The ongoing spirited conversation about emergency mental health reform and community response protocol is getting tiring. When I say exhausted, it is about time we reach a consensus – the issue on the docket: the 988 Rollout.
When will we reform the way crisis intervention works in the community? There need to be more definitions laid out around the term: ‘crisis’.
I am a social worker. I am also a person with lived experience. I can tell you that a crisis for one person may look different than for another person, even with the same disorder, problem, or diagnosis.
Now, imagine two people present differently. Add location (city versus rural), context (domestic situation), etc. I am pointing out that every case is different, even for a mental health crisis in the community. It is impossible to devise a protocol for each situation, and how to train and educate responders is complex, urgent, and urgent.
Regardless, the proper intervention would help to establish a ‘soft landing’ in the mental health system for people in crisis. The rise of mental health crisis triage centres or crisis respite beds across the country also diverts traffic into already overstretched inpatient units. Critical for short-term stabilisation in systems where hospital beds are in short supply.
There needs to be a community response to people having a mental health crisis: emergency medical technicians (EMTs), social workers, peers, and police. In cases with an additional risk of violence, there should be severe consideration around how the intervention is implemented and by whom. In terms of more diverse community response, the CAHOOTS model continues to lead the charge in nonviolent and low-risk interventions across the US. Still, in many situations, when a large enough degree of risk is present, CAHOOTS teams will not intervene in the crisis response and defer to the police.
I recommend having police, social workers, and peers work side by side. Down to the setup and configuration of the police station, social workers, EMTs, and peers can be regular members of the police force and community to cross-pollinate intervention strategies with the visionary and its staff.
Since the line regarding how threatening a crisis can escalate is blurred, in terms of a ‘crisis’ response, the readiness and effectiveness of crisis intervention will require more education, practice time, and to a lesser extent, additional training for all field workers.
In social work, the Social Work Accreditation Boards, the Association of Social Work Boards (ASWB), and other regulatory bodies credential and assess content areas’ rigour in disciplines of education and curriculum.
A lot more is lacking but let us start somewhere. Curriculums need to bridge an academic understanding of what it means to be in a crisis. We can begin with arming peers interested in doing this work with fundamental skills and interventions beyond Social Work 101. I am afraid learning ‘motivational interviewing’ and basic de-escalation strategies is not a sufficient skill set to take on emergency response calls.
Let’s look at the current state regulatory instruments already established for determining which mental health disciplines are ready and competent to perform the crisis work.
Let’s also advance both the curriculum of the peer workforce and practicum towards readiness in crisis intervention and social work education in addressing violence and safety issues in threatening environments.
How can states and local agencies roll this out? On the level of education and practice, one pathway forward is to require peer internships to have a much more elaborate and specific crisis intervention component beyond a tandem or extra element to their certification. In my opinion, the current broad ‘forensic’ certification isn’t enough when discussing peers going into potentially dangerous environments alongside police.
I believe the mental health community is making a big mistake by throwing any emergency service worker into a precarious situation when the potential loss of life is involved.
At the very least, we must agree on how dangerous a crisis is before intervening.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.
