Mental health services in the United States are in an utter shambles. Constant cuts to services mean that many people can’t access continuity of care, can’t afford to adhere to treatment, including medications, therapy, and other modalities, and struggle to survive. Despite the fact that nearly 20 percent of the population experiences symptoms of mental illness in any given year, the country doesn’t dedicate the necessary resources to prevention, treatment, and maintenance, and the mentally ill community pays a high price.
When someone goes into crisis in your community and you call for help, do you know who will respond? If you’re a resident in most communities, it’s going to be police officers. Encounters between police and mentally ill people typically do not go well. People get hurt, and sometimes they die. But you may be caught between a rock and a hard place as you try to help someone who needs specialised care.
Mentally ill people are not inherently dangerous, but when they’re in distress, a factor of unpredictability can arise. Someone who is experiencing severe depression, a sharp break with reality, intense mania, or other heightened symptoms has a tough time understanding what is going on. That means that people may be unwilling to follow recommendations and suggestions like ‘I think maybe we should go to the hospital.’ They may lash out due to paranoia and fear. They are not themselves, and may be so distressed that they don’t even realise it.
In situations like that, people without training in dealing with mental health crises — which is to say, most people — really can’t safely help people who are in urgent need of assistance. And they shouldn’t try, because they could endanger everyone involved, which is not good. So most civilians are taught to call 911 and wait for assistance. Many of them likely imagine that an ambulance is going to arrive, with paramedics who will get things straightened out and help someone access the care they need. However, in many cities, it’s not medical responders who handle what is, strictly speaking, a medical crisis. It’s police.
This has happened for a variety of reasons. The same cuts that are affecting the quality of mental health care are also affecting emergency services. Many ambulances are underfunded, and going on too many runs with too few resources. It’s why firefighters are responding to more and more medical aid calls — local ambulance crews just cannot keep up. And when it comes to mental health, the myth that mentally ill people are dangerous leads many communities to believe that law enforcement officers are the ones who should respond, even though the presence of armed people in uniforms can escalate a situation when someone is already in distress.
This isn’t the fault of police. Law enforcement officers have a specific job and mandate, and medical aid isn’t it, though they do receive basic first aid training for emergencies. And while we need a lot of reform to the law enforcement landscape for the better health and safety of everyone, we shouldn’t be investing resources in training cops to do something they’re not supposed to be doing. We should be sinking those resources into more appropriate venues.
In the long term, that means making mental health services more accessible. People don’t go into mental health crisis or for fun, or because they’re too inept to manage their own health care needs. People go into crisis because severe untreated mental illness can ruin your life. Mental illness goes untreated when people can’t go to the doctor, so warning signs and a potential for referral to a mental health professional are missed. It goes untreated when people know they have a problem, but they can’t get an appointment anywhere. It goes untreated when people can’t afford to keep going to therapy, or to stay on their medications. Or when they have unstable housing situations that make it difficult to make and keep appointments. Or when they’re overworked and don’t have time to dedicate to their mental health care — and experience an exacerbation of symptoms due to stress.
If mental illness wasn’t so heavily stigmatised, and if people could readily access the care they need from competent professionals, we’d see a radical decline in mental health crises. And maybe it would be possible for ambulance crews to attend those calls, because there wouldn’t be so many. And those crews could apply their medical training to get people stabilised and get them where they need to go.
But this is long term. In the short term, these things can’t be built in a day. Which means we need some kind of option, so that when people pick up the phone for help, the people who show up will be trained, and will know what to do. Which is where crisis intervention teams come in. Some cities are starting to experiment, and more need to follow. Such teams do include specially-trained law enforcement, but also mental health professionals, and social workers. Their goal is to peacefully, safely, and swiftly resolve crisis situations, but they’re trained in how to handle the specifics of mental health crises, which leads to much better outcomes for people who would otherwise be at risk of police shootings and abuse.
Investing in a crisis team is not cheap, even with government grants and support. But it is worth it. They work. And until we have a functional mental health care framework in this country, they’re vitally needed.
Image: Ambulance!, Isaías Campbell, Flickr