PROTECTING THE VULNERABLE, by Kevin L. Tower
I recently read an article entitled “NO-ONE RECEIVES PSYCHIATRIC TREATMENT IN A SQUAD CAR,” [54 Tex. Tech. L. Rev. 645 (Summer 2022)] by attorneys Judy Ann Clausen and Joanmarie Davoli.
The article is well done and gives a thorough overview of the current response to the severely mental ill (“SMI”) during crisis. The article describes three main areas to focus on: 1) advanced directives for mental health, 2) identification system for SMI clients, 3) response to a SMI crisis and transportation for stabilization.
The current approach is to patch a government system that is underfunded and inappropriate for these services. Let’s think about this. If you were at an inpatient psychiatric facility and had a crisis, who would you want to respond to assist you? Probably not the police even if they had specific training. Probably not a paramedic largely untrained in mental health and if so, probably little more than the police. I would hope that it would be a skilled mental health responder. In fact, if I had a twin and we both suffered from SMI and my twin was having a SMI crisis, the last thing I would do would be to call the police or an ambulance. Why? I would not want them treated like they are responsible and everybody responding is more concerned about protecting themselves instead of ensuring the safety of my twin. If I call an ambulance, the ambulance by protocol must call the police. If I call government mental health, they also will call the police and ambulance.
When the response turns to protecting others before the patient with SMI is protected, that is an inappropriate response before it starts. A threefold response team of police, mental health and paramedic has good intentions, but does not fill the role. Guess what? Even these well intentioned systems collapse upon any mention of violent or aggressive behavior by the SMI client. Only the police respond to these incidents.
Here in the United States, when the police, fire and ems respond to a 911 call, the type of emergency determines who is in charge. If it is a fire, the Fire Department is in Charge, If it is a medical, EMS is in Charge, if it is a crime scene, the Police are in Charge. Why then(?) are the police in charge during a SMI crisis even if the person is violent or aggressive. Is everyone with mental health problems so undesirable they are a criminal until proven otherwise?
Our Country has quickly adapted to substance abuse overdoses by making narcan widely available to police, fire, ems and the at risk public. Why then, can’t we do the same for SMI crisis? We have begun they decriminalization of substance abuse, but not mental health reform. We are way behind!
Our Country periodically goes through reform. Today, that is mental health and criminal justice reform. If we only ate beans and the beans became infested, we might be quick to destroy all of the bean plants, leaving people starving until it reaches our own doorstep. Our Country needs a structural change in the approach to mental health and criminal justice. I believe, once identified, a behavioral health system is more humanely qualified to service both ends of the spectrum.
Behavioral Health can serve both mentally ill and criminally deviant clients. Today, although understaffed and well underfunded our jails and prisons utilize mental health to treat mental illness and cognitive behavioral therapy for the offender. They also provide evaluations to courts and parole boards. It is time to expand the scope of behavioral health and refocus the scope of law enforcement.
Modern neuroscience and psychology have embrace both mental illness and criminally deviant clients. The quality, efficiency and effectiveness of our institutions depend on the expansion of both the educational infrastructure for behavioral health and the career opportunities in behavioral health.
My proposal is to: 1) expand the educational infrastructure for behavioral health, 2) develop a blue collar behavioral health technician program to provide emergent and urgent intervention and prevention through education and coaching to promote healing, 3) develop a confidential awareness and support system that provides ongoing contact with “at risk” persons to prevent and / or provide early intervention when necessary, 4) base mental health systems around school districts.
In my proposal for Citizens for Social Awareness and Response (CSAR) I explain how this can fit together in a cohesive system of professionals and volunteers. I think the CSAR technicians could be trained in a twelve month full-time academy at Community Colleges. That training could look like this: 16 weeks prescience, 16 weeks behavioral health awareness, and 16 weeks behavioral health response. The starting wage for a qualified technicians after the academy would be $25 – $28 per hour.
In utilizing technicians, the law must be clear when they are called and that they are in charge at the scene. The Tech’s in a SMI crisis would be trained to deescalate the crisis, medically restrain or immobilize the patient when necessary, or provide coaching to promote and wellness.
CSAR would embrace Advance Directives for Behavioral Health and include substance abuse to the list of qualifying conditions. CSAR would also embrace the advance directives being listed in the confidential database with permission to transport.
CSAR would recommend that insurance companies and Medicaid / Medicare be required to cover: SMI Crisis Response, Transportation, Emergency Evaluation & Treatment, and processing and maintaining Advance Directives for Mental Health.
It is the duty of this Country to embrace change and to correct injustices by developing a behavioral health awareness and response that is desperately needed. CSAR supports and encourages this reform.
DO NO HARM: CRISIS CARE RESPONSE
Our Country has experienced great tragedy in handling mental health crisis. I believe we should not have “crisis intervention” nor “crisis response,” but have “CRISIS CARE RESPONSE.”
Currently, if someone is having a mental health crisis and there is no aggression or violence involved, the encounters are generally safe and no tragedy occurs. When aggression or violence is reported or observed, only the police are involved until the scene is rendered safe. That means, when mental health responders are needed the most, they are unavailable. That is the “CRISIS” of a “crisis response.”
I propose a “Crisis Care Response,” where technicians are trained to deescalate and immobilize aggressive and violent mental health clients in a patient safety and care first approach.
I recently proposed an organization called “Citizens for Social Awareness and Response,” (CSAR). My objective in CSAR is to prevent mental health crisis before the start. This requires an “awareness.” Communities must become actively aware of the social needs of the community. This would require volunteers to check in with “at risk” persons in the community, tailored as needed to prevent mental health crisis. Secondly, a skilled technician would develop a compassionate and empathic relationship with the “at risk” person. I would wholeheartedly agree with the use of advanced directives for mental health and include transportation in those directives.
I disagree with the current approach to the severely mentally ill (SMI) crisis response. The response needs to be “non harmful,” not “lethal” or “less than lethal.” The response needs to be a “crisis care response” and mental health needs to be in charge of mental health emergencies. When you call 911 for yourself or someone else who is having a mental health crisis, you need mental health to respond and be in charge.
I want to see a new program that trains technicians to respond to mental health crisis and provide cognitive behavioral coaching for “at risk” persons. Because behavioral health provides and oversees education and therapy for mental illness and criminal offenders, behavioral health technicians could be trained to cover both. That means a behavioral health technician may provide cognitive behavioral coaching to a mental health patient and to an offender all in the course of a days work. When there is a crisis emergency, the technician responds like a paramedic for the mentally ill. This frees up police and ems resources. Secondly, it prevents mental health providers from having to respond.
The behavioral health technicians would need extensive training. This might require a full-time year long training program. The training could be divided into three successive areas: Prescience of mental health and criminology, subject area training, and finally cognitive behavioral coaching and crisis response. The technicians would also be trained to utilize equipment that would immobilize a person in a medical way using “non-harmful” equipment and techniques.
I am asking our Federal Government to issue emergency funding for rapid research and development of non harmful equipment to immobilize individuals when necessary. The equipment must allow use by medical and mental health responders.
Stop the Harm and demand our government provide a non harmful crisis care response to mental health crisis and to immobilize police suspects who may resist due to mental health crisis, substance abuse or stress.
Thank you for your consideration.
Kevin L. Tower
No. 253542
Lakeland Correctional Facility
141 First Street
Coldwater, Mi 49036
