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My last tweet re: MH & the effectiveness of de-escalation seemed to resonate w/ many MH clinicians & staff, medical staff, educators, etc., It’s great to see that these skills ARE impactful. However, I have some thoughts as to how we can reduce LE involvement. A long thread
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MH in the US is often reactionary. We don’t typically invest in early intervention & prevention services. We tend to offer immediate services only in or after crisis situations. I know bc I have worked in clinical & forensic county & community MH settings 2/15
When there is a crisis—I run. Fast. Cops call. Lawyers call. Community members call. It’s not a situation I take lightly bc there have been many instances where I couldn’t respond & so the person in crisis was arrested (often w/ force) vs being diverted into treatment 3/15
This is what works for me. This is not clinical advice or guidance. It is my approach based on my training. I’ve worked crises at homes, shelters, hospitals, courtrooms, schools, the street, etc., I have seen A LOT. I usually approach in a calm manner & introduce myself 4/15
in a non-threatening way. I tell them that they are not in trouble & that I am here to help. The biggest agent of change is the therapeutic alliance. Look it up there’s a lot of research on it. When someone feels connected to you, if they know you’re listening & LOOKING 5/15
at them, & are truly trying to understand how they are feeling & WHY they feel the way that they do—they’re more likely to engage with you. People do not respond well to aggression. I DON’T, so why would I assume they would? I then do an assessment to determine whether/not 6/15
they’re an imminent risk. If I can safety plan (encourage them to voluntarily engage in MH treatment w/ me, accept food, water, shelter, talk to fam etc.,)then—great & I see them every single day, stabilize, & link to long-term MH care no matter how long that takes (months!) 7/15
If they appear to be at risk & I can’t divert the crisis, I have had LE/AMR assist w/ involuntary holds (transportation only). I see them every day in the psych hospital & link them to long-term services. This is a lot of work but it’s effective. I call it the “hot handoff” 8/15
IMAGINE—if instead of having to work from this reactionary model...what if we intentionally invested in effective & preventative community-led services that don’t have long waitlists & aren’t “too clinical” but warm, inviting, & helpful? Would that mitigate risk of crises? 9/15
YES! We have to invest in all forms of MH care. We need collaborative community-led programs in which people feel welcomed & that they WANT to go to. We need to destigmatize MH disorders. We need experts AND peers in recovery & who are THRIVING to lead this & provide hope 10/15
We need intensive wraparound care provided by people who they feel safe w/ & are connected to. When we don’t invest in community members, we add to public safety issues. When we don’t provide basic but *fundamental* care & resources, we are harming & not helping 11/15
Many times (not all times), people commit crimes (which then lead to police involvement & often escalate) bc they’re ill, hungry, or tired. They’re arrested for shoplifting, panhandling, sleeping in abandoned buildings bc they have no other alternatives in order to survive 12/15
Historically unjust policies have prevented folks from obtaining generational wealth, income for education, affordable housing, food, meds, transportation, etc., I’ve helped clients apply for benefits & health insurance—it is tedious, confusing, & another systemic barrier 13/15
There are ways to truly help people who are struggling. I’ve talked to them. I’ve asked what would reduce negative behavior—it’s *resources* & connection. People need to feel a sense-of-belonging within their community. Tragically, they do not feel & HAVE not ever felt that 14/15
Also, 90% of kids & teens in the juvenile justice system endorse a form of trauma. We know that many of those same kids end up in the adult criminal justice system. We NEED to address underlying trauma in order to prevent MH crises from leading to more deaths (15/15)
