What Is the Proper Mental Health Crisis Response?

Millions of Americans suffer from mental health issues. However, research suggests that only half of those individuals receive any mental health treatment. It is estimated that nearly twenty percent of Americans are in some mental crisis at some point in their lives. These stats do not even include people suffering from substance abuse problems. These numbers are problematic. How can we have this many people suffering from mental health issues and so few receiving the treatment they need?

We are getting to a point where most people agree that we need more and better responses to mental health crises than simply calling 911. While law enforcement can be a valuable tool, responding to mental health crises is not and should not be the sole responsibility of police officers. CIT International would even argue that the police should not be involved unless necessary.

Outside of CIT(Crisis Intervention Training) trained officers, most police are not trained to properly handle individuals who are actively suffering from mental health crises. Which often causes the situation to escalate and leads to incarceration and worse injuries or even deaths of people suffering from mental health and substance abuse issues.

Escalation of mental health calls is most certainly not always due to police officers being untrained to handle these situations. However, that may be part of it. It is also a result of people feeling threatened by the mere presence of an armed police officer, especially when they are currently suffering from a mental health crisis.

Individuals suffering from a mental health crisis could end up arrested and then stuck in the criminal justice system. Law Enforcement has minimal options or alternatives. Embedding people with mental health problems in the criminal justice system is counterproductive for everyone involved. It wastes the resources and time of law enforcement involved. Their time would be much better spent responding to more threatening and dangerous situations that cannot be handled by anyone other than law enforcement. Additionally, it is traumatic for the individual in crisis, and they rarely get the treatment they desperately need.

As more communities implement better tools, such as Crisis Intervention Training, co-responder programs, and community-based response teams, there is a great debate on which model is the best and most effective. Therefore, it is essential to truly understand how each program operates to determine which is best for a specific circumstance or community.

Crisis Intervention Team (CIT) Model

In 2018, 1,000 people in the United States were killed by police officers. Of those, it is estimated that 25 percent were individuals suffering from mental health issues. Unfortunately, not only are police officers usually the first responders in these types of crises, but they are also often the only responders. As a result, a police officer’s only response to mental health calls is dangerous for everyone involved, including the police officers themselves. 

In an attempt to combat this dire situation, community intervention teams were implemented in many communities. For example, CIT is a community team that includes law enforcement, mental health professionals, addiction professionals, and individuals who live with addiction or other mental health issues and their families. These people work together to ensure that individuals who need mental health or addiction treatment receive that help, rather than being arrested and placed into the vicious cycle of the criminal justice system. It also focuses on officer safety as well as the safety of the individual in crisis. 

So how exactly does CIT work?

  1. Self-selected police officers receive 40 hours of special training from mental health professionals, people with mental illnesses and their families, and other police officers familiar with CIT.
  2. Dispatchers who are specially trained to identify crisis situations are used instead of the untrained. They can quickly and more easily dispatch CIT officers rather than an untrained first responder to the scene. CIT officers are specifically taught to use de-escalation tactics and transport the individual in crisis to a mental health facility if necessary. 
  3. Identify mental health and psychiatric facilities that have a no-refusal policy. Finding available mental health clinics is significant because CIT-trained officers respond and do their best to help the individual in crisis. Conversely, it will all be for naught if there is nowhere to take the individual in crisis.

It is essential to understand that CIT is about more than just training. The goal is to change police department procedures and collaborate between police officers, mental health providers, and other community members. Some police departments believe that instead of training only select officers, all officers should participate in CIT training. Because no matter how effective the program is, it is likely that every officer will interact with a person in crisis at one point or another. There’s no data suggesting that training all or training some officers is more effective.

According to CIT International, the ultimate goal is to remove police officers from this situation altogether. Instead, mobile crisis teams that consist of trained mental health professionals and community members should respond. CIT opposes co-responder programs, where the police assist mental health professionals in these crisis situations. They feel it is better to dispatch a police officer only when there is a clear threat to public safety. In the meantime, dispatching officers with this particular training will undoubtedly be beneficial. 

Co-Responder Program 

A co-responder program aims to provide treatment and diversion away from the criminal justice system for individuals living with mental illnesses and substance abuse issues. This model pairs police officers with mental health professionals when engaging with a person suffering from mental health or substance abuse issues. The idea is for the mental health professional to assist law enforcement in de-escalating the situation. 

Since mental health professionals, rather than just the police, are involved, the belief is that they will be able to de-escalate the situation more effectively than if only law enforcement were to respond. Generally, there are two different approaches to co-responder programs.

  1. A police officer and mental health professional ride together for an entire shift, so they  
  2. can assist each other if necessary; or
  3. The mental health professional is called to the scene only when necessary. Then, they work together with law enforcement to handle the situation. 

After de-escalating the situation, the goal is to ensure that the individual in crisis receives treatment rather than being arrested and incarcerated. While in jail, they will receive inadequate treatment or no treatment at all. Additionally, co-responder programs follow-up with the individual in crisis and assist them with placement into ongoing treatment and other day-to-day activities if necessary, such as applying for and receiving the necessary documents in order to help them obtain food and housing.

Another primary goal of co-responder programs is to increase information sharing between law enforcement and mental health professionals. The idea is to determine if the person in crisis already has services in place and, if they do, to be able to quickly and easily reach out to a counsellor or someone familiar with that individual. Additionally, diverting people away from the criminal justice system and into treatment will reduce the costs of unnecessarily incarcerating people.

Community-Based Response for Mental Health Crises

Community-based response teams are an alternative to law enforcement acting as first responders when the situation involves a person suffering from a mental health or addiction crisis. Instead of police officers responding, a mobile mental health crisis team responds on their own. This team usually consists of a mental health professional and a medical professional, such as a nurse or an EMT.

For this type of program to work, the 911 dispatchers must discern when a call requires law enforcement and when sending a mental health crisis team would be more effective. Then, suppose the crisis response team is dispatched. In that case, they can de-escalate the situation and provide any emergency health care that the individual might need.

Additionally, the goal is to transport the individual to a mental health facility and ensure that they get the treatment they need. It has been shown repeatedly that throwing a person who is in crisis in jail is the worst scenario for the individual. It also costs significantly more money than if the situation were handled better.

Crisis Assistance Helping Out On the Streets (CAHOOTS) is the most famous example of this type of program. CAHOOTS was implemented in 1989, and its goal is to improve the response to mental illness, substance abuse, and homelessness. 

CAHOOTS operates in teams of two. Each team consists of a crisis intervention worker skilled and trained in de-escalation tactics and counselling and a medical professional, either an EMT or a nurse. This model allows the team to respond to a multitude of situations.

For example, suppose a person is suicidal and attempts to harm themselves. In that case, this team can respond and handle the mental health aspect of the situation and any immediate physical health issues that exist. In areas where community-based response teams do not exist, these types of calls would almost always be responded to by law enforcement. Unfortunately, law enforcement response is generally an overreaction, is unnecessary, and often worsens the situation.

Other Types Of Community-Based Response

In addition to CAHOOTS and similar programs, there are other ways that the community can be involved in these types of crisis situations and help people suffering from mental health and substance abuse issues. 

  • Crisis And Warm Lines

Crisis lines and warm lines were implemented to support people who need to talk to someone struggling with their mental health. The crisis phone lines are staffed by trained mental health professionals and provide remote counselling to a person who is either in crisis or near crisis.

Warm lines are staffed by community members who have personally experienced mental health or substance abuse issues. Qualified mental health professionals train them. While these lines are purely remote, they can act as an alternative to calling the police, and they can help prevent a more serious mental health crisis from occurring. 

  • Peer Navigation Programs

These programs hire and train community members who have had and may still be having personal experience with mental health and substance abuse issues. The goal is to provide support for individuals who are at risk of criminal justice involvement.

Jail Diversion and Alternative Responses Work

While there are advantages and disadvantages to each type of program discussed, there are valuable aspects to all of them. Anytime we can divert people away from the criminal justice system into treatment, it should be considered a success.

Software programs, such as Julota, can assist the community and other responders place people in available treatment centers. While ideally, there would be psychiatric and other treatment centers with the no-refusal policy discussed above, this is not always practical.

With Julota, officers and other responders can immediately see if an individual is currently involved in community services. It also shows what facilities have open beds and are immediately available to help. Moreover, it dramatically improves the communication between behavioural health and law enforcement.

Getting people the help they truly need is invaluable.