One of the consequences of the death of George Floyd and subsequent civil unrest has been the idea of defunding the police to reallocate money back to social service programs that provide care to those with mental illness. On paper and as a media sound bite, this sounds good, but it is unlikely to succeed. Rather, it is a reactionary measure to poor decision-making and systemic lack of funding for the mentally ill that dates back to the 1960s.
Deinstitutionalization was the idea that scores of mentally ill could be released from mental health wards and given prescription drugs to manage their conditions. They would live productively in society, checking in at outpatient community mental health centers when experiencing crises or when their medications needed adjustment. Well, we all know how that went. Through underfunding and reallocation of money, the outpatient community mental health centers never materialized. Those with mental illness flooded the ER, the rates of homelessness skyrocketed, and jails and prisons became the new psych units. In 1980 alone, we had half of the outpatient centers we needed.
Today, the situation has worsened, even before COVID-19. There are not enough psychiatric units, not enough community mental health centers and not enough dedicated funding. Defunding police at the expense of community safety and necessary officer training is merely “robbing Peter to pay Paul” with no real plan in place when the money runs out – and it will. What happens then? Where will more money come from, and at what cost to services? What politicians and activists do not seem to understand is that mental health programs need to have structure and a plan in place. It is not so simple to take money from one entity and give it to another, especially when underfunding has been the norm. Reactionary measures such as these often fail.
The lack of funding, organization and structure has made law enforcement the go-to entity for those with mental illness. And while Crisis Intervention Training (CIT) has helped thousands of officers safely interact with individuals with mental illness and help them get the services they need, it is by no means a panacea. As a CIT trainer and coordinator, I am a strong proponent of CIT; its value is immeasurable to the officer on the street. In fact, I would love to have every police officer in the country trained and certified on CIT. Sadly, I know it is merely a Band-Aid for a much larger problem, as CIT only deals with the crisis at the moment, not the need for resources once the individual is brought to the hospital nor the necessary aftercare.
Hence the vicious cycle continues of officers being called to the same home numerous times and bringing individuals to the hospital, only to see them discharged a short time later, oftentimes on the same shift. The idea that defunding the police is going to help those with mental illness is shortsighted. Why? Because police agencies need money for training – such as CIT training – and to cover the overtime while officers are in that 40-hour CIT course and someone else is covering their shift. Not to mention the numerous other trainings, oftentimes unfunded mandates required by cities and states. Taking money from the police without a real plan on how to use that money or how much you will need to help the mentally ill is poor planning.
So where do we go from here? Instead of complaining and making reactionary decisions, let’s look at some real possible solutions.
Separate funding
The first obvious solution is to separately fund mental healthcare, more so than has been done in this country. This is not going to be accomplished by taking money from other agencies only to detrimentally impact those existing services, like our needed police forces.
Earmarking specific funding for mental health would allow for community mental health centers along with crisis centers that could provide individuals an option other than going to the ER. Crisis triage stabilization centers offer such an option. These centers provide 23-hour observation and stabilization to assist those struggling with a mental health crisis. They also allow officers to drop off individuals who would have normally been brought to the ER or the jail. The Department of Justice just approved a $750,000 grant in Lake County, Ill., for this program to open this year.
This type of program will help to divert persons with mental illness out of the criminal justice system and toward the help they need, addressing the challenges of individuals who are not taking their medications or those who need new medication or counseling. This, in turn, frees up the ER as well as needed police resources.
Alternatively, some emergency rooms have gone a step further by having hospital-based psychiatric emergency rooms to stabilize individuals with mental illness within 24 hours, freeing up needed inpatient beds and getting the person on the path to recovery. Once again, this allows for more structured treatment, which helps break the cycle of going in and out of the ER.
Both hospital-based psychiatric emergency rooms and crisis triage stabilization centers also reduce the chances that officers will need to transport the individual to a state mental health facility. Typically, 70%-80% of psychiatric emergency room patients can be successfully stabilized and returned home or to outpatient treatment in less than 24 hours. [1,2] This may also significantly reduce the need for certificate and petitioning/involuntary commitment as the person may be more willing to go to a crisis center than a hospital.
Crisis outreach teams
Many of you are thinking, this sounds good, but what about those persons who still interact with the police or with a CIT-trained officer? How do we keep them from repeating that cycle of law enforcement going back and forth to their house monthly or weekly?
In Lake County, our Crisis Outreach and Support Team (COaST) program was started in 2018 as a pilot program and has now been made a permanent part of the department. The COaST program supports persons with mental or behavioral health illnesses who interact with law enforcement. The team has one deputy and one licensed mental health counselor. Within three days of a law enforcement officer having an interaction with a person in crisis or with mental illness, the COaST deputy arranges a meeting or cold-calls their residence. During that meeting, the deputy does a wellbeing check of the person and determines whether they have sought any treatment or services since the initial event. The deputy then provides a “warm handoff” to the Health Department counselor, who conducts a brief assessment, and if necessary, refers the person to appropriate services.
While this program is not new, it is effective. Many communities across the United States have seen success implementing these types of programs, resulting in a reduction in law enforcement interactions with people having a mental illness. These programs are also shown to reduce the likelihood of individuals being arrested or re-arrested. The COaST program to date has successfully made contact 83% of the referrals to offer and help set up service to those with behavioral health and substance abuse challenges.
Respond together
Another issue with the simplistic idea of defunding the police to fund mental health is its failure to address the safety of our mental health workers. Having social workers handle crisis calls and taking the police out of it sounds tempting, but is it realistic? The short answer is no. In calls where a potential threat of violence exists, EMS routinely stages until law enforcement clears the scene. How can we expect to send an unarmed social worker into an unknown situation that has the potential to turn violent?
If you defund police and reallocate money, you will have fewer police. And while you could have a lone social worker respond to a crisis call, what happens when he or she needs to call 9-1-1 for assistance and there are no available units because the police department was defunded? This is why it’s essential to independently fund mental health without taking away other vital community services.
Rather than taking the police out of the equation, let’s have an officer and a social worker respond together to these crisis calls, not separately. Let’s create a unit designated for crisis calls only (think of Ernie and Joe: Crisis Cops).
Real solutions
If we are really going to address mental health in this country, it will not be from sacrificing one thing for another. It is going to require sitting down – politicians, police, healthcare workers, social services professionals and community members – and making a plan that gets away from Band-Aid approaches. Start with a solid CIT program that has follow-up, add psychiatric emergency rooms to hospitals, establish crisis stabilization units, and adequately fund outpatient mental health centers so people have somewhere to get proper care.
This is how you start to create meaningful results. This is how you break the cycle.
References
1. Zeller S, Calma N, Stone A. Effects of a dedicated regional psychiatric emergency service on boarding of psychiatric patients in area emergency departments. West J Emerg Med, 2014;15:1-6.
