We already have a mental health crisis system — time to build on it | Opinion
There is a lot of discussion across the state — and the country — about how to help people experiencing a mental health crisis. There is general consensus — even among police officers — that it shouldn’t be police. The big question: If not police, then who?
That question has been answered in Minnesota. Public officials and activists are looking at what other cities are doing, but they overlook what is happening in our own backyard.
For over a decade we have had 37 mental health crisis teams serving both children and adults covering all 87 counties in the state, plus four tribal teams. These teams are regulated by the Minnesota Department of Human Services. DHS recognizes one team per county (or groups of counties in greater Minnesota). They are staffed by mental health professionals and practitioners along with peer specialists.
The crisis team can engage someone over the phone or travel to them to de-escalate the situation, provide therapeutic interventions, determine if a higher level of care is necessary, engage family members and develop a plan to avoid a mental health crisis in the future. In some instances, community members may have rapid access to a prescriber or assistance with obtaining insurance and community services.
Under state law, these teams are required to provide a set of services, such as assessment, a treatment plan and crisis stabilization. Crisis staff must have training in delivering crisis services like assessment, treatment engagement, working with families, clinical decision making and knowledge of local resources. And they are required to have training to ensure that services are culturally informed. These teams also collect data so we can measure their effectiveness and the outcomes.
In 2019, the mental health crisis team in Hennepin County known as COPE took over 34,000 calls and met with over 3,800 people. Statewide, teams across the state provided 13,314 face-to-face crisis assessments in 2020. The response times from referral to assessment was less than 2 hours, 84% of the time. Most people were able to remain in their own home thanks to the services provided.
Thus, people were diverted from emergency rooms and, likely, jails. Minnesota also has crisis beds for adults who need more assistance during the crisis but don’t need a hospital level of care. There are 22 programs like this available across the state with 110 beds. These programs are another important part of our crisis system.
As people consider the answer to the opening question — what crisis system? — we are hearing of cities and counties developing their own crisis response models. Some are hiring social workers to co-respond with police or hiring social workers to simply respond to calls by themselves.
There are valid concerns with our current crisis system. The teams can’t respond quickly enough or meet the needs of their community. And that’s true — because they are underfunded. Few people know how to access them, since there are over 40 phone numbers across the state. 911 dispatches crisis teams in just a few locales.
But instead of trying to address the problems within our mental health crisis system, police departments and cities are developing their own models. We at NAMI Minnesota (National Alliance on Mental Illness) are concerned that more models will lead to greater confusion.
We don’t know what services each of these city-run teams will provide, the training of the responders, how they will interact with the rest of the mental health system, or what type of records will be kept. Will these be police notes or medical records governed by HIPAA? Ordinary people won’t know the difference between the county crisis team and the city-run model, which may create confusion.
Recent legislation known as Travis’ Law requires 911 operators to refer to crisis teams where appropriate. We rely on consistency in our emergency response system. Many people call 911 in a crisis, and it makes sense for them to send out the appropriate response — fire, EMTs, police or mental health crisis teams.
While we do not have the resources for crisis teams to respond to every situation right now, many people are not even accessing the resources we do have because it is not available through 911, which is the most well known channel. 911 doesn’t need to dispatch a team for every call; many situations can be resolved over the phone. The 911 system and crisis teams should begin working together to provide a consistent response to mental health crises by connecting people over the phone and dispatching when appropriate.
Additional police training and contracting with current crisis teams for co-responder models may prove beneficial when the situation is dangerous, but there are times when law enforcement does not need to get involved.
CIT International, which provides the gold standard for training police on mental health issues, recognizes that properly trained officers can provide an effective response to a person experiencing a mental health crisis.
They note, however, that sending out law enforcement defines the situation as more of a criminal matter, which can then escalate and lead to tragic outcomes. Given the disparities of our criminal justice system, this is why Black, Indigenous and other people of color, as well as the mental health community are demanding alternatives to law enforcement responses.
CIT International went on to state that they do “not promote embedded co-responder models,” because “putting a clinician in a police car does not address these concerns.” Cities could simply contract with their county team to increase their ability to respond to more calls. Again, we have crisis teams covering every county — we should use them.
The best way to prevent people from entering the criminal justice system is to build the mental health system. Let’s put more money into our current mental health crisis system, not in our criminal justice system. At the same time, adding social workers to police departments will not be a panacea.
Let’s work together to build on the mental health crisis system that exists, making it stronger and increasing its capacity to address the mental health needs of Minnesotans.
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