Crisis Response in California
By Elizabeth Hancq
Alternative models of crisis intervention to responding to individuals in psychiatric crisis are being considered in municipalities throughout the country. Providing a mental health response to someone in a mental health crisis is an obvious solution, while diverting non-violent calls for service away from law enforcement.
In Los Angeles in June, the City Council voted to develop an unarmed model of crisis response to respond to individuals in psychiatric distress and instructed the Office of the Chief Legislative Analyst to analyze model crisis response programs in the United States and abroad. The report was presented to the Los Angeles City Council last month, and the Council voted to approve the motion unanimously last week.
The city plans to develop a team of specialized, unarmed mental health crisis responders to respond to nonviolent calls, looking to partner with a local nonprofit to develop and operate the model. The report from the Office of the Chief Legislative Analyst on unarmed models of crisis response in Los Angeles can serve as an example of a thoughtful and thorough investigation into how the current crisis response system is operating, where the gaps are and model programs in other areas that may address local needs.
Office of Chief Legislative Analyst research report
The report to the Los Angeles City Council begins with an overview of the current crisis response units in Los Angeles County, stating that most crisis calls come through 9-1-1 and the Los Angeles Police Department (LAPD), Los Angeles Fire Department (LAFD) or Los Angeles County (LAC) Sheriffs’ Office are often the first responder. As a result, multiple specialty law enforcement units have been developed:
- Mental evaluation units in LAPD: co-response of trained law enforcement officer and mental health professional
- Domestic abuse response teams in LAPD: co-response of trained law enforcement officer and specialty service provider
- Advanced provider response units in LAFD: co-response of a paramedic and advanced practice mental health professional
- Mental evaluation team in LAC: co-response of sheriff deputy and mental health professional
The motion passed by the City Council requires the City to develop a plan for a psychiatric crisis response system that replaces law enforcement with trained mental health professionals for non-violent and non-criminal situations. The analysts then detailed a variety of different model programs throughout the country and abroad that could be considered:
- Crisis Assistance Helping Out on the Streets (CAHOOTS), Eugene, Ore.: Mobile crisis intervention program that has been in operation for more than 30 years with great success.
- Expanded Mobile Crisis Outreach Team (EMCOT), Austin, Texas: 24/7 mobile crisis co-response model of mental health professionals and law enforcement officers.
- Support Team Assisted Response (STAR), Denver, Colo.: Mobile crisis response teams including a Licensed Clinical Social Worker and paramedic.
- Psychiatric Emergency Response Team (PAM), Stockholm, Sweden: Team of two specialized nurse practitioners and a paramedic that responds to psychiatric crisis calls with a focus on people exhibiting suicidal behavior.
While the motion in Los Angeles County is waiting for approval from Los Angeles Mayor Eric Garcetti, pilot programs for new mobile crisis response teams are being developed in other cities in California: In Oakland, the Mobile Assistance Community Responders of Oakland is a proposed pilot program operated out of the Oakland Department of Violent Prevention that pairs a mental health professional and paramedic to respond to psychiatric crises in the community instead of law enforcement. In San Francisco, a new 24-hour street crisis response team consisting of a mental health professional, paramedic, and peer support worker will be in operation sometime next month.
As more municipalities begin to develop and implement new models of crisis response for individuals in psychiatric crisis, research into the effectiveness of these programs in improving access to treatment for people with severe mental illness will become even more important. Incorporating data collection and evaluation into the design and implementation of these programs is vital to ensuring research into their effectiveness can be conducted.
Elizabeth Hancq is the director of research at the Treatment Advocacy Center