Mobile crisis teams still sidelined despite growing need for mental health services in US, advocates warn
Via ABC News, September 2023
Advocates say these teams offer a "humanity-first lens" to mental health.
In the summer of 2022, on a balmy Midwestern day, Marisa Stevenson said she found herself grooving to the Steve Miller Band at a stranger's house.
Stevenson, a licensed counselor, was in that apartment on the South Side of Minneapolis because the woman who lived there—Indigenous, late 60's, living alone—had called the city's 988 lifeline: she was suicidal. And Stevenson's team at Canopy Roots, a behavioral crisis unit composed of mental health professionals devoted to responding to these situations in place of the police, was there to help.
The iconic tune from the 70's she danced to—"The Joker"—was just one way they de-escalated the situation, providing the woman the care she needed.
That model of using mental health professionals to respond to behavioral crises that would typically go through 911 is not unique to Minneapolis.
Mobile crisis teams have been around for decades in places like Oregon, Arizona, and Georgia. Federal agencies like the Department of Justice (DOJ) and Department of Health and Human Services (HHS) have praised these teams as essential to addressing mental health and substance abuse crises. In March 2022, the White House included them as a key pillar of its mental health Unity Agenda, investing almost $1 billion into community-based services that include mobile crisis response.
Since its launch in July 2022, demand for the Biden Administration's signature 988 crisis hotline has surged: as of September 2023, 5 million individuals had received support by calling, texting, or messaging the line. During that time the hotline has also rolled out specific subnetworks for Veterans, LGBTQ+, Spanish-speakers, and users of American Sign Language to meet each group’s distinct needs.
But over a year after its launch–as hiccups plagued the rollout of the 988 hotline and as data from the Centers for Disease Control and Prevention showed deaths by suicide hitting record highs in the U.S.– some mobile crisis teams say they're still sitting on the sidelines.
Across the country, some teams say they are strapped for resources, leading them to operate at reduced hours and only in limited geographies. As a result, in many places, police are still responding to most mental health crises.
That concerns people like Stevenson, who say they have seen firsthand how effective teams like hers can be.
"This model, and the program itself, is trailblazing what it means to be a mental health first responder," Stevenson said.
"[But] that's new for people ... there is definitely some warming up that needs to happen," she added, referring to the emergency agencies who dispatch first responders.
A shifting paradigm
Stevenson's team was born in the aftermath of George Floyd's killing by police in Minneapolis in May 2020.
The U.S. Department of Justice said in June that the Minneapolis Police Department "unlawfully discriminates against Black people and Native American people in its enforcement activities, including the use of force following stops," a pattern that continued even after former Officer Derek Chauvin's conviction for murder and the police department's ban on chokeholds and neck restraints.
"In these circumstances, a law enforcement-led response can lead to trauma, injury and even death to people experiencing behavioral health issues," Assistant Attorney General Kristin Clarke said of the report's findings.
The City of Minneapolis and the police department said it fully cooperated with the investigation and the city agreed to a consent decree with the DOJ that will be overseen by a federal judge.
But the investigation "reignited interest in behavioral crisis response overnight" in Minneapolis and across the country, Stevenson said.
People in the throes of a mental health crisis are 12-times more likely to face a police response involving the use of force, according to a study published in the medical journal BMC Psychiatry. Some 25% of deaths at the hands of the police are related to mental health events, research from the American Journal of Preventive Medicine shows.
And even when an encounter with police around mental health isn't deadly, the trauma from the experience can live on, mental health advocates say.
Rae Powell says she had a similar experience while living in Michigan.
In March 2021, she said her student loans came due following a COVID freeze, and within weeks, despite working 40-hour weeks on top of her college courseload, she defaulted. She says she called the then-National Suicide Prevention Hotline with a plan to take her own life. The operator informed her they'd have to send an in-person response, "wellness check," Powell said.
Powell, who said she had attended rallies in support of George Floyd just months before, pleaded with them not to send police officers. "I am a black woman in a mental health crisis," she says she told the operator, "I am afraid of the police."
When the police arrived, they had their hands on their holsters, she claimed. They snatched the stuffed animal out of her hands, walked her outside in pajamas, and patted her down with hands on her car. Powell said they drove her to a local emergency room, and dropped her off at the front door.
Powell said she eventually recovered from that episode, but she would hesitate before asking for help in the future.
"My experience is that, when you call, you are not getting someone who is familiar with mental health crises," Powell told ABC News. "[But] there's no way to get in touch and say, hey, this was bad—this was really bad."
The police department in Redford, the Michigan town in which she lived, said they did not have any information on the incident in their records.
Mobile crisis teams take a vastly different—and unarmed—approach.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of HHS, mobile crisis teams leverage standardized assessment tools "intended to reduce the impacts of bias"; advance de-escalation strategies including "respecting…physical space" and utilizing "sensory soothing" (such as blankets or smells); prioritize safety planning as a "collaborative and strengths-based process" to avoid the emergency department; and coordinate follow-up care to ensure "ongoing care after a crisis episode."
Many agencies including the DOJ, HHS, and SAMHSA consider mobile crisis teams to be essential. Where available, 988 centers can deploy them—rather than the police—for the 10% of 911 calls that are mental health-related and require an emergency response, advocates for mobile crisis teams say.
That latter point—diversion away from often unnecessary police involvement—is "especially important for communities of color where people…are at a higher risk of a negative, and potentially fatal, encounter with law enforcement," Anita Everett, director of the Center for Mental Health Services at SAMHSA, told ABC News.
Swaths of the country lack access
However, one year after the launch of the 988 hotline and almost a billion federal dollars later, many Americans still lack access to mobile crisis teams.
According to data from the past year obtained by ABC News from state health agencies, in Wyoming and Vermont, 100% of calls to 988 centers that required an in-person intervention received a police response. In New Mexico, 98% did; in Kansas, the figure was 87%; in Michigan, 79%.
The challenges for such states include, among other things, the spreading-thin of existing mobile crisis teams amid record demand, coupled with a lack of funding to expand these programs, Everett says.
In these so-called "crisis-service deserts" where these crisis teams don't have a presence, "law enforcement often serves as the de facto behavioral health crisis responders," Everett said, which she claims can increase the risk for "tragic outcomes."
In other states, the proportion of police responses is not even known. For example, Alabama, Virginia, and Washington do not track the number of police versus mobile crisis team responses, according to their health departments.
Even in the largest, ostensibly most well-resourced places, mobile crisis response is faltering. In California—where authorities have invested tens of millions of state dollars into the model—a recent Los Angeles Times investigation found that one-third of crisis callers waited over 8 hours for a mobile crisis team to arrive; that the majority waited at least 4 hours; and that wait times have tripled since 2019.
These numbers stand in stark contrast to states that have a much more robust crisis response system. For example, in Massachusetts and North Carolina, only 16% and 25% of callers to 988 needing in-person intervention encountered police as opposed to mobile crisis teams, according to data obtained by ABC News from the states' health departments.
To people like Stevenson, the benefits to mobile crisis response are obvious: something she calls a "humanity-first lens."
In the case of that elderly woman on the South Side that Stevenson helped, rather than taking her against her stated will to the emergency room for further evaluation given the woman's explicit intent to self-harm, Stevenson's team at Canopy Roots brainstormed alternatives. The one they came up with: using a power ballad, a building superintendent, and a granddaughter to help de-escalate the situation, was better for everyone, Stevenson said.
SAMHSA, for its part, said in a report that mobile crisis response—paired with community resources—can often be a safe alternative to emergency rooms.
Still, "there are people who are very attached to the status quo," Stevenson said of officials in regions that are not investing in mobile crisis teams.
"People have difficulty conceptualizing that there's something out there that could be better…because they've never seen it," she says.