Last week, Crisis Now partners and leaders from around the world released the Washington DC International Declaration, which calls for comprehensive and integrated networks as the first defense for mental health crises. In most nations, there’s unrelenting inequity in access to care for people experiencing mental health emergencies compared to those deemed physical. Both warrant timely attention, “but it’s much more than that,” says Brian Hepburn, M.D., executive director of the National Association of State Mental Health Program Directors (NASMHPD), the lead organization for Crisis Now. People in mental health crisis also must receive “the level of care that best aligns with their needs instead of defaulting to the emergency room or jail.”
The latter isn’t hyperbole, says Angela Kimball, the national director of advocacy and public policy at the National Alliance on Mental Illness (NAMI), a Crisis Now supporting organization. People experience a range of mental health crises, but in the United States, they are often referred to the emergency room, waiting long periods of time for treatment. Sometimes that’s hours. Sometimes it’s days. Psychiatric boarding, which is defined by these long waits, harms outcomes. In fact, researchers Sidra Goldman-Mellor, Ph.D., Mark Olfson, M.D., MPH, Cristina Lidon-Moyano, Ph.D., and their colleagues found that, in the U.S., there’s an increased risk of suicide after emergency room visits.
Encounters with law enforcement, says Kimball, are no less risky. Estimates suggest that 25-50% of fatal encounters with law enforcement in the U.S. involve a person experiencing mental illness. Ron Bruno, executive director of CIT International, a Crisis Now supporting organization, and a signatory to the declaration, told CrisisTalk in December that while law enforcement are essential partners in mental healthcare, they should not be the de facto mental health crisis response system. “It fell to us, but we aren’t the best solution or help to a person in an escalated state.” He said that mental healthcare shouldn’t come in a police car, and crises should be treated in the “most compassionate and least intrusive manner.” To do so, Kimball says that nations need crisis systems that offer non-law enforcement responses, like 24-hour crisis lines and crisis stabilization services, so that “people experiencing a mental health crisis can receive help, not handcuffs.” “For decades, NAMI has been in the fight to create better responses for people in crisis. The declaration is a welcomed step towards making this vision a reality.”
The ongoing COVID-19 pandemic and the movement toward community response as opposed to law enforcement, says Dr. Hepburn, makes the declaration’s tenets “more vital than ever.” Chuck Ingoglia, president and CEO at National Council for Behavioral Health, a Crisis Now partner, agrees and says that as more people experience stressors related to the pandemic, there will be an increased need for accessible crisis services and supports from an infrastructure that remains fractured. “The status quo isn’t working. Our country’s faulty, patchwork approach to crisis care represents a dramatic example of the shortcomings in our continuum of care for those with mental illness.” Ingoglia points out that while improving crisis care may pose a challenge, the need for change can no longer be ignored or delayed. “Developing an accessible, affordable, and comprehensive approach to crisis care requires leadership. It requires compassion. Most of all, it requires us to acknowledge the need for immediate change.”
Colleen Carr, director and secretariat of the National Action Alliance for Suicide Prevention, a Crisis Now partner, says the declaration is the result of years spent developing a roadmap for comprehensive and integrated mental health crisis care. “It’s amazing to see the progress made around crisis services since the launch of the Action Alliance’s Crisis Now report back in 2016.” That said, she highlights it’s now time for realization. “We know there is more work to be done to ensure we have a comprehensive and integrated crisis network. The Action Alliance is committed to working with our partners to ensure the recommendations laid out in the newly released declaration are fully implemented.”
To move the pendulum forward, says Ingoglia, institutions throughout healthcare must join NASMHPD and its Crisis Now partners to help repair crisis care and shift mental healthcare in America by way of the Washington DC International Declaration,” so people receive the care they deserve.” “We can no longer ignore the tattered safety net that is crisis care in America, and we can no longer ignore those with mental illness.”