actively involving resident input during the pandemic, these municipalities were more inclined to pursue federal aid and other revenue-enhancing measures such as borrowing. Community trust and participation were crucial in supporting these strategies, as users of public services generally prefer revenue increases over service cuts to bridge budget gaps. The availability of federal aid and low-interest rates during the pandemic likely influenced the preference for revenue-raising measures. Furthermore, constituents may have supported these strategies, trusting their local governments to use additional funds effectively to improve community services.

Influencing Factors

Confidence in Preparedness

Fiscal Stress

Availability of Healthcare Resources

Reopening of Schools

Community Engagement

Healthcare System Concerns

Public Safety Concerns

Council-Manager Government

Budget Constraints to Human Services and Youth Programs

Large Population

Figure 2. Drivers of Cutback Management Strategies

Municipalities concerned with healthcare system strain and public safety were also more likely to adopt revenue enhancements, aligning financial strategies with the immediate needs of their communities. Given the substantial federal aid available to address the unique challenges of the COVID-19 pandemic, public managers sought intergovernmental assistance to mitigate potential budgetary shortfalls. Borrowing practices, similar to those observed in state governments, also were employed.

Productivity Gains

Productivity measures were particularly favored by councilmanager forms of government, which are well-suited to implement efficiency-driven solutions due to their professional management structures. These governments often reduced reliance on mere expenditure cuts, opting instead to foster innovation and adapt organizational structures and processes. Budget constraints, especially in areas like human services and youth programs, significantly influenced the adoption of productivity measures. This approach allowed them to meet the needs of such populations without sacrificing services.

Municipalities with larger populations also tended toward productivity gains, leveraging economies of scale to modernize operations and streamline services. These larger governments demonstrated adaptability, using their professional frameworks to balance cost savings with effective service delivery.

Conclusion: Building Resilient Fiscal Systems

The COVID-19 pandemic has underscored the critical need for resilient fiscal systems within local governments. By integrating cost reductions, revenue enhancements, and operational efficiencies into their strategies, municipalities have shown their capability to navigate financial uncertainties while preserving essential services. The roles of community engagement and professional management in ensuring decisions are inclusive, transparent, and tailored to both immediate and long-term community needs are vital. As local governments plan for the future, the lessons from the pandemic serve as a blueprint for creating stronger, more adaptable institutions. Emphasizing innovation, preparedness, and collaboration will enable municipalities to better withstand future crises and foster sustainable growth for their communities.

ENDNOTES AND RESOURCES

1 Arapis, T., & Chatterjee, V. (2024). Analysing cutback management strategies amidst the Covid 19 pandemic: Insights from Pennsylvania municipalities. Public Money & Management, 1-12.

2 Chatterjee, V., & Arapis, T. (2024). Crisis communication during COVID-19: Insights from Pennsylvania and Florida local governments. Risk, Hazards & Crisis in Public Policy.

3 Arapis, T., & Chatterjee, V. (2024). Analysing cutback management strategies amidst the Covid 19 pandemic: Insights from Pennsylvania municipalities. Public Money & Management, 1-12.

4 Chatterjee, V., & Arapis, T. (2023). Examining COVID-19 response among local governments through the political market framework. Journal of Emergency Management, 21(7), 111-131.

Actionable Recommendations for Local Governments

1. Invest in Preparedness

• Establish and routinely update continuity of operations and emergency response plans to address evolving risks.

• Foster a culture of preparedness through staff training and resource allocation for crisis response capabilities.

2. Foster Community Engagement

• Develop transparent communication channels to collect resident input and build trust.

• Implement participatory budgeting to align fiscal strategies with community needs and priorities.

3. Leverage Professional Management

• Encourage the adoption of council-manager governance structures to boost professionalism and efficiency.

• Provide leaders with training in adaptive management techniques and crisis leadership.

4. Adopt a Balanced Approach

• Strategically combine expenditure cuts with revenue enhancements to minimize disruptions to essential services.

• Focus on productivity gains through organizational restructuring, technological modernization, and innovative practices.

5. Maximize Federal and State Support

• Seek available grants and aid programs to bolster local budgets during crises.

• Advocate for flexible funding policies that cater to both immediate challenges and long-term sustainability goals.

THEODORE ARAPIS, PhD, is associate professor and chair of the department of public administration at Villanova University.

VASWATI CHATTERJEE, PhD, is an assistant professor of public administration at Villanova University.

From Ambition to Achievement: Career Growth Tips for Women

Unlock your full potential and reach new heights in your career.

BY KASSANDRA T. ALESKOVA

Women leaders are more essential than ever for the success of organizations. Research highlights that women bring unique strengths to leadership, such as empathy, inclusiveness, and strong relationship-building skills. Yet, despite these strengths, women are still underrepresented in senior leadership positions. The 2023 Gender Gap report by the World Economic Forum shows that while progress has been made, women hold significantly fewer top roles.1 This gap is not due to lack of ambition. According to McKinsey’s 2023 Women in the Workplace report, 90% of women under 30 are actively seeking promotions.2

If you are a woman striving for a leadership position, it’s essential to harness strategies that will set you on the right path. Whether you’re just starting out or already in a leadership role, these practical tips will help you navigate your career with confidence.

1. Build your support network and get involved.

KASSANDRA T. ALESKOVA is the management analyst principal for Wickenburg, Arizona, USA, and currently serves on the board of directors for Arizona

Women Leading Government (AZ WLG).

Having a strong support system is key to career growth. This means not just networking for the sake of collecting business cards and making another connection on LinkedIn, but developing relationships with mentors and sponsors. In addition to one-on-one relationships, consider joining professional organizations like your local Women Leading Government association. Networking within these groups can connect you with others who understand your experiences and provide you with valuable insights. Becoming actively involved in professional organizations opens doors for new opportunities, boosts your visibility, and creates meaningful connections. Attend meetings, conferences, or webinars to stay informed and to engage with others. Volunteering for committees or leadership positions within these groups can also give your career a boost and provide further mentorship opportunities.

2. Apply for that job (even if you don’t meet every single qualification).

It’s easy to hold back from applying for a job if you don’t meet every qualification. But don’t let that stop you—if you meet most of the qualifications and are eager to learn, apply anyway! The worst-case scenario is that you don’t get the role, but you’ll gain valuable experience and show initiative. Taking that first step demonstrates your commitment to growth, even if you’re not 100% qualified. Also, don’t forget that many skills are transferable so we just might have more experience than we give ourselves credit for.

3. Don’t be afraid to negotiate your salary.

Negotiation is key to making sure you’re fairly compensated for your work. Women sometimes shy away from asking for what they are worth, but advocating for yourself—whether it’s negotiating a salary or asking for a raise—is critical. Do your research, know your value, and don’t be afraid of asking for what you deserve.

4. Keep learning. Stay curious and stay ahead.

Growth doesn’t stop once you land a job. Continuous learning—through courses, webinars, or staying up to date with industry trends—is essential. Take on new challenges, learn new skills, and expand your expertise. The more you invest in your development, the more you’ll be prepared for the next opportunity that comes your way.

Career growth is a journey that requires dedication, support, and self-advocacy. By building a strong network, continuously learning, and confidently negotiating for what you deserve, you can unlock your full potential and reach new heights in your career. While organizations must create environments that support women in leadership roles, it’s up to us to take charge of our own path and make it to the top!

ENDNOTES

1 https://www3.weforum.org/docs/WEF_GGGR_2023.pdf

2 https://www.mckinsey.com/featured-insights/diversity-and-inclusion/ women-in-the-workplace

Communication, Self-Care, and Relationship Building

BY ANDREW E. NEIDITZ, ICMA-CM

Musings of a Washington State senior advisor on what’s most important in one’s local government career.

As I reflect on the high points and low points of my 45-year career in local government professional management, I recall the incredibly important relationships and the role that communication and trust played in all of the success stories. Conversely, the difficult times were often marked by poor communication and lack of trust. As important as technological skills, engineering knowledge, and financial acumen may be, it is the ability to develop and manage working relationships that enable a city/county manager to thrive and succeed. When facilitating an organization in a forward, innovative direction, there’s truth in the maxim, They won’t care about how much you know until they know how much you care. It’s been said that a city/county manager is expected to know a little bit about a lot of subjects, without being an expert in any one of them. I believe the expertise must be about the quality of communication, the sincerity of trust, and the commitment to the mission. It must be bolstered by self-awareness, humility, occasional introspection, and a sense of humor.

ANDREW

E. NEIDITZ, ICMA-CM, is a senior advisor for ICMA and the Washington City/County Management Association.

I’m honored to have been appointed as one of six senior advisors in Washington State. We work closely with the state association and its executive board. We regularly meet with our professional colleagues as a mentor and a confidential “sounding board” as they deal with new jobs, difficult circumstances, career planning, and navigating through crisis. We refrain from telling “war stories” or coming off as know-it-alls because we know that listening is a major component of good communication.

I believe

that self-care and personal mental health are as important as physical health and fitness when achieving a positive work-life balance that allows a city/county manager to be content and to thrive.

I believe that self-care and personal mental health are as important as physical health and fitness when achieving a positive work-life balance that allows a city/county manager to be content and to thrive. I also believe that our colleagues who lose track of the vitality of self-awareness are the ones who often end up with difficult times. We all know we have to care about councilmembers, department directors, general employees, and sometimes disgruntled residents. But self-care is equally important so that the “it’s lonely at the top” syndrome does not carry the day.

Our profession is an honorable one, more often a “calling” than a career. As a former ICMA executive board member and former state association president, I urge our colleagues to take good care of themselves, be open to self-assessment, and reach out for a mentor (whether it’s a senior advisor or not). We are all lucky to be in positions of trust.

A Catalytic Opportunity to Invest in Economic Mobility and Opportunity Leadership

Host community applications are open for the Economic Mobility and Opportunity Special Assistants (EMO SA) Program — a new initiative that supports local governments to advance policies to enable all residents to climb the economic ladder. ICMA will select 15 local governments to receive grant funding to hire full-time senior leaders for 2+ years and will provide technical assistance to help special assistants and their teams succeed.

This program from ICMA is made possible with support from the Gates Foundation.

Applications close on May 30, 2025. Learn more at www.icma.org/emo-sa.

How to Restore Hope in Uncertain Times

To bring about positive change—in yourself, your staff, and your community— restoring hope is a necessary first step.

BY LINDSEY ALLEN

It’s easy to feel discouraged by current struggles, whether in your personal life or on a global scale.

Psychologists, some of whom have a close-up view of the suffering these difficulties inflict, may find it especially difficult to stay positive about the future. Yet a growing body of research suggests that if you want to cultivate positive change—in yourself, others, or society—restoring hope is a vital first step.

Start by understanding what hope is—and what it isn’t. Though often equated with burying your head in the sand and waiting for things to get better, in reality, hope is a more nuanced, cognitive process involving well-known psychological concepts such as goal-setting, agency, and cognitive restructuring.

Unlike optimism, which is simply the expectation of a better future, hope is action-oriented and a skill that can be learned. “We often use the word ‘hope’ in place of wishing, like you hope it rains today or you hope someone’s well,” said Chan Hellman, PhD, a professor of psychology and founding director of the Hope Research Center at the University of Oklahoma. “But wishing is passive toward a goal, and hope is about taking action toward it.”

Experts on hope recommend the following strategies for cultivating hope:

1. Break goals into smaller chunks that allow more frequent achievements, highlighting the possibility of progress.

2. Stay in community with hopeful people who can inspire by encouraging you, helping you pivot when you encounter obstacles, or by simply reminding you that overcoming difficulty is possible.

3. Reflect on the past, especially if you feel your hopefulness wavering. “I’ll ask people to be their own ‘hope models’ by reflecting back on a time they achieved something really difficult in their lives, when they chose to take action and it made all the difference,” said Hellman.

4. Prepare to pivot, maintaining hope when action doesn’t directly lead to success and drains your motivation.

5. Celebrate wins to stay energized as you move forward. Take time to acknowledge—and celebrate—what you’ve accomplished in the present to support your hopeful mindset for the future.

Why We Need Hope

Psychologists’ research has found that hope is not an unrealistic luxury, but a necessity. It can help buffer people against the stress and trauma of adversity and can prompt us all to do good in the world.

In an episode of the podcast, Speaking of Psychology (available at https://at.apa.org/o2p), Hellman and Jacqueline Mattis, PhD, of Rutgers University–Newark, dive into their research and experiences to share what we can do to find hope in trying times.

How are you taking action toward hope with a season of new beginnings just around the corner?

How to Deal with the Stress of Uncertainty

In the wake of uncertainty, stress is inevitable—but as the season turns to spring, we can pivot some of our energy toward ways to mitigate distress and improve resilience.

Limiting exposure to the news, engaging in self-care practices such as going out for a walk and eating well, leaning on our support systems, and focusing on what we can control are proven ways to reduce stress. Also important: Be kind to yourself, and seek solutions in past successes.

Mindfulness Meditation: A Research-Proven Way to Reduce Stress

Mindfulness meditation improves mental and physical well-being by centering attention on our body and its sensations. Becoming in tune with our breath, thoughts, and feelings is a gateway to emotion regulation, and ultimately to dialing down our body’s response to stress.

Research reveals that mindfulness-based interventions, which can include practices such as breathing exercises, yoga, and guided lessons, can help reduce depression and anxiety, and even relieve fatigue and pain for those with chronic pain.

Reprinted with permission from the American Psychological Association, apa.org, 2025.

LINDSEY ALLEN is managing editor at the American Psychological Association.

Budgeting is one of the most important responsibilities that local government managers undertake every year. The new book, A Budgeting Guide for Local Government, Fourth Edition, provides new tools and methodologies to produce effective budgets that yield the desired results.

Learn more at icma.org/budgetingguide.

ICMA CAREER GUIDES

ICMA’s Career Guides are local government professional toolkits to help you thrive, from finding a position to succeeding as a first-time manager, or how to break into the profession from another field, and preparing the next generation through internships and Fellowships. icma.org/careerguides

Lead Change. Transform Communities.

ACCEPTING APPLICATIONS FOR THE 2026 ICMA LEADERSHIP INSTITUTE ON RACE, EQUITY, AND INCLUSION

Unlock the Power of Inclusive Leadership

Apply for this groundbreaking program, in its 5th year, a 12-to-18-month journey designed for leaders committed to driving meaningful change in their communities.

Why Apply?

Gain Insight: Explore the intersection of race, equity, and inclusion in local governance through expert-led sessions and interactive workshops.

Drive Impact: Equip yourself with practical tools and strategies to address systemic inequities and foster inclusive policies and practices.

Build Networks: Connect with a diverse cohort of leaders from across the nation, fostering collaboration and peer support.

Apply Today!

Spaces are limited.

Visit icma.org/Lead-the-Change to learn more, and complete and submit the application. Deadline extended to June 30!

icma.org/Lead-the-Change

Helping Local Governments Navigate Large-Scale Solar Development

Explore the Solar@Scale Guidebook to learn strategies that improve large-scale solar projects.

Access our growing collection of recorded webinars to hear from national experts and experienced local government practitioners.

Check out these free resources and learn more at icma.org/ programs-and-projects/solarscale or by scanning the QR code: