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I was interviewed today by a student about mental health crisis response. Here is a thread of my answers to their questions on why, when emergency response is needed at all, sending trained peers w/ shared lived experience, along with an EMT, is better than sending police.
Most ppl in severe mental health crisis are not threats. Ppl displaying unusual behavior or experiencing altered states of consciousness are not inherently violent or criminal. There is a threshold for when an emergency response is even useful. Avoid escalating the crisis.
How to respond to a crisis as a community member and how to know when to escalate is a topic for a different thread. Assume for now that an emergency response is needed beyond the capacity of those who are around.
Safety is priority. Interruption of harm is distinct from supporting someone in an acute crisis or providing long-term support. Mental health crisis should be treated as a community issue and a health issue, not a criminal justice issue.
Often, mental health crisis is the result of multiple, unaddressed issues with a person's ability to comfortably exist in their environment. Short + longer-term support should involve addressing these conditions, not punishing the person for their reaction to those conditions.
People in mental health crisis have agency. Their behavior is a response to their internal + external environment. It has its own logic. Challenge the assumption that people need to be coerced into treatment for their own good + that their resistance to care is irrational.
If people are resisting support, it is because they do not feel safe or comfortable with the type of support being offered. If people know that you are going to violate their autonomy if they go with you or provide information, they are not irrational for not doing so.
People in crisis may communicate in ways that are unusual, but they still communicate. When a responder is nondirective + attuned to the information the person is providing with their behavior, they are able to figure out what to do to create an environment of safety and choice.
Ppl in severe enough crisis where an emergency response is warranted usually do want support. They can't always communicate what kind + they don't want to be coerced. If you establish safety + offer options that are relevant + viable, they usually will consent to engage with you.
Altered states may be the result of an underlying medical issue. Once safety + consent have been established, if there is a cause for concern about immediate life-threats, the person who is seeking support should be checked out by an EMT who is not an agent of state surveillance.
EMTs and police are not equipped to provide mental health support. EMTs assess for life threats, once there is consent. I advocate for a trained peer from the community who shares lived experience w/ the person in crisis to be the one to offer non-coercive, non-directive support.
Someone with lived experience with the type of crisis a person is experiencing will have a much easier time connecting with them. Connection and safety are what is needed when someone in crisis, not coercion.
Loss of autonomy is at a core of many of the reasons people experience mental health crises. Threats to people's autonomy intensify their response. People experiencing mental health crisis are also often sensitive to environmental stimuli.
When you send a team of multiple, uniformed officers with weapons, they use loud voices, disregard consent, and make a big scene, what that serves to do is make people in crisis suspicious, defensive, and afraid, which undermines any attempt to create safety.
A goal of crisis support should be avoiding transport, not coercing it. If home isn't safe, they can consent to go somewhere equipped to support. Jails + emergency rooms are not good places for ppl who are sensitive to environmental stimuli. We need to create safer environments.
One time I saw 911 get called on someone surviving outside. When they got there it was someone they knew who was always being harassed by folks for no reason and he said, "You better not be here for me." The EMT got back in the ambulance and said, "I don't see a patient here." A+
