Rolling the Crisis Dice: Calling for Help During a Behavioral Health Crisis
I recently had the unfortunate experience of trying to get mental health support for someone very close to me. They were in an acute crisis. The co-morbidities included trauma history, brain trauma, and a history of addiction all exacerbated by recent loss. Trying to navigate the mental health system while they were in crisis was made all the more difficult by the fact that they were on probation.
If I called for a wellness check, I might have gotten a co-responder unit that included a mental health worker, but police involvement invited the potential for escalation or violation of probation. The Alachua County Crisis Center’s Mobile Response Team wouldn’t have intervened because there was a legal history that included violence. I couldn’t call the Gainesville Fire Rescue Community Resource Paramedicine program because it wasn’t during operating hours and there wasn’t any acute drug involvement. They could not just go to therapy because of the history of seizures and potential brain trauma, and that’s not a realistic option in the middle of a crisis.
I felt stuck. Frozen. Helplessly watching someone I love struggle. If there had been any outside observers of their behavior, police would likely have been called and they’d be sitting in jail waiting to see a judge who cared very little about brain trauma, history of mental health issues or any other mitigating circumstances. This would be a cut-and-dry violation of probation and this person would sit and wait on their fate with little to no mental health intervention. (I know all too well how easy it is to end up with incarceration instead of support - read about my personal experience here).
If someone in our community has a behavioral health crisis, there are several gaps in the system. To start, if someone is in fear of the police or has been traumatized by institutions, they will not call 911. Even if they seek alternative emergency responses, the currently available programs are limited in the support they offer and are not always easily accessible. For example:
The Alachua County Crisis Center is a great resource for mental health support in our community. It also has 24/7 Mobile Response Teams for mental health crises, but they do not dispense medication or handle physical health issues, and there are several things they will not respond to (e.g. someone with a history of violence).
The Gainesville Fire Rescue Community Resource Paramedicine (CRP) program is amazing. CRP shows up to overdoses and addiction crises and travels with a medic and social worker to build relationships and connect people to resources. However, it does not have a mental health component, is not dispatchable from 911, and does not operate 24/7.
The co-responder programs consist of a mental health worker from Meridian Behavioral Healthcare riding along with a crisis-trained police officer and can be dispatched via 911. They do not operate 24/7 and the rules of engagement require the officer to make first contact, which can leave the mental health support as an afterthought. And of course the co-responders still include the police, which carries the risk of trauma, physical harm and arrest for the person in crisis.
The current system is outdated and unable to respond to present-day needs. 50 years ago paramedicine didn’t exist as a profession, but it was recognized as a crucial gap in emergency response. Similarly, while our modern first responder system has some good parts, the currently available resources each lack a key cog in the wheel of behavioral health. It should not be a guessing game as to what you’re going to get when you call for help. In the situation I faced, or any of hundreds of other examples of people in our community in acute crisis, what’s needed is support and what people are getting is a huge gamble on whether they receive care or incarceration.
Dozens of communities around the country have already started building alternatives that show how our systems can work together to offer people support and resources in crisis. One prime example is CAHOOTS (Crisis Assistance Helping Out On The Streets) in Eugene, Oregon. CAHOOTS is dispatchable through 911 and offers not only immediate stabilization of individuals in acute psychological distress and addiction crisis, but then offers follow-up support or care, referrals, advocacy and transportation to their next steps. Each team travels with a medic and behavioral health professional so they are ready to help in whatever way the case calls for. Eugene is a university city of comparable size and demographic makeup to Gainesville, so CAHOOTS is a feasible model for our community.
That’s why Links Not Locks is advocating for an alternative first responder program. We envision teams of medics, mental health professionals and social workers, easily dispatched from 911 or 988. See our proposal here or visit our website for more information. These teams could address all angles of behavioral health - whether that’s medication, mental health counseling, rehab or community resources - without police intervention. An alternative crisis response will save lives and connect people to the support they need in real time. Otherwise we are just frozen; paralyzed in fear by having to roll the dice that you may get an armed response rather than a compassionate one.
