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Abstract
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Models of community mental health crisis response have multiplied in the last few decades, yet an estimated one quarter to half of all fatal police encounters continue to be mental health related. Persons with untreated mental illness are 16 times more likely than other civilians to be killed when encountering law enforcement.1 Being African American and having mental illness are factors strongly associated with police fatality.2 Moreover, rates of routine mental health care access are particularly low among many minority communities, resulting in adverse interactions with police that too often lead to criminalization, trauma, and deterioration of mental illness.3,4
Response systems for mental health crises were broadly classified into three models put forward by Deane and colleagues5 in 1999 and refined by Hails and Borum6 in 2003. In this framework, crisis responses are performed by specially trained police, or mental health workers, or both, and are either police-based or mental health-based. Exemplary models include crisis intervention teams (CIT), which are a police-based specialized police response; police co-response teams (CRT), which are a police-based specialized mental health response; and mobile crisis units (MCU), which are a mental-health-based specialized mental health response.7
Existing research shows gaps and troubling trends in approaches to crisis response, such as investment in policies lacking evidence of positive patient-level outcomes. In real life, the practical use of these models differs from their theoretical constructs by virtue of their composition, resources, accessibility, and their ability to meet the needs of the community. Because of the differences among models, it is difficult to measure and compare outcomes. Today, there is no single standardized metric for determining the best model.7,8
At the heart of the existing crisis response infrastructure in the United States is the 911 call center. How these calls are handled can determine if the incident ends safely, the person in crisis is arrested, or the person is connected to appropriate care. A recent study by the Pew Research Center found that few responding call centers have staff with behavioral health crisis training and specialized resources to address mental health or substance use-related emergencies.8 Another analysis of 911 calls in eight cities found that 21 to 38 percent of those calls were for mental health, substance use, homelessness, or other quality-of-life concerns that could be better addressed by civilian first responders instead of police.9 A gradual consensus is building that crisis response systems must shed their reliance on the emergency response system and law enforcement, and must transform from the present limited availability of mental health specialized response to the point where a specialized mental health response is the standard of care...
Language: en |