The case for cri­sis re­spon­ders

Bal­ti­more should send men­tal health re­sponse teams to help those in dis­tress

Baltimore Sun - - COMMENTARY - By Lau­ren Young Lau­ren Young is direc­tor of lit­i­ga­tion at Dis­abil­ity Rights Mary­land; her email is lau­reny@dis­abil­i­

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.

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