Who Responds Best to Mental Health Emergencies?

Mobile crisis teams and peer support services can help to serve those struggling with a mental health crisis and connect them to care, but can they replace police?

As calls for defunding the police increase, the question has become even more timely and was front and center at a hearing on Thursday of the Subcommittee on Criminal Justice and Counterterrorism for the Senate Judiciary Committee, which focused on policing and behavioral health.

Among both the subcommittee members and the other witnesses, there appeared to be broad support for improving police training in deescalation tactics and for engaging mobile crisis teams and other types of support. Some witnesses, however, questioned the ability of mobile teams to safely address and quickly respond to high-risk situations.

"The purpose of the hearing is to talk about changes we need to make when it comes to how we as an overall society are going to respond to people dealing with mental health crisis," said Subcommittee Chair Cory Booker (D-N.J.).

Police officers have become de facto social workers, mental health counselors, and medical experts, as they are often called on to respond to individuals in the throes of a mental health crisis, but most police have neither the training nor the skills to address these problems, Booker said.

As a result, situations can escalate quickly, he said, noting that people with untreated mental illness are 16 times more likely to be killed during a police encounter compared with the general public.

One of the hearing's witnesses, Keris Jän Myrick, MBA, MS, co-director of the Mental Health Strategic Impact Initiative and a board member of the executive committee for the National Association of Peer Supporters, has been diagnosed with schizophrenia.

Her first close-up encounter with police happened in her 30s in Los Angeles, she related. She was in emotional distress and feeling paranoid. She was expecting an ambulance or fire truck with paramedics, but instead, to her embarrassment, the police arrived at her apartment, announced loudly that they were doing a welfare check, deemed Myrick a danger to herself, and took her to a police station, where she was handcuffed to a chair. She was terrified.

This was the first time she had ever experienced a heightened sense of distress and the need for mental health support, she said. "What I didn't need was the police response, and being treated like a criminal."

Scarred by that experience, Myrick said, she was reluctant to ask for help to deal with mental health problems in the future, when she needed them most.

Mobile Crisis Response Teams

Ebony Morgan, RN, program coordinator for Crisis Assistance Helping Out On The Streets (CAHOOTS), a mobile crisis response team, described how the response to a mental health crisis can be dramatically different from what Myrick experienced.

CAHOOTS staff operate in unarmed pairs of a crisis worker and a medical professional and respond to calls taken by police dispatchers. Using police radios the teams coordinate with the police departments and community partners to determine which calls are appropriate for their staff, and then meet community members where they are. This frees up local police to respond to the kinds of calls they are trained to address.

If CAHOOTS employees arrive at a scene and determine that they need law enforcement's support, they can contact them over their radios.

These mobile crisis teams can also link clients to community resources such as walk-in crisis centers, permanent supportive housing, or sobering and "detox" centers. But communities must, in turn, identify these needs and invest in such programs.

"No employee has ever lost their life or been seriously injured on the job despite never carrying a weapon, and no clients have died as a result of us showing up to help," Morgan said.

Policing issues hit close to home: Morgan's father Charles died during an encounter with police when he was 25 and she was 5.

Peer Support Services

Witnesses also highlighted the benefits of engaging peer support specialists, individuals with lived experience of a mental or behavioral health problem, when responding to crises.

Certified peer support specialists, those with special training, can be particularly helpful in the midst of a crisis in helping to identify the needs of an individual in crisis and to "slow things down," Myrick said.

Peers can be part of a mobile crisis response team and should also be incorporated into the response to calls to 988 -- the three-digit suicide prevention hotline, expected to launch in 2022.

Myrick also pointed to peer "respites," safe spaces where a person with a behavioral health problem can go after a crisis, as an alternative to hospitalization.

In addition, she said, as part of a more long-term solution, peers can help others develop Wellness Recovery Action Plans as well as a strategy for responding to potential future crises, known as psychiatric advanced directives.

She said that there is evidence that when peers engage others who are in crisis, by sharing their own stories of recovery, those struggling with a mental health problem are more willing to participate and adhere to treatment and hospitalizations; homelessness also drops, Myrick noted.

Safety Issues, Timeliness

Terri O'Connor, a former 911 dispatcher from Philadelphia, whose husband, Sgt. James O'Connor, was killed in the line of duty in 2020, said she didn't think it was realistic to expect a mobile response team to arrive quickly to a scene.

"I don't know how long it would take to get a mental health worker to show up to a situation. I feel like the police are always going to be the first one to respond," she said.

Rafael Mangual, JD, senior fellow and deputy director of legal policy at the Manhattan Institute in New York City, said mobile response teams are not necessarily built to replace police but the model could be helpful when complementary to a police response.

Mangual cited data from a study conducted in Philadelphia showing that in 20% of police calls, the nature of a call does not appear to be "predictable." In other words, calls made regarding situations that are initially viewed to be public health-related may later be deemed criminal activity.

"While reform is a worthy pursuit," the government's first duty is to provide for the public's safety, he said.

The Demand for Services

Morgan disagreed with the notion that mobile response teams were not sufficient on their own to respond to most mental health crises.

According to the latest CAHOOTS call data from 2019, she said, staff responded to about 17% of calls to police or about 17,700 calls. Of those, staff requested police backup for 1.5% of calls or 311 times, and of those 311 calls, only 5% of them were seen as situations where there was an "imminent threat."

Another witness, Major Martin Bartness, commander for the Education & Training Section of the Baltimore Police Department, praised the co-responder model, but said there are glaring capacity issues.

Response teams in Baltimore consist of a licensed clinical social worker and a trained crisis intervention team officer, he explained. They're accessible 7 days a week, but only 8 hours a day, and are responsible for the entire city.

Such teams do respond quickly to calls but, he said, "in order to do that to scale, there has to be more funding."

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