(New York) – Communities across the country are developing alternative models for mental health crisis response Human Rights Watch, New York Lawyers for the Public Interest, and the Center for Racial and Disability Justice at UCLA Law School said in a report released today. This approach is sorely needed as US police kill hundreds of people each year, many of whom have documented mental health conditions, and as federal, state, and local jurisdictions seek to implement a more forceful approach to mental health crisis response and treatment.
The 66-page report, “‘Self-Determination is the Path to Liberation’: Alternative Mental Health Crisis Responses in the United States,” identifies key elements of a rights-respecting response to mental health crises and explores how alternative mental health crisis response programs have implemented this approach in practice. Many of these models share core elements, including promoting individual autonomy, providing voluntary support rather than ordering compliance, and avoiding unnecessary law enforcement involvement.
“Having the police as the primary or default response to people experiencing a mental health crisis is ineffective and sometimes lethal, if the focus is on force and compliance,” said Tanya Greene, US program director at Human Rights Watch. “Fortunately, there are alternative approaches that emphasize personal autonomy and consent to treatment.”
Researchers studied more than 150 crisis response programs from across the United States and found eight that have committed to implementing key aspects of a supportive, rights-based mental health crisis response without police as the primary or default responder. The researcher interviewed program administrators and, when possible, community members and advocates for perspectives unrelated to the program. The researchers used international human rights law and standards as tools to identify key elements of rights-respecting programs.
In many cases, the presence of the police leads to mental health crises and leads to coercion and violence. People with mental health conditions are particularly at risk of police violence and are more likely to be killed in police encounters than people without disabilities. This risk is especially true for black people and other people of color with mental health conditions. The police often tend to approach people in crisis with orders and call for compliance in situations when the interaction is more nuanced and supportive which peers who have mental health experience live-and mental health workers can provide.
The eight programs featured in the report are based in communities around the United States. Some are connected to local governments, while others operate independently. Response teams vary in composition, although most include peers, social workers, emergency medical technicians or paramedics, and crisis intervention specialists. They typically respond on-site to people experiencing crisis, and provide a variety of services, including assessment, de-escalation, safety planning, crisis counseling, education, transportation, referrals to community resources, and follow-up.
The program was developed in recognition that police-centred mental health crisis responses often result in violence and harm to those in need of support. Black people and people of color are particularly exposed to that violence and harm, due in part to the structural racism that exists in policing, mental health care, and society in general.
Programs that emphasize a non-coercive model and a non-police response seek to avoid that violence and provide more effective support to people in crisis by mobilizing and training peers and other professionals, who are interested in the culture and community they serve.
The metrics by which the program is evaluated include eliminating the police as primary or standard responders, avoiding involuntary treatment, implementing a consent-centered approach to treatment, promoting peer participation, providing trauma-informed and culturally responsive training, and maintaining a deep connection to the community they serve. The study evaluated the program’s commitment to providing accessible services, response times compared to other emergency services, follow-up care, and minimizing power imbalances between service providers and those they support.
“This program serves as an example of how we can truly serve individuals and communities to make their own decisions through support and care,” said William Juhn, senior staff attorney for the Disability Justice Program at New York Lawyers for the Public Interest.
Although no single program plans to embrace or implement all criteria that respect these rights, each program is oriented toward at least some of them. The study did not evaluate outcomes and did not endorse any program-specific model or approach to crisis response.
“As federal, state, and local governments move toward more coercive approaches to mental health crisis response, such as involuntary commitment, hospitalization, and forced treatment, it’s important to understand that programs that respect human rights actually exist,” said Jordyn Jensen, community engagement and communications manager at the Center for Racial and Disability Justice.
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