By Hannah Wesolowski
About 2 million times each year, people with mental illness are booked in our nation’s jails, often because communities rely on law enforcement to respond to mental health crises — and they lack the needed resources to truly support someone in crisis. It should not be the job of law enforcement to respond to health care crises, and people experiencing a mental health emergency deserve quick access to effective mental health care — just as people expect when experiencing physical health emergencies.
In 2020, Congress passed the National Suicide Hotline Designation Act, creating 988 as the nationwide number for suicide prevention and mental health crisis response. This number will be available in every community beginning in July this year, with the goal of connecting people in mental health crisis with mental health services.
NAMI supports the National Guidelines for Behavioral Health Crisis Care, released by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) in early 2020. This framework identifies three pillars of services that every person experiencing a mental health crisis should have:
The second pillar, mobile crisis teams (MCTs), presents an opportunity to significantly reduce the role of law enforcement in mental health crisis response. Unfortunately, very few communities currently have this type of service available.
Ultimately, the goal of MCTs is to provide effective and timely care, while allowing individuals to remain in their communities, whenever possible.
One of the most well-known and established MCT programs is CAHOOTS, Crisis Assistance Helping Out On The Streets, which has been operating in Eugene, Ore., through the White Bird Clinic since 1989. In a NAMI Ask the Expert special webinar series last year featuring CAHOOTS Program Director Ebony Morgan, she described their program as “operating in unarmed pairs with an EMT and a crisis worker.” The service is available throughout the city offering crisis intervention, support and resources to the community.
CAHOOTS and similar MCT programs are often dispatched when someone calls 911 or non-emergency police lines. When 988 becomes available, ideally 988 call centers will also be able to dispatch CAHOOTS-like teams — although 911 and 988 should always be in close collaboration. Once on the scene, MCTs assess a situation and are, as Morgan says, “ready to be helpful in whatever way is most effective.”
In some cases, a family member may call and request law enforcement, but Morgan notes that often, “Family members don’t know that we’re an option.” In these cases, CAHOOTS will work closely with dispatch and can be sent to the scene. There, they can build rapport with the individual, provide on-the-spot counseling and de-escalation, or transport the individual to a local emergency room that has psychiatric services, if needed.
Sometimes, an individual who needs more care than can be provided in the community may not want to go to the hospital. The team can’t force anyone to go anywhere, so instead, they try to explain how it might be helpful. “It’s a lot more comfortable to come with us of your own choice and just ride in the back of our van than to be handcuffed and put in a police vehicle and taken there against your will,” says Morgan. Once at the hospital, the team provides a warm handoff by sharing information with the hospital staff.
MCT programs provide many types of support in addition to crisis response. They can provide grief counseling or wellness check-ins They are also trained in basic medical care and carry Narcan, a prescription medication that can reverse an opioid overdose, in case they are first to arrive on the scene. Morgan says CAHOOTS “brings both the medical and crisis intervention perspectives, which allows us to have a more holistic approach to each call.”
CAHOOTS leaders agree that partnership with law enforcement is critical. “We are not trained in law enforcement and do not have the same authority as police,” says Morgan. But the partnership with local police is a benefit to everyone, especially law enforcement. “It benefited the police when they were able to drop someone off that did not need to be in jail but did need some support.”
Now, CAHOOTS holds monthly meetings with the police department and works collaboratively to solve problems for the community together. Some situations require both the police and the CAHOOTS team to respond together, or one may call on the other for help. “What we do is work with these partners to figure out in what way we can best meet the situation’s needs.”
The evidence surrounding the impact of MCTs is compelling. MCTs have been shown to save money by reducing the number of hospital admissions and incarceration for people with mental health needs or substance use disorders. Nearly 85% of people who had an interaction with an MCT received an intervention other than hospitalization.
People who have become disconnected from mental health services are more likely to re-engage with those services after having contact with an MCT. This is especially true for those with depressive disorder, mood disorders and psychotic disorders.
Creating these teams locally is not a given; advocates will have to push for their availability to ensure that the response we need to divert from justice system involvement when someone calls 988 is available everywhere. It’s critical that advocates push for these programs in their communities and across their state. Bringing key stakeholders to the table, including law enforcement, is important to build programs that have buy-in and cross-system support.
There are also opportunities for funding MCT programs that can be leveraged immediately. The recently-enacted American Rescue Plan Act included an option for state Medicaid programs to cover mobile crisis services, which was named after the CAHOOTS program and championed by Senator Ron Wyden (D–Ore). States can currently choose to provide this in their Medicaid program. Additionally, a pending proposal in Congress would establish a grant program to help communities create CAHOOTS-like mobile crisis teams.
As we reimagine the future of mental health care, supporting MCTs will be a critical step in transforming our currently insufficient approach to crisis response.
Learn more about 988 and the crisis services NAMI is advocating for by visiting nami.org/988. To urge your members of Congress to support MCTs and other parts of the crisis continuum of care, visit nami.org/crisisadvocacy.
Note: This article was originally published in the Spring 2022 Issue of the Advocate.
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