What should crisis response look like?

Responding to individuals experiencing a mental health crisis has become a significant part of law enforcement’s function in our country, involving approximately 20% of emergency calls. In most cases, police officers are not adequately qualified to respond to these crises but are first on the scene. Thankfully, efforts to create alternative responses and provide appropriate training for police officers have become a priority. State legislatures and law enforcement are working hard to implement what crisis response should look like with new solutions that can help divert individuals with mental health needs away from the criminal justice system and into treatment.

Frequently, well-meaning officers do not have the training when they encounter individuals suffering from a crisis. There may be few options if the officer doesn’t have an alternative to bring the individual, such as a mental health clinic or crisis center. Lack of options can result in arrest, escalating situations resulting in potential violence, and rare circumstances, even death.

According to the National Alliance on Mental Illness (NAMI), one in four people shot and killed by law enforcement between 2015 and 2020 suffered from a mental health condition. 

Logically, incidents involving behavioural health issues should solicit a public health response, but law enforcement has become the default solution because of inadequate crisis services. When police are called upon to address a mental health crisis without adequate support services, law enforcement fills the void.

Over two million people with a severe mental illness (SMI) are incarcerated each year, often for law or non-violent crimes. Sadly, the prevalence of mental illness and substance use disorders in prisons and jails equate to three to four times that of the general population.

Few receive treatment, and many are incarcerated twice as long. Given these statistics, it may be time to redirect reliance on law enforcement in behavioural health crises situations and allow mental health professionals to assume the dominant role in crisis response. 

Increasingly, questions have arisen as to whether reducing the role of law enforcement is feasible and, if so, what should crisis response look like. In this article, we’ll examine a few of the proposed models.

Crisis Intervention Teams (CIT).

It came about following the fatal shooting of a man with a history of mental illness and substance abuse by a Memphis police officer in 1988. What was to become known as the Memphis CIT model was developed through the collaborative efforts of law enforcement, mental health and addiction professionals, and mental health advocates.

Though the core of the CIT model involves 40 hours of specialized training provided by mental health professionals, advocates, and police trainers, the program is much more than training. Through community and organizational intervention, this is a determined effort to establish what should crisis response look like for mental health response systems. Improved communication, increased safety of officers and individuals, reduced trauma, and diversion from the criminal justice system to treatment are critical components of the program.

The CIT model has enjoyed some success in improved police officer attitude and a reduction of stigma in those who complete mental health training. In many communities, response time in mental health calls has been significantly reduced, and fewer officer injuries are reported. As more law enforcement officials receive training and become better acquainted with community mental health services, diversion from the criminal justice system and treatment is becoming more common. 

Co-Responder Teams

Typically, co-responder teams include specially trained law enforcement officers or other first responders and mental health professionals responding jointly to situations involving behavioural health crises. These individuals often work side by side for an entire shift, riding in the same vehicle.

Working together, co-responders can deescalate intense or emotional situations without using force and divert individuals from the criminal justice system to appropriate treatment. Efficient communication between the responding team and mental health centers or other facilities is crucial in stabilizing a situation. With Julota, co-responders can make the referral en route so that there is no delay in treatment. 

successful co-responder model has the potential to produce numerous benefits, including:

  1. Improved and more immediate responses to mental health crises
  1. Decreased arrests and incarceration of individuals in crisis
  1. More effective follow-up with individuals, families, and caregivers after a crisis, reducing the likelihood of future incidents
  1. Reduced psychiatric hospitalizations
  1. Better on-scene needs assessments

Mobile Crisis Teams.

The mobile crisis team model is based on providing a different and safer way to respond to mental health emergencies. In a practical system, two or three-person teams consisting of mental health professionals, including peers, and Emergency Medical Team members are dispatched to the location of the individual in crisis. On-site assessments are made, and the person is transported to appropriate care, if deemed necessary, by the response team.

While the models will vary depending on the jurisdiction, mobile crisis teams are not operated by law enforcement. They are managed by community mental health organizations or government agencies, such as the health department. Just what crisis response should look like.

Although they collaborate closely with law enforcement, police intervention is only used as warranted in high-risk situations. Limiting this intervention has helped free officers’ time to focus on their primary crime and public safety responsibilities. It has also reduced the number of people experiencing behavioural health crises from cycling through the criminal justice system, which often exacerbates the situation. 

One of the most well-known mobile response programs is CAHOOTS (Crisis Assistance Helping Out on the Streets). The program was launched in 1989 by the White Bird Clinic in Eugene, Oregon, partially funded by the Eugene Police Department.

Their teams are made up of a medic and behavioural health trained crisis worker. They provide emergency counselling, welfare checks, suicide assessments, and nonviolent conflict resolution. Transportation is often provided to treatment centers for substance abuse and mental health, clinical care, and shelters – without the use of handcuffs.

Many CAHOOTS workers are peers who have lived experience with mental illness. Statistically, 30% of the people they have served between 2014 and 2019 suffered from “severe and persistent mental illness.” In 2019, police backup was only deemed necessary in 150 out of 24,000 dispatches, making CAHOOTS the most sought-after mobile crisis program in the U.S. 

988 – National Behavioral Crisis Hotline

In 2020, 988 was established as a nationwide 3-digit number designated for mental health crisis and suicide prevention services and will be operational nationwide by July 16, 2022. The idea behind 988 is simple: a mental health crisis needs a mental health response.

988 will be more than a number – it will be an entire crisis response system that can change the way mental health crises are handled in this country. There are three critical elements to this ideal crisis response system:

  1. 24/7 crisis call center “hubs.”
  1. Mobile crisis teams
  1. Crisis stabilization

When a person experiencing a mental health crisis dials 988, a professional trained to handle mental health, substance use, and suicide crises will be available 24 hours a day, 7 days a week. If an on-site response is needed, a crisis call center should dispatch mobile crisis teams to de-escalate the situation, provide transportation for stabilization, or connect individuals to needed services and supports.

Access to Julota’s software can facilitate the communication between the crisis team and service providers for a seamless, efficient transition.  

If a situation warrants more intensive care, short-term crisis stabilization should be available such as the capacity to diagnose and provide initial stabilization and observation. Services should be provided in a home-like environment for short-term (under 24 hours) acute services followed by a “warm” hand-off to follow-up care.

Follow-up care might include residential care, peer assistance, or substance use detox. Peer support is an integral part of any crisis response system. Peers, including peer recovery coaches, peer support specialists, and peer support staff, have lived experience of mental illness or substance use disorders. They are trained or certified to provide supportive services. Their involvement can be critical in creating rapport with a person in crisis and offering hope in recovery. 

These three elements represent the ideal scenario, but each community will need to collaborate with lawmakers, community partners, and mental health experts to identify existing resources and current needs. A robust crisis response system made possible through the implementation of 988 will positively impact the entire country.

It will free up law enforcement to address their primary responsibility to protect the public. It helps states reduce expensive and less effective response methods like incarceration, emergency room visits, and reoccurring psychiatric hospitalizations. Most importantly, tragic outcomes can be avoided, and people in a mental health crisis will be able to get the help they need. 

There is a growing need in the United States today to find appropriate crisis response solutions to mental health crises. In these cases, the traditional use of only using police officers has proven to be less than an effective solution. The models discussed here may provide suggestions for transitioning to programs that reduce the role of law enforcement and address the question of what the alternative crisis response could look like.