Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at editor@crisisnow.com.
Handcuffed in the back of a police car after being pepper-sprayed, a nine-year-old in Rochester, New York, is sitting hunched over. Between sobs, she says to the nearby officer, “Please don’t do this to me.” The officer replies, “You did it to yourself, hon.”
Nine officers are at the scene, responding to a call of “family trouble” and a possible stolen car. On the body camera footage, the child, who is African American, is visibly in distress. Instead of lessening her suffering and quickly connecting her to care, the officers’ use of force and pepper spray exacerbate it.
What’s painful about watching the body camera footage is the lack of humanity shown to a child. Equally disturbing is how many missed opportunities there were to respond appropriately to the nine-year-old’s escalated state and connect her with proper care.
Law enforcement have long been shoved into the role of default mental health provider, but an emergency response primarily focused on safety, not how to help a person in psychiatric distress, isn’t the best help to a person in crisis. The Forensic Intervention Team (FIT) was just a call away, illustrating the chronic disconnect in many communities between 911, law enforcement, and mobile crisis services.
Racial and mental health inequality and police brutality are playing out on a national scale, says Ken Zimmerman, founder and co-director of the Mental Health Strategic Impact Initiative (S2i). At the same time, the pandemic marches on, with nearly 8 million Americans sliding into poverty since the summer, and rises in student suicides have pushed school districts to reopen even as infection rates haven’t abated.
The intersection between race, criminal justice, health inequities, and Americans’ increasing awareness of the pandemic’s associated challenges on day-to-day life has created an opportunity. “It has pushed mental health to the forefront of people’s awareness unlike any other moment in U.S. history,” says Zimmerman. He says it’s a chance for social justice reform that we must realize or lose.
Over his 25 year career, Zimmerman has been a civil rights lawyer and policymaker in the Obama and Clinton administrations. He was the director of George Soros’ domestic philanthropy at Open Society Foundations and has held many other positions that have taken on challenging social policy areas such as homelessness, criminal justice reform, and urban development.
Despite vast experience in social change, his involvement in mental health policy and programs began when his oldest son, Jared, developed a serious mental illness, which resulted in his son’s death in 2016. “The deficits of the mental health system,” says Zimmerman, “left us unable to get the supports we needed, and the result was our worst nightmare.”
Zimmerman adds, “And our tragedy occurred even though we had many advantages, including access to committed and well-meaning professionals.” “It put into stark relief how broken the system is.”
System insufficiencies meant, for example, that when Jared needed a crisis response, his family was told the only place they could take him was the emergency room, where he, and they, languished for days awaiting care.
Navigating the behavioral healthcare system with his son led Zimmerman to realize that while a fragmented mental healthcare system has universal consequences, it’s mostly remained stagnant as an area of social policy. “There hasn’t been the same movement in mental health social justice reform as criminal justice over the past 15-20 years,” he says.
Not too long ago, terms like tough-on-crime, the War on Drugs, and superpredator peppered criminal justice language on the hill in Washington, D.C. It gave real momentum to the growing levels of incarceration in the United States, says Zimmerman. Academic John J. DiIulio Jr. coined the term “superpredators” in 1995. President Nixon first declared war on drugs in 1971, around the same time that states across the nation focused their public safety policies on getting tough-on-crime.
“No one would have thought then that the consensus among Americans today would be that we incarcerate far too many people,” says Zimmerman. “There’s a disparate impact on people of color, it’s not cost-effective, and there’s a moral case for shifting how we do criminal justice.”
Unlikely partners, including law enforcement and social justice advocates, propelled the momentum of reform forward. These groups rarely saw eye-to-eye but came together because they realized the criminal justice system wasn’t working and had to change. Evangelical Christians, fiscal policy experts, and racial justice leaders also worked collectively, believing that imprisoning people for lengthy periods, particularly people with mental health challenges or substance use disorders, wasn’t just unfair, it was immoral. State and local governments, overwhelmed by recidivism rates and the budgetary implications, also got on board.
“The high costs weren’t advancing public safety or public health,” says Zimmerman. “In fact, they were undermining it.”
Celebrities spoke out, and continue to speak out, on criminal justice reform, stating it would address longstanding racial inequities. “Enough is enough,” They said. The data scientists and policy experts at groups like the Vera Institute of Justice and the Urban Institute provided analysis and data that reinforced the point that criminal justice penalties and policies like cash bail disproportionately hurt disadvantaged defendants and their communities.
Zimmerman founded the New Jersey Institute for Social Justice, a non-profit think tank in Newark that advocates for racial equity and systemic reform. It has long fought for policies that strengthen urban communities while addressing inequities. He continued that fight as Governor Jon Corzine’s chief counsel, advancing programs and policies that enabled New Jersey to lead the nation in per capita incarceration reduction.
In 2017, New Jersey made comprehensive pretrial justice system reforms, which included moving away from a cash bail system, resulting in misdemeanor arrest reductions and fewer people sitting behind bars awaiting due process.
Judge Steven Leifman told us in 2019 that there are three kinds of people who remain in jail until their case is heard: those who have an attached felony, those who can’t afford to bond out, and those experiencing a mental health crisis and don’t know how to get out. Zimmerman says addressing mental health inequities can take the same approach as criminal justice reform. “It means creating bridges across systems and constituencies,” he says.
With 988 on the horizon, Zimmerman points out that speaking the right language with each constituency matters. The three-digit number will mirror 911 for behavioral health emergencies and must be available nationwide no later than July 16, 2022. He says the first step is “listening to people.” To do just that for criminal justice reform, he and his colleagues convened a reentry roundtable in New Jersey.
It brought together community activists, law enforcement, elected officials, social service providers, family members, and people who’d been incarcerated and were constrained by their criminal records. “Each group had their particular concerns, but we identified specific areas where we could gain traction,” says Zimmerman. Over a year, these roundtable cross-sectoral conversations turned into a consensus.
During this same time, pilot programs illustrated what worked. For example, the New Jersey Institute for Social Justice ran a program connecting formerly incarcerated people to jobs that could get them into the building construction trade unions.
Dialogue expanded to organizations and entities that weren’t interested in criminal justice reform, per se, but were attracted to the cost-effectiveness of the programs and outcomes. Another hook, says Zimmerman, was the power of storytelling, with people sharing their experiences. “This helped to engage the greater public, people who otherwise wouldn’t have gotten involved,” he says. “It began a positive, virtuous cycle of more people realizing, ‘Oh, we can get reform and build it out.’”
However, funding is a crucial component of social justice reform. Zimmerman notes criminal justice reform took a funding commitment to say, “We’re going to see what does or doesn’t work.” He points out while mental health has all the core elements to be a top philanthropic priority, philanthropies haven’t taken it on. “They’ve been unsure what one can do to change the mental health system,” he says. “It’s a big system with many new acronyms.” He also believes stigma plays a role. Healthcare reform is the number one domestic issue among the public, but somehow that hasn’t crossed into mental and behavioral health. “The disconnect is astonishing,” he says.
This is where intermediary organizations like S2i come in, a disruptive think tank that can speak both philanthropy and mental health, bridging the gap between them. “It’s hard to break in if the philanthropic community doesn’t have sufficient familiarity with the topic,” says Zimmerman.
Intersections between criminal justice and mental health aren’t novel, and experts have long been aware of the dire need for partnership and collaborations. Pre- and post-arrest diversion programs and partnerships between CIT police officers—officers trained in de-escalation and trauma-informed care—and crisis care services are making a much-needed change in some communities. “Approaches that are far better for the person in crisis,” says Zimmerman, “and they also cut costs.”
However, these convergences haven’t, until now, reached a tenor that’s caught the attention of the public or philanthropic organizations. That’s beginning to change. For example, in Maryland, the Horizon Foundation—a health philanthropy—pioneered an initiative and provided the seed money to transform behavioral health crisis care in four counties. They explicitly aim to address racial inequities in behavioral healthcare. However, this is still a rarity. Zimmerman points out that mental health reform is inseparable from social justice but rarely thought of as part of the social justice movement.
“That’s part of the problem,” he says. “There needs to be a shift in the narrative.”
Americans have shared the Covid pandemic experience and are aware of how it has affected their mental health and that of their parents, children, neighbors, friends, colleagues, and communities. They’ve also witnessed, through police body cameras, George Floyd’s murder by four Minneapolis police officers on May 25.
The inhumane treatment of the nine-year-old in a mental health crisis came on the heels of another tragedy in Rochester when officers responded to a mental health crisis call in March 2020. Officers found Daniel Prude, a 41-year-old Black man, naked in the street. When he began spitting, they put a mesh bag over his head and pushed his head into the pavement. Two minutes later, he stopped breathing.
After Prude’s death, Rochester put together specialized Person in Crisis (PIC) teams made up of mental health workers, including family crisis intervention and mental health crisis response teams. They are early in the pilot phase and had only been open a week when the child’s mother called 911. Why wasn’t PIC called to respond to the nine-year-old’s crisis? Because existing protocols—the 911 initial call was for “family trouble” and a possible stolen car—triggered a police response. It’s unclear how this case will shift protocols.
At present, PIC mobile crisis teams go out in place of the police. Meaning, a call either triggers law enforcement or PIC, not both. Officers can’t call PIC for assistance.
However, the officers could have called the Forensic Intervention Team (FIT), diverting the child to appropriate care once the mom told police the child threatened to harm herself and her mother. Unlike PIC, Fairport Police Chief Samuel Farina said officers can call FIT to assist people facing mental health challenges or family trouble. Adam J. Bello, county executive in Monroe, said a FIT team was available at the time of the incident to respond to a call from the officers.
Strengthening the behavioral healthcare system, while necessary, won’t suffice unless partnerships across intersecting systems are fortified. Zimmerman says it will take collaborations across K-12 education, housing, employment, and criminal justice to move the marker and reform mental health. To do so, S2i draws on the expertise of Zimmerman’s co-directors: Keris Myrick, a national leader in mental health including engagement of people with lived experience, and Fred Karnas, who has held many senior public and philanthropic roles and is a former executive director of what’s now the U.S. Interagency Council on Homelessness. The initiative also has an advisory committee and council of experts with experience in healthcare, labor, civil rights, and community engagement.
One of S2i’s initial efforts is to build appropriate connections between the criminal justice and behavioral healthcare systems and halt the inappropriate ones. To do so, S2i has developed a cross-sectoral collaboration with Fountain House, the Center for Court Innovation, the Technical Assistance Collaborative (TAC), and the W. Haywood Burns Institute. The partnership will bring a racial justice and lived experience lens to identify gaps and the policies, programs, practices, and innovations to address them.
The intersections between criminal justice and mental health crisis services are a leading example of where philanthropic investments can change outcomes. “I call it a Goldilocks issue,” says Zimmerman, “It’s big enough where philanthropies can make a difference over a period of years, but not so large that it feels like you’ll never be able to make a change.” To effectuate real change with funding dollars, he says mainstream philanthropy needs to “step up and step in.”
“This moment is flush with possibilities,” says Zimmerman. It’s these seedlings of change that underlie his optimism and hope for the future, but he points out that the effort will take all of us. “Together, we have the greatest potential for change.”
Photo: Rochester Police Department | YouTube
