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Changes are Afoot in How We Respond to Mental Health Crises

October 14, 2020
Ron Manderscheid
By Ron Manderscheid, President and CEO, NACBHDD and NARMH
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

Major changes are afoot in our response to persons who experience behavioral health crises. In every quarter of the field, we are debating the pros and cons of police involvement, and many of us are beginning to experiment with new staffing and service configurations. This brief report will highlight some of these changes.

Just a few weeks ago, Congress and the FCC approved the national implementation of a new 988 number specifically for mental health. It will replace the use of 911, with the intent of changing the culture around how we respond to mental illness crises. Clearly, 911 evokes images of a police response; 988 does not.

At the same time, a Community-Based Response Act has been introduced in the Senate by Sen. Chris Van Hollen of Maryland, and in the House by Rep. Karen Bass of California. This act would create a new, community-based emergency and non-emergency response grant program through the U.S. Department of Health and Human Services. That initiative would establish programs to provide an additional option beyond law enforcement for community-based emergency response. The bill would allow the dispatch of professionals trained in mental and behavioral health or crisis response instead of law enforcement. 

These changes are needed badly. But as we develop new approaches to mobile crisis response that make better use of peers, who are essential for such work, as well as social workers and psychologists, we also must remember that a crisis response team is only part of the solution. We also must have a place to take the person who is in crisis. Obviously, that should not be the local hospital’s emergency department or the local jail. Rather, a crisis response center is needed, designed specifically for this purpose.

Excellent examples of such centers already exist, and others are planned. Washington County, Oregon, just on the outskirts of Portland, has implemented an excellent, easily accessible center open to all walk-ins, including those brought by the police. The state of Kansas currently is developing a series of regional crisis response centers so that such crisis services become available in rural counties. Many others are planned.

This report would not be complete without some comment about how COVID-19 already has altered how we respond to crises. Peer outreach, peer-operated warm lines and virtual care, including telephonic care, have expanded dramatically in the past seven months. At the same time, we have also been learning about the critical role these modalities play in response to behavioral health crises.

Thus, as we contemplate the future of crisis services, it seems clear that a complete crisis response system in the future will include warm lines and virtual care, mobile teams staffed by peers and behavioral healthcare providers, and a response center capable of accepting clients when the need arises. 

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