In my opinion, the current emergency response system often overlooks the complexity of mental health crises. First of all, every mental health crisis looks different. One of the biggest misconceptions on mental health as a whole is that idea that there is one standard look to each mental illness. For example, society (and the DSM) put each mental illness into a box. Symptoms of depression, like hopelessness and sadness and fatigue, fit into one box; and symptoms of anxiety, like worrisome and overthinking, fit into another box. They often forget to take into consideration not only the overlap of two mental illnesses but also the root cause of the mental illness(es), such as genetics, brain chemistry, trauma, environmental factors, etc. Thus, even if two people have the same mental illness, that does not mean they have the same root cause. Different causes, different symptoms, different traumas, different resources accessible, different backgrounds, and more all create different ways of coping and reacting to a mental health crisis.
Why is this important? Without understanding the complexity of a mental health crisis, we cannot begin to form an approach that provides safety and support to individuals struggling.
Let’s look at the facts.
There are 4 million adults with untreated severe mental illness. Adults with severe mental illness make up:
1 in 4 of fatal police encounters.
1 in 5 of jail and prison inmates.
1 in 10 of all low enforcement responses.
In 2015, a study found that people with untreated mental illness are 16 times more likely to be killed during a police encounter than other civilians approached or stopped by law enforcement.
Using data covering 2009-2012, a study in the American Journal of Preventative Medicine found that “one in five (21.7%) legal intervention deaths were directly related to issues with the victim’s mental health or substance-induced disruptive behaviors.”
Meanwhile, surveys by the National Alliance on Mental Illness have found that people in a mental health crisis are more likely to encounter police than to get medical attention, resulting in two million people jailed every year.
What is one of the top factors contributing to these statistics?
A lack of listening.
A few months ago, I was privileged to have the opportunity to share in a conversation with a licensed social worker. The social worker dedicates time to train police officers on how to properly approach and de-escalate a mental health crisis. During our conversation, we spoke about how the current emergency response system fails mental health and what we can do about it. The biggest concern she shared was a lack of truly listening.
What do I mean by a lack of listening? According to the social worker, when a police officer is dealing with an individual experiencing a mental health crisis, a few of the most important things they need to do are:
- Be honest about what the process is. Ex. Are you taking them to jail? Are you taking them to a behavioral health facility?
- Explain why. Ex. I have to take you to jail because … I have to take you to behavioral health facility because …
- Actively Listen. Do not keep your head over the radio ignoring the person speaking. Do not interrupt the person speaking, allow them the space to speak.
Note: This is not inclusive of threatening situations where the police officer’s or civilians’ lives are in danger.
Remember, sometimes we just need someone to listen to us. If we offered a listening ear instead of assuming we know what to do, we can significantly reduce the number of fatalities and jail time for individuals experiencing a mental health crisis.
Crisis Intervention Teams (CIT)
While I was speaking with the social worker, I learned a lot about Crisis Intervention Teams.
Recently, there have been amazing developments with the formation CITs which consist of specially trained police offers and mental health professionals. The goal of this team is to address and de-escalate a mental health crisis while also having the skillset required to manage unsafe situations, such as abuse and violence. Having both police officers and mental health professionals at the scene helps the individual struggling to receive emotional support, ensures there are options other than arrest (unless arrest is necessary) such as mental health treatment, and still offers the required skillset to navigate life-threatening situations. Some CITs even offer a follow-up care system, where they pick up the individual as they are released from a Behavioral Health hospitalization or jail following the mental health crisis. This is followed by helping to ensure the individual has a safety plan in place and offering resources to the individual and family.
Someone experiencing a mental health crisis is 16 times more likely to experience a fatal police encounter. We can work to significantly reduce this statistic. How? By engaging our lawmakers in conversations regarding mandating Crisis Intervention Teams. Paying attention to whom we are voting for as our city and county Sheriffs. By listening to individuals experiencing a mental health crisis (when not in immediate danger), instead of assuming the situation is dangerous.
1 thought on “Does the current emergency response system fail mental health?￼”
Fran nice post and see The hidden links between mental disorders https://www.nature.com/articles/d41586-020-00922-8
Perhaps there are several dimensions of mental illness — so, depending on how a person scores on each dimension, they might be more prone to some disorders than to others.
The details are still fuzzy, but most psychiatrists agree that one thing is clear: the old system of categorizing mental disorders into neat boxes does not work.
Even before the DSM-5 was published in 2013, many researchers argued that this approach was flawed. “Any clinician could have told you that patients had not read the DSM and didn’t conform to the DSM,” says Hyman, who helped to draft the manual’s fifth edition.
Few patients fit into each neat set of criteria. Instead, people often have a mix of symptoms from different disorders. Even if someone has a fairly clear diagnosis of depression, they often have symptoms of another disorder such as anxiety. “If you have one disorder, you’re much more likely to have another,” says Ted Satterthwaite, a neuropsychiatrist at the University of Pennsylvania in Philadelphia.
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