The case for crisis responders
Baltimore should send mental health response teams to help those in distress
The knife-wielding man shot by Baltimore police last week was “apparently suffering from a mental health crisis,” according to Police Commissioner Kevin Davis. Yet instead of responding with a mobile crisis team trained to de-escalate, engage and obtain mental health services, officers took aim and fired their weapons.
The Baltimore Police Department (BPD) has a history of violating the rights of people with disabilities and the Americans with Disabilities Act, according to the U.S. Department of Justice (DOJ). In its recent investigation report finding discrimination based on race, the federal agency also found the BPD routinely used unreasonable force against individuals with disabilities and those in crisis — including in situations where the person has not committed a crime or is in restraints. Officers were found to have assaulted people with mental health disabilities and inappropriately used drivestun Tasers on them, and the DOJ pointed to at least one questionable police shooting resulting in the death of an individual in crisis. ACLU-Maryland reports that of the 109 people who died in police interactions 2004-2014, 38 percent (41 people) were likely individuals with mental health and/or substance abuse issues.
While the DOJ has investigated multiple police departments across the country, only BPD has been found to engage in systemic disability-based discrimination. Disability discrimination intersects with race discrimination, and we stand in support of community responses to end both within the BPD. We offer these comments, however, specifically in response to the unconstitutional stops, excessive force, physical harm and over criminalization of disability that the DOJ’s investigation revealed.
The BPDand our criminal system should rarely be the first line of response for individuals with behavioral health crisis related to a disability. Public health issues should be addressed whenever possible as health care matters. Nor is “trans-incarceration” (moving people from locked detention facilities to locked hospitals or psychiatric institutions) a proper response. Recently there has been pressure to increase the beds at state psychiatric hospitals for courtinvolved individuals. A group studying this issue recommended more community care for people in crisis to reduce the risk of entry/re-entry into the criminal justice system. The DOJ too notes that police are often used to respond to incidents involving an individual in mental health crisis who has committed no crime or a minor crime. We have historically relied upon mass incarceration and institutionalization to control the poor, disabled and people of color. We can be better.
Baltimore can do the right thing: Develop a crisis-response system as an essential component of our health care system. Such a system facilitates the involvement of mental health professionals and peers rather than police, and provides an alternative to costly and ineffective jails, hospital emergency departments and state-operated facilities.
This is what it looks like and why Baltimore can do it: A crisis response system uses clinical social workers and experienced crisis line workers to reply to 911 calls involving individuals with disabilities in crisis. This is an initial contact point for triage and diversion, and it ensures that mobile crisis teams and service connections are made immediately as needed. Baltimore can add this component to its 911 call center and establish tracking mechanisms to report if an individual was diverted to a crisis center or emergency services, and when law enforcement is used.
Baltimore has tenured mobile crisis teams, but they are only partially funded and erratically used. They shut down at midnight for adults, and at 8 p.m. for youth. (This gap in service leaves us scratching our heads; what emergency first responders shut down for the evening?)
Baltimore also has experienced service providers who have developed plans for 24-hour sober home and restoration centers to offer immediate crisis residences with peer and clinical support (in lieu of in-patient medical beds or jail). We have elements for a comprehensive crisis response system, but in truncated form.
People in crisis prefer hope, support and community over locked buildings and threats of force. Police, jails and hospitals should be used as a last resort and in collaboration with a crisis response system. Crisis alternatives save money, alleviate pressure on facilities and police, offer recovery-oriented and trauma-informed support, and are demonstrably effective.
A crisis response system provides significant remedy to the civil rights violations detailed in the DOJ report. As Baltimore has come to reject zero tolerance as a law enforcement policy, so too must Baltimore reject zero funding for a crisis response system. We have lived with the crisis of a sick system that discriminates and incarcerates. The consequences for individuals and our communities have been devastating. It is time for a healthy response.
This frame from a Baltimore police body camera shows the aftermath of a police-involved shooting last week. The man shot, left, was armed with two knives; he survived and remains hospitalized.