Recently, 20 states received grants from the Centers for Medicare and Medicaid Services, an agency of the U.S. Department of Health and Human Services, totaling $15 Million to fund the development of programs that reduce reliance on police by connecting people experiencing mental health and substance use crises with behavioral health specialist and critical treatment, according to a CMS news release. At first glance, these grants could be viewed as only supporting stand alone response models of crisis response services; however, if we widen the view, we can see that funding and support of only one type of model is a short-sided reaction to public pressure without truly understanding either the crisis system or law enforcement response. It is also not specified in the funding that program development and design must center on stand alone crisis response teams.
A healthy crisis system includes a robust menu of services to meet the needs of each individual. As such, a healthy crisis system needs to have both a stand-alone team and a team embedded with law enforcement; and teams that can communicate well with one another, in addition to other crisis services including crisis respite centers, psychiatric emergency departments and emergency medication prescribers. This is not an either/or, better/worse, more important/less important scenario. Each spoke of the wheel is vital to its function.
In Roberts’s Crisis Intervention Handbook (Roberts, 2000), a model comprehensive community crisis system is discussed. This includes: telephone crisis services, walk in crisis services, mobile crisis services, access to crisis residential unit, emergency psychiatric crisis stabilization, and critical incident stress management. When discussing mobile crisis services, a case scenario is presented broken down using Roberts’s seven stage crisis intervention model. He states, “Because of various inconsistencies and misinformation provided by the client on the initial phone contact, the major problems were unknown at the time of dispatch. It was not until the crisis worker and the police officer arrived on the scene that the critical nature of the problem was identified.” Herein lies the problem with putting the full focus of crisis services solely on the shoulders of crisis response programs that are not inclusive of law enforcement: it leaves out those calls which cannot be safely managed without a law enforcement presence. In order for crisis teams to respond safely, it is important that the individual meets all of the following criteria: they are not displaying any violence, has no weapon, the individual is agreeable to stay safe until the mental health responder can arrive, no crime has been committed, they are voluntarily agreeing to get services, there are no medical needs including overdose, and the individual has not consumed drugs or alcohol. The rest of the calls are where the embedded teams come in.
Crisis systems need response teams that are not inclusive of law enforcement. Voluntary individuals who are experiencing distress should not need to have involvement with the criminal justice system in order to get help. However; it is of vital importance that we do not let the decision makers forget one simple fact, law enforcement will forever be responding to crisis in our community. Embedded models of response must have a seat at the table and must be equally implemented in communities who desire to create a most effective crisis system. When systems make decisions that are reactionary versus thoughtful; the results can be catastrophic.
In reality, even communities who have a robust menu of crisis services available will still have law enforcement responding directly to individuals in crisis. In addition the challenge of crisis response teams which are not embedded with law enforcement leaving out those calls which cannot be safely managed without a law enforcement presence, it also leaves out those calls which may have an underlying behavioral health component which would never be screened to a non-law enforcement crisis team. For example, an individual calls 911 to report he can hear a woman screaming on his neighbors property. No way would this call screen in for a crisis team; however, upon arrival, officers discover there is no woman in distress on the neighbors property, in fact, the house is vacant and no one is there (confirmed by a building search). The reporting party presents as “odd” to the officers. Having cleared the original complaint, it would be easy for the officers to walk away. However, the officer arriving happens to have a mental health professional with him and responded in the event there was a victim who may need support. Instead, the mental health professional begins taking with the reporting party and quickly ascertains that he is experiencing paranoid auditory hallucinations. This is not uncommon for him when he forgets to take his medicine. The mental health professional is able to develop a crisis safety plan with him and they coordinate taking him to a family members home after making a stop at the pharmacy to pick up his medication. The ability to have the mental health professional on scene to make an immediate assessment facilitated:
- The reporting party was able to get his necessary medication.
- The reporting party was able to be connected to a family resource who would provide him with observation until he was stable again.
- They prevented additional calls to 911 which would take valuable resources away from the community and others in need.
- They prevented further decompensation – including hospitalization, as was the case for this person when they continued without medication in the past.
We also forget that community crisis response teams are often focused solely on individuals who are experiencing a mental health or substance use crisis; but what about those individuals who find themselves in a crisis who have no diagnosis. By definition, a crisis is “a time of intense difficulty, trouble, or danger.” This is so varied person to person. If we leave out the human component of crisis definition, we are, in fact, failing a large majority of the population. One could argue that the mere fact that someone has had to call 911 is, in fact, of itself a crisis. We do not call 911 to tell them about our best day or experience. . . we call when something is wrong, sometimes terribly wrong. Perhaps a runaway adolescent is being reported by their parents, someone discovers their house has been robbed and their most prized possessions taken, or an elderly spouse who wakes to find the love of their life has passed away as they slept. Crisis work is not intended to be something that “we” do for “them,” it is something that we all do for one another.
Creating a variety of services that meet individual needs in the moment, we create healthier communities. Thus our Mission: Creating the RIGHT response, at the RIGHT time, by the RIGHT people.
Roberts, A.R. (2000) Crisis Intervention Handbook. Oxford University Press.
Roberts, A.R. (1991). Conceptualizaing crisis theory and the crisis intervention model. Contemporary perspectives on crisis intervention and prevention. Englewood Cliffs, NJ: Prentice-Hall