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Mental health crises not the job of police | COMMENTARY

Baltimore City Commissioner Michael Harrison, left, and Deputy Commissioner of the Public Integrity Unit, Brian Nadeau,during a press conference earlier this year to discuss the release of body camera footage from the July 1, police shooting in the 5800 block of Falkirk Road of a man experiencing a behaviorial health crisis.
Baltimore City Commissioner Michael Harrison, left, and Deputy Commissioner of the Public Integrity Unit, Brian Nadeau,during a press conference earlier this year to discuss the release of body camera footage from the July 1, police shooting in the 5800 block of Falkirk Road of a man experiencing a behaviorial health crisis. (Amy Davis/Baltimore Sun)

Over the past several months there has been a great deal of discussion and support for moving the role of responding to individuals experiencing a mental health crisis from police departments to more appropriate mental health professionals.

Sen. Chris Van Hollen and Rep. Karen Bass introduced legislation last week that would provide additional funding that supports crisis intervention initiatives outside of law enforcement.

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U.S. District Judge James K. Bredar brought up the issue in July during a Baltimore Police Department consent decree hearing in which he discussed the case of Ricky Walker Jr., shot by officers in the Northeast part of the city while suffering a mental health crisis last summer. The judge said that the shooting is an example of how mental health-related incidents should not fall exclusively to police officers.

That has always been the goal of most public behavioral health systems, including in Baltimore.

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In 1992 when I was CEO of Baltimore’s Mental Health Systems, Inc., we established Baltimore Crisis Response, Inc. as the city’s crisis response agency. Over time, the city’s behavioral health authority has expanded the scope and capacity of the crisis response agency. It offers a 24-hour crisis line that handles more than 35,000 calls a year, mobile crisis services, crisis residential services as well as services for individuals with substance use disorders. However, additional steps must be taken to put and support mental health professionals as the primary responder to mental health crisis calls.

The process of reaching the goal to have social workers and other mental health personnel respond to a mental health situation will require a great deal of planning and oversight as well as additional funding. At a minimum the following should be addressed:

  • Determine the potential volume of calls. This will take an analysis of several data bases including looking at the inexact (due to the difficulty in many situations to determine the reason for the call) data from the 911 dispatch system, crisis response agency’s crisis line call volume and police data for mental health calls as well as others that may exist.
  • Based on data analysis, determine the volume potential and ensure that the mental health mobile crisis services are staffed to meet the increase volume expectation and are staffed to respond in 30 minutes or less. Timely response is critical as without it, there will be a loss of confidence in the system and it will not be utilized at the necessary level.
  • Promote one phone number to access mental health services, which is either the 911 service or linked to the 911 structure. There is national discussion about a new 988 mental health number that when implemented will be extremely helpful. Whatever number is used should be authorized to dispatch the mobile mental health services.
  • Ensure that whatever entity receives the call is well integrated within the mental health and police structures and able to track and respond to the mental health staff in the field.
  • Ensure coordination with the police department to guarantee immediate police support for the mental health staff when needed.
  • Develop quality improvement processes that can monitor the strengths and weaknesses of the structure and address high risk and poor outcome situations on an ongoing basis.
  • Develop oversight capacity that includes both law enforcement, mental health authorities and citizens.
  • Analyze the effectiveness of any effort to increase mental health capacity and evaluate if outcomes have improved and reliance on police is lessened. Make these findings public.

Having mental health staff serve as first responders to ensure better outcomes for our fellow citizens experiencing a mental health crisis is critical. The International Bipolar Foundation has said that nationwide at least 25% of people who are shot and killed by police officers suffer from acute mental illness at the time of their death. People with untreated mental illness are 16 times more likely to be fatally shot during an encounter with police than people with their mental illnesses under control. These are unacceptable outcomes and we can do better.

Stephen Baron (stevetbaron@gmail.com) was president and CEO of Baltimore Mental Health Systems, Inc. from 1988 to 2006 and the director of the Department of Mental Health and Department of Behavioral Health in Washington, D.C., from 2006 to 2015.

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