Responding to Mental Health Crises in a New Way

Written by Lance Leonhard

True leadership often calls for someone to challenge the status quo — asking tough questions and challenging people to do something differently to improve.


With May being Mental Health Awareness Month, we continue to challenge ourselves to learn more about how mental illness impacts millions of people in our country and how we can provide a more person-centered, trauma-informed approach to working with those affected. It’s fitting this May to shine a light on an innovative partnership among the Marathon County Sheriff’s Office, Wausau Police Department, and North Central Health Care — a partnership known as CART.

What Is CART?

CART is an acronym (yes, in government, every great program needs an acronym) that stands for Crisis Assessment Response Team. Each CART is made up of one law enforcement officer and one mental health crisis worker. In Marathon County, we have two teams in our CART program:

  • Sheriff’s Deputy Megan Sowinski and Stacey Rozelle from North Central Health Care
  • Wausau Police Officer David Bertram and Chuck Kerstell from North Central Health Care
CART Team members Officer David Bertram, Deputy Megan Sowinski, Stacey Rozelle, and Chuck Kerstell.

Each officer has undergone considerable training, including Crisis Intervention Training (known as CIT), in how to identify when someone is suffering from a mental health condition and how particular conditions might change how that person may perceive law enforcement’s presence.

In an emergency, the public should simply call 911. If the dispatcher can determine that CART is needed, he or she will contact CART on the caller’s behalf. Similarly, if law enforcement arrives to assist in a crisis situation and an officer determines CART might be better situated to deal with the incident, he or she will call for CART.

Why Did We Start CART?

In 2016, Marathon County Sheriff’s Office Chief Deputy Chad Billeb and NCHC Senior Executive Laura Scudiere were struggling to address the impact that mental health crisis events were having on both the county jail and our in-patient hospital. To learn more, they attended a national conference aimed at doing a better job of dealing with crisis in the community, as opposed to in a locked setting. When they returned home, they got right to work… And the result is our new CART program.

The premise of CART is simple:

If we work proactively with people before they go into a mental health crisis, and we follow up more closely with people who have recently gone through a crisis event, we are going to reduce the number of serious mental health crisis events.

The focus in the CART program is to develop trust with individuals who face mental health challenges (and their families) and to offer them services and resources that allow them to be safe and successful in the community.

How Is a CART Approach Different From a Traditional Law Enforcement Response?

The first thing you’ll notice is that the CART approach looks different. Law enforcement team members are dressed in a softer uniform, typically a polo shirt. Rather than a standard marked squad car, CART members drive an unmarked, specially painted vehicle outfitted with various supplies, including items that might be needed by individuals who are homeless.

In addition to looking different, law enforcement members have specialized training to handle situations differently

Step #1: Slow the situation down through specialized de-escalation techniques for those in mental health crisis.

Step #2: Take a holistic approach and try to develop a solution by working with the individual, his or her family, and community resources to connect the person with the support he or she needs.

Step #3: Check back on the person regularly to make sure various needs have been met so the person doesn’t spiral into a crisis event.

How Is CART Working Thus Far?

In the less than 5 months the program has been fully up and running, the teams have responded to hundreds of calls, so we know that the teams have been busy — really busy. But, effectiveness is more than just having a great deal of work or responding to hundreds of calls for service; how do we know the program is effective? The short answer is data.

So, what do the data show?

“We are continuing to collect data to analyze the program, but anecdotally, community partners and patients have expressed great enthusiasm about the project and have reported positive experiences with CART. We’ve used CART to have a coordinated response for some particularly complex situations, and due to the team’s hard work, we were able to keep patients out of more restrictive care settings or the Marathon County Jail.”

Laura Scudiere
NCHC Senior Executive, Human Services Operations

The feedback from law enforcement is similar:

“The CART program has allowed us to reach a segment of our community that is often underserved. Through the efforts of each of the teams, we have seen improved responses from individuals who in the past were not receptive to our efforts to assist them. The training, skill, and experience of each of the individual team members and the collaborative approach that the CART program utilizes not only is leading to better outcomes for individuals with mental health issues and their families, but we expect for it to have the added benefit of reducing expenses associated with highly restrictive behavioral health placements and law enforcement transports.”

Chad Billeb
Chief Deputy, Marathon County Sheriff’s Office

Marathon County’s CART program is modeled on programs from other innovative jurisdictions around the country, including Portland, OR; San Antonio, TX; and both Madison and Milwaukee, WI.

Those jurisdictions have seen the CART program produce staggering results. In Milwaukee,

“when CART intervenes, 85 percent of the time clients are diverted to appropriate supportive services as an alternative to incarceration or involuntary detention . . . reducing emergency detentions by 50 percent, compared to 2011.”[1]

The leadership demonstrated by the Marathon County Sheriff’s Office, Wausau Police Department, and North Central Health Care to think beyond the way we’ve always done things and innovate is central to our strategic vision of being the healthiest, safest, and most prosperous county in Wisconsin. 

We are fortunate to live in a community where that leadership is supported not only by our elected leaders, but by numerous community groups and benevolent foundations. The CART Program has been financially supported by two such pillars in our community: the Community Foundation of North Central Wisconsin and the B.A. & Esther Greenheck Foundation.



If you’d like to learn more, I invite you to view, print, and share the CART brochure. It contains our CART Team hours and contact information, as well as helpful community resources and counseling/psychiatry service providers — including specialized services for veterans — in the Wausau and Marshfield area.

[1] Milwaukee County’s approach to mental health reform is a national success story. (2017, February 18). Milwaukee Courier. Retrieved May 21, 2018, from

Lance Leonard - Marathon County Deputy AdministratorLance Leonhard

Marathon County Deputy Administrator 

Lance Leonhard began his career in Marathon County government in the Office of Corporation Counsel and currently serves as the Marathon County Deputy Administrator. Lance’s career in public service has spanned more than a decade, having worked for the federal government as a law clerk on the U.S. Court of Appeals for the Seventh Circuit and for the state of Wisconsin as an Assistant District Attorney. Outside of work, you’re likely to find Lance spending time with his family, traveling, teeing off on a local golf course, or sitting around a campfire with friends.  Email Lance Leonhard.

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Image Credit
Mental Health Awareness Month graphic by Anders Abrahamsson  |  CC BY 2.0