Mental Health Policy: Actual Mental Health Services Are A Good Place to Start

A few months ago I read an interesting piece in The Seattle Times about the creation of a mental health crisis center that provided emergency beds for patients in distress discovered on the streets. It offered a radical new alternative to the city’s existing framework for handling people in a state of mental health crisis, and presents a model for policy advocates elsewhere. The underpinning of this approach is that providing actual mental health services should be a critical part of policy models, and that setting up such frameworks and getting them into place is critical for addressing larger issues within the mentally ill community.

The first people to come into contact with people experiencing mental health crises are often police officers, thanks to significant shortfalls in the safety net. Many of these officers lack training and don’t have the experience to deal with people who may be in profound emotional distress. This is still an issue that critically needs to be addressed, but it’s something that’s going to take time, policy, and a whole lot of money, which means that we need a better system in place now for police handling of people with severe mental illness.

Prior to the opening of this crisis center, when police encountered mentally ill people who were a danger to themselves or others, they had two options, neither of which was very appealing. One was to take them to the police station and book them in under the area set aside for mentally ill people, where limited intervention services were available; inmates would be released only to come right back again. The other option was to attempt to send them to a public hospital, putting strain on an overbooked system that would also have trouble providing services.

The crisis center provides a third option: Take patients to a facility with dedicated beds where they can get counseling and support from a staff dedicated to addressing issues specific to these cases. The goal of the facility is therapeutic, not punitive or aimed on getting people out as fast as possible to free up beds. Patients get a chance to meet with counselors who take time to get to know them, learn more about their specific cases, and develop a discharge plan that is intended to provide them with a framework for managing their mental illness more effectively.

It’s a far cry from the options available in many other cities, where mentally ill people on the streets are jailed, crammed into public hospitals, or shot rather than provided with the services they need. Critically, the center also provides an opportunity for early intervention and treatment; I think, for example, of the fact that Aaron Bassler had multiple incidents with the Fort Bragg Police Department before the Jere Melo shooting in 2011. Had such a center existed in Fort Bragg, it’s possible Bassler could have gotten services and appropriate interventions, rather than just bouncing around in a system that didn’t have any mechanisms for handling him because it was focused on emergency response and law enforcement, not provision of mental health services.

People with mental illness are more likely to be homeless, unemployed, or low-income if they are employed. Instability in their lives can make it harder to manage their mental illness, and increases the chances of developing a crisis. These are all known and acknowledged issues in the mental health community, which is trying to convince regional governments as well of law enforcement of the importance of providing consistent interventions and services. Otherwise, people cycle through the system over and over again, and often end up in more and more dangerous situations each time; police pick a man up while walking in the middle of the street and endangering himself, and the next few times they see him, he’s committing a misdemeanor. The next time, he’s brandishing a gun at someone.

The issue here is not that mental illness endangers people, but that poor frameworks for handling mental illness create dangerous situations. Crisis centers like this are one way of filling the immediate need for mental health services and I’m interested to see how this program in Seattle works out; it might lead to more diversion of mentally ill people away from the justice system and into care, and it might lead to a reduction in cases of violence committed against mentally ill people. It could result in some positive changes for the mentally ill population of Seattle and may also allow for the more accurate identification of people with severe treatment-resistant mental illness who might need more extensive interventions.

And it could make Seattle a safer place to be mentally ill while the city, and the nation, works on creating a mental health policy focused on the needs of mentally ill people, rather than on criminalising mental illness, denying the humanity of mentally ill people, and assuming that locking people up and hiding them is the best solution to their existence. With growing numbers of people in the United States experiencing symptoms of mental illness, particularly depression, it’s more important than ever to be making radical adjustments to mental health policy, because mental illness is something that can, and does, happen to anyone.

Crisis centers could spare us all a lot of heartbreak and frustration.