Rethinking Emergency Response to Mental Health Crises

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I’ve been handcuffed in the back of a police car twice in my life. Both times were because I was having a mental health crisis. I wasn’t violent, threatening to hurt myself, or noncompliant. It was just the policy.

The second time was because I was being transported to an in-patient mental health facility two hours away and the policy was to wrap a chain around my waist and handcuff me to it. But that’s a story for another time.

The first time happened at the height of a manic episode. I was extremely agitated. My mind and body were locked into high gear as I paced in circles and chattered on about everything that was running through my head. It had been hard to get more than an hour or two of sleep per night at that point, and I’d wake up drenched in sweat. I was exercising all the time and constantly in motion. As a result, I was rail-thin and on the low end of the roller coaster ride of weight that has accompanied my bipolar I disorder. But I hadn’t been diagnosed yet.

My girlfriend Meredith was justifiably concerned. She’s trained as a Certified Nursing Assistant and works as a patient care coordinator for a community health organization. So, when she couldn’t convince me to go with her to get assessed at a mental health facility, she thought about Crisis Intervention Team (CIT) programs. They’re programs designed to teach law enforcement officers about different types of mental illness and how to use de-escalation and calming techniques to handle people experiencing a mental health crisis. CIT programs not only reduce the number of arrests of people with mental illness, they also provide law enforcement officers with tools to help connect those in crisis with appropriate mental health resources.

Meredith, quite cleverly I might add, pivoted to convincing me to talk to someone if they came to us. She and a friend who’s a registered nurse and also works in community health were both on the phone, trying to explain that this was a mental health crisis and we needed someone with CIT training. Unfortunately, when the police arrived at the door, they were responding to what they thought was a domestic disturbance. When asked about CIT training, the lead officer seemed unfamiliar with the term.

By this time, I was sitting calmly at the kitchen table. I remember thinking that I should keep my hands visible, so I placed them on top of the table. I could still talk your ear off, but I had switched to “speak when spoken to” mode. That couldn't last forever.

To his credit, even without CIT training, the lead officer quickly assessed the situation and asked me what was going on, why they’d been called, and if I could express what I thought might help. He talked with Meredith and asked her what she wanted them to do. She asked if they could help get me to a local mental health facility with a crisis stabilization center. He said they could. I agreed to go.

Then he said I’d have to go in handcuffs. Everything almost fell apart. I didn’t get belligerent or combative, but I didn’t want to do a “perp walk” in front of the neighbors. I eventually agreed, in no small part because I could see the toll this was all taking on Meredith.

My experience could have gone better, but it also could have gone much worse. And if I weren’t white, it could have gone much, much, worse. Police are five times more likely to shoot and kill unarmed Black men over age 54 than unarmed white men the same age. Police are also more likely to shoot and kill unarmed Black men who exhibit signs of mental illness compared to white men with similar behaviors.

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Mental Health Crisis Response

That was several years ago. I’m now an education, outreach, and advocacy volunteer with NAMI Wake County and NAMI North Carolina. They sponsored me to attend the 2022 North Carolina CIT Conference on February 24, 2022, to learn more about CIT and other alternative crisis response models in our state.

CIT isn’t the only alternative approach to dealing with mental health crises. For example, co-responder programs embed mental health professionals into patrol divisions so that a law enforcement officer and a mental health professional can respond to crises as two-person teams. There are also Crisis Assistance Helping Out On The Streets (CAHOOTS) programs that respond with two-person teams, but with someone skilled in counseling and de-escalation techniques paired with a medic who is either an EMT or a nurse.

Some of the data I saw presented yesterday showed that every alternative program studied has provided better outcomes than the traditional approach, with CIT appearing to be most effective in reducing arrests of people with mental illness and increasing the likelihood that individuals will receive mental health services. Among law enforcement officers who have undergone CIT training, 82% believe the training should be mandatory. The element of training that CIT-trained law enforcement officers perceive to be the most beneficial in responding to mental health crisis calls is, by far, the program’s training in de-escalation skills for first responders.

In July 2022, the 988 hotline will go live for all who seek help during a mental health crisis. It’s an incredibly important initiative to divert callers away from 911 and connect them to local mental health services, resources, and/or alternative crisis responders. Troublingly, only four states have passed legislation to fund 988 call centers, and many local mobile crisis programs have not been augmented to meet the demand that the 988 hotline will bring. As they stand, very few mobile crisis teams in the country are available 24/7, nor are more than a few able to reliably arrive to help an individual in crisis in less than one hour.

What is needed is adequate funding for mobile crisis services, whether through legislation, Medicaid reimbursements, or nontraditional funding mechanisms. For example, some funding programs for 911 are still based only on fees from landlines. Since cellular accounts are responsible for more than 80% of total telephone spending, including fees based on cellular service accounts can significantly boost funding.

When done well, mobile crisis services save money by putting resources to work where they are most effective. They also reduce officer injuries by up to 80% and, critically, save lives. It's time they became the norm.