The tragic death of George Floyd and the resulting protests against police brutality have produced calls by the Black Lives Matter movement and others to “defund the police.”
While the slogan has different interpretations, the movement brings welcome attention to what the National Shattering Silence Coalition (NSSC) and other advocates have long called for—the need to invest in psychiatric care and social services specifically targeting those experiencing serious brain disorders, not the “worried well,” and to shift responsibilities such as brain illness-related crises and homelessness away from law enforcement and into the hands of medical and social service professionals. The responsibility for the failure of our health system should not fall on the police.
In many respects, the goals of the Black Lives Matter movement and those of brain illness advocates are aligned. The lives of those with serious brain illnesses commonly known as “serious mental illnesses” matter too (#SBILM), and these individuals, black and white, are also disproportionately killed and jailed. They, too, are discriminated against, marginalized, and profiled.
Despite the many efforts over the years to provide crisis training to law enforcement, the sad reality is, the risk of being killed by a police encounter is 16 times greater for individuals with untreated brain illness than for other civilians. As many as one in four people killed by police have a severe brain illness. These tragedies are a direct result of our failure to invest in treatment, housing, and other services for people with serious brain disorders such as schizophrenia and bipolar disorder. With the closures of psychiatric hospitals over the past almost six decades and a lack of community health services to take their place, there are now ten times more people with severe brain illnesses in jails and prisons than in state hospitals. There is simply nowhere for law enforcement to take people in crisis.
We at the NSSC have experienced firsthand the toll our broken health system has taken on our families and patients. Our children and siblings have been discriminated against, arrested, denied treatment, left homeless, and jailed for the crime of being ill. And we are left stunned by our country’s indifference.
It is somehow acceptable in our country to treat those with some brain disorders differently than others. A person with Alzheimer’s would never be left to wander the streets, yet we leave people with a different type of brain illness homeless. If people with Alzheimer’s need treatment but don’t recognize they’re ill, we don’t ignore their needs in the name of protecting their civil rights. But we deny treatment to those suffering from brain illnesses like schizophrenia—unless or until they become a danger to themselves or others. It’s time to insist on a health care system that places the same priority on early intervention for this type of brain illness as it does for other brain illnesses, knowing that is how to achieve the best outcomes.
Brain illnesses like schizophrenia and bipolar disorder are the only health emergencies in which a police officer responds instead of a medical professional. When armed police respond to people experiencing a brain illness crisis, too often the encounter ends in tragedy. It’s the only illness where people are denied treatment because there is nowhere to treat them and/or because they cannot recognize they are ill.
The FCC is set to vote at it’s July 16th open meeting to make 9-8-8 the number people can dial when having a mental health emergency. All telecommunication carriers and Voice over IP service providers will be required to implement the new number nationwide by July 16, 2022. Currently, they have to call 1-800-273-8255 (TALK). This is a huge step in the right direction. No longer will people have to call the police when experiencing a psychiatric emergency. This will provide people with the services of a trained clinician who can help them access services and take the pressure off of the police to deal with situations they were not adequately trained to handle.
In concert with a national mental health hotline, if we invest in a continuum of treatment and services for these individuals instead of settling for the broken patchwork of Band-aids that is our health system, the investment would pay for itself and alleviate, if not, do away with the need for law enforcement’s involvement with those experiencing brain disorders. We would also save on criminal justice expenditures and need fewer jails. If we invest in hospital beds, reform nonsensical civil commitment laws, and take advantage of life-saving AOT for those patients suffering from anosognosia, we could ensure that more people with brain illness get treatment before a crisis, not after. And it would free up police resources to focus on true law enforcement matters. This is not to say that law enforcement will no longer need to be able to identify and assist people experiencing a psychiatric crisis. There will still be a need for them to be able to recognize when someone is experiencing psychosis versus being under the influence of illicit substances or alcohol, or just being combative. NSSC believes that going forward, CIT training should be a required course for everyone attending law enforcement school and not as just an afterthought for those who are already officers.
In order to access prompt medical attention during a psychiatric crisis, it’s time for the rest of the country to follow RI International’s lead. They have created extremely successful crisis care systems operating in California, Arizona, Delaware, North Carolina, Texas, and Washington using the “Crisis Now” concept that brings help to people immediately and doesn’t require a call to the police.
Using the “Crisis Now” concept, SAMHSA has created the National Guidelines for Behavioral Health Crisis Care – A Best Practice Toolkit that provides mental health authorities, agency administrators, service providers, and state and local leaders with a roadmap for how to design, develop and implement crisis care systems and provide continuous quality improvement efforts.
The core elements of these crisis systems are a regional crisis call center, a mobile crisis team response, and crisis receiving and stabilization facilities (see video here). The crisis call center is staffed 24/7 with clinicians overseeing triage and other trained team members to respond to all calls received. The mobile crisis team response offers community-based intervention to individuals in need wherever they are, including at home, work, or anywhere else in the community where the person is experiencing a crisis. They recommend two-person teams including a clinician able to assess the person’s needs, a peer support person, and an ambulance crew if warranted. They respond to calls without law enforcement “unless special circumstances warrant inclusion in order to support true justice system diversion.”
In the “Crisis Now” model, “crisis receiving and stabilization services offer the community a no-wrong-door access to mental health and substance use care, operating much like a hospital emergency department that accepts all walk-ins, ambulance, fire and police drop-offs.” They are also required to accept patients picked up by the police requiring involuntary care or those brought to an ED.
RI’s flagship facility in Phoenix, Arizona, has accepted more than 20,000 successive law enforcement drop-offs without rejecting a single one. Those who need longer stays or more intensive treatment are provided a warm handoff to a psychiatric hospital, assisted living facility, or wherever is deemed to be the most appropriate placement. RI’s services work together with AOT for individuals with anosognosia. It is vitally important that all crisis care systems also utilize AOT given the fact that approximately half of those experiencing schizophrenia and 40% of those with bipolar disorder do not know they are ill and will not seek help on their own. It’s the number one reason why they refuse medication or do not seek treatment.
It’s time to stop thinking of involuntary commitment and Assisted Outpatient Treatment (AOT) as dirty words. AOT is mandated outpatient treatment, usually through court-order, for people with psychosis who have a history of medication noncompliance, as a condition of remaining out of inpatient units. This can include orders to adhere to prescribed medication, attend outpatient appointments or both.
Involuntary commitment and AOT are life-saving tools that bring treatment to those who are too ill to access treatment on their own. Those who disagree should listen to this podcast by Eric Dias, who serves on NSSC's Steering Committee. His interview with Eric Smith, an AOT graduate, is a powerful testimony to #AOT as a life-saving treatment tool. Smith is an articulate, well-informed, and thoughtful speaker. He does a great job of dispelling the myth that disability rights groups at the government-funded Protection & Advocacy for Individuals with Mental Illness (PAIMI) and others wish to perpetuate—the notion that it's better to die with one's rights on than to receive life-saving treatment.
NSSC supports these efforts and any others that will direct more funding to treatment for those with serious brain illnesses. Implementation of additional positions in the NSSC’s Points of Unity would further reduce the need for law enforcement involvement, and therefore the potential for acts of excessive force against clearly ill individuals of all races.
#BLM #SBILM #SilentNoMore #CostOfNotCaring