By Ashley Sanchez-Garcia, Behavioral Health Intern, Health Systems Transformation
Many people rely on the police in times of crisis, and reports estimate that approximately 20 percent of calls made to the police involve a behavioral health emergency. However, police officers are often unequipped with the resources and strategies to adequately handle situations involving a mental health or substance use crisis. Consequently, a substantial number of people with serious mental illnesses become involved in the criminal justice system. Although serious mental illnesses (i.e., schizophrenia, bipolar disorder, and major depression) are present in five percent of the general population, 26 percent of people in jail and 14 percent of people in prison have a serious mental illness. Many police encounters lead to arrests or fatal shootings, which disproportionately affect people of color, including adolescents and young adults.
Behavioral Health Crisis Response and MCH
In recent years, the mental health crisis among adolescents and young adults has been a major concern for the MCH community. From 2009 to 2019, there was a 44% increase in suicidal behaviors among high school students in the U.S. Furthermore, from 2016 to 2020, among children aged 3-17 years old, anxiety diagnoses grew by 29 percent and depression diagnoses grew by 27 percent. The youth mental crisis has been exacerbated by the COVID-19 pandemic, which has increased feelings of alienation, disrupted school attendance and impeded access to social and health-related services. Persistent behavioral and mental health disparities between racial groups and the overall decline in youth mental health highlight the urgent demand for a crisis response that will adequately meet the needs of youth. This is especially true for adolescents and young adults of color, whose experiences and needs must be emphasized in crisis response efforts.
Police interventions are more likely to result in violence when the adolescent in crisis belongs to a racial or ethnic minority group. Between 2018 and 2020 in New York City, Black children were more likely to be handcuffed than their white peers. Regardless of racial and ethnic identity, encountering the police in adolescence can impact the mental well-being of youth. Adolescents who were stopped by police officers were more likely to experience signs of psychological distress, such as disengagement, anger, anxiety, and depression. Experiences with the police also impact family lives and dynamics. When young people are arrested, the resulting family disruptions often have lasting consequences and perpetuate systemic racial injustices. These inequitable outcomes have led to a shift towards community models of intervention and support for young people experiencing crises.
Alternative Crisis Response Models
Community crisis services are defined as alternatives to traditional law enforcement in behavioral health crises. According to CLASP, these services are designed to quickly respond to youth and young adults who are experiencing a traumatic event, mental health symptoms or crisis in their communities. Community crisis services are showing promise across the country.
- Oregon’s community-centered behavioral health program, CAHOOTS (Crisis Assistance Helping Out On The Streets), has been adopted in many states and is viewed as a successful and innovative approach to de-escalating situations that otherwise could lead to arrest and possible incarceration.
- The Baltimore County Mobile Crisis program utilizes a call center clinician to assess and divert residents from criminal justice services, in order to connect them to more appropriate behavioral health resources. The program has worked by teaming licensed mental health clinicians with trained police officers, who respond to behavioral health-related calls. These calls may include situations such as family conflicts, juvenile complaints, and substance use crises.
- The Missoula Mobile Support Team (MST) is a collaboration of the fire and police departments and the city’s community health center, to help people in crisis without sending them to jail or the emergency room. Through this program, behavioral health calls coming to 911 are rerouted to MST, and a mental health clinician and an emergency medical technician are dispatched to offer behavioral health support on the scene. The MST also uses a case facilitator, who follows up with clients to provide additional support and connect them to resources. In less than a year, the MST responded to 537 calls, resulting in 169 emergency department diversions and 13 jail diversions.
Community crisis response programs that are specifically tailored to youth experiencing crises are especially necessary in light of the youth and adolescent mental health crisis:
- UMass Memorial Hospital’s Youth Mobile Crisis Intervention (YMCI) program supports youth from birth to age 21 and their families during crises by providing behavioral health assessments, interventions, support options and links to community resources. YMCI’s professionals evaluate the needs of youth on the scene; they travel to locations such as the youth’s home, school, community, or hospital settings to deliver crisis intervention services. This program is particularly innovative in that it incorporates a holistic view of the child’s medical, behavioral, and family history in order to determine which stabilizing activities, or treatment options, would be the best fit for them. Some of the activities recommended for youth include creating risk management safety plans, behavioral interventions, crisis counseling sessions, and referrals to other treatment options such as inpatient facilities.
- A similar crisis response program geared towards youth is the Child and Adolescent Mobile Crisis team based in Norfolk, Virginia. This service provides crisis intervention with the goal of preventing psychiatric hospitalization as well as injury to the self or others. This team aids children and youth up to age 17 who are experiencing crises, and this program does not require insurance or prior mental health diagnoses. The team performs assessments, provides counseling for children and their families, and links those they serve to community resources and other services.
Role for State Title V/MCH Programs
There are important roles that MCH/Title V programs can play to promote MCH mental health crisis response efforts in their states:
- Promote Medicaid coverage of peer support specialists and community health workers, who can serve as mobile response team staff
- Promote the smooth implementation of the 988 Suicide and Crisis Lifeline, and support training in youth behavioral health crisis management for state hotline operators
- Ensure that the Title V/MCH staff are represented on all stakeholder/planning committees in states that are considering implementation of crisis response programs to ensure youth and family needs are prioritized
Strengthening Community Crisis Services for MCH Populations
To build a more equitable crisis response system for youth, young adults, and families, mental health clinicians and trained community members should be meaningfully integrated into crisis response services. The shift towards centering community voices and including behavioral health specialists and medical professionals offers hope for undoing the systemic harm faced by populations of color. Leveraging these innovative crisis response programs may prove successful in reducing mortality, adverse mental health outcomes, and the rate of incarceration among adolescents and young adults. Recent demonstrations of police brutality have illuminated the racial disparities within the crisis response and criminal justice systems. These events have underscored the need for alternative models that address the social and cultural needs of individuals and families navigating behavioral health emergencies. This knowledge can motivate us to imagine and build a more equitable crisis system for families, youth, and communities.
- SAMHSA: Guidelines for Behavioral Health Crisis Care
- Mental Health America: Access to MH Care & Incarceration
- Mental Health America: Position Statement: Responding to BH Crises
- NAMI: Crisis Intervention Team Resources
- SAMHSA: 988 Hotline
- HRSA: National Maternal Mental Health Hotline
- Treatment Alternatives for Safer Communities: Homepage
- Center for Cognitive Therapy: Race, Mental Health and the Police
- NAMI: Mental Health Guide: How Parents Can Help Youth
- The Center for Law and Social Policy (CLASP): Youth Mobile Response Services: An Investment to Decriminalize Mental Health