As communities struggle with COVID-19 and increasingly respond to emergency rules, Major Sam Cochran (ret.), co-chair of CIT International’s Board of Directors, said leaders must support and keep open essential mental health crisis services. He shared with #CrisisTalk that without them, the default mental healthcare provider and law enforcement drop off location would typically be the local county jail. As cases of COVID-19 continue to rise in institutional corrections facilities, “the county jail is saying, ‘No, this can not come into our facility.’” That then leads law enforcement to drop off people experiencing a crisis directly to the hospital emergency room, which is not only overburdened but also a source of the virus. “Neither one of those options is good, but the officer has to make a decision.”
Maj. Cochran said while this pandemic is new, getting leaders to understand the importance of supporting comprehensive crisis services isn’t. In 1996, he was in Memphis, sitting at a long table with county executives at one end and those from the state at the other. Representing CIT, he sat in the middle with a NAMI advocate. The topic was emergency room crisis services. “The emergency room no longer wanted to be the first line, crisis service provider. This is after several years of successful relationship building and dropoffs, but something changed.” In response, NAMI and CIT, along with other partners in the community, put their heads together and came up with adding a community crisis assessment center. The center would have multiple disciplines attached to it to address the needs of the whole person, such as housing, employment, and treatment.
We Need Leaders With Heart to Get Us Through COVID-19
In Memphis, the county takes on the majority of the funding roles when it comes to social services. During the meeting about the community crisis assessment center, the state and county began pointing fingers at one another, saying it was the other one’s responsibility. It was at this point that the mayor interrupted and said, ‘So, I can spend more money to build additional jail floors, or I can put county money in this program you’re talking about, trying to keep people out of jail.’ That’s when the mayor decided to invest in funding the center. It took a leader, said Maj. Cochran, to shift the dialogue and attached dollars to improving the situation for people in crisis. “It’s one thing to be a leader, but we need leaders who are going to improve people’s quality of life; that’s leadership with heart.”
During the pandemic, Maj. Cochran has had to point out to community leaders in Memphis where this crisis will go without adequate support of behavioral health crisis services. He shared with them that there will likely be increased demand on crisis facilities because of rises in stress, unemployment, and housing instability. Also, some facilities will have to close due to infection, so others will need to pick up the slack. “Unfortunately, most facilities are limited in space, which makes it challenging to implement social distancing.” To address this, Maj. Cochran communicated with his partners and contacted the facility where the local crisis service is housed, asking for additional space. “To get their cooperation, I just said, ‘Hey guys, if we can’t drop people off at the crisis facility, the next level of care is the hospital emergency room. That’s the worst scenario.’ Addressing and resolving these concerns was quick, and space was immediately added, which is a testament to robust partnerships supporting each other.”
Community Partnerships Move System Issues
It’s during disasters like the COVID-19 pandemic where a built-out CIT platform is especially crucial. Maj. Cochran said outcomes will be far superior where it already exists “because we can quickly make phone calls to leaders within our partnerships to coordinate logical, practical solutions to the issues we are confronting with the virus.” While having a platform in place beforehand is optimal, it doesn’t mean that leaders can’t develop those vital relationships and start supporting crisis services now, but “it does mean they need to value it in terms of funding.”
The partnerships in the CIT platform aren’t just focused on crisis services, said Maj. Cochran, but more broadly, they are designed to move system issues that are barriers to people with mental illness getting the help they need. He says because crisis care is siloed in many communities, the pandemic has the potential to exacerbate problems in systems that may not be working very well in the first place. “The system or systems in communities across the United States are fragmented or non-existent. Either way, it’s not helping, and the burden then falls to law enforcement.”
Leaders Need to Prioritize Supporting and Keeping Essential Crisis Services Open
Even in instances where communities have a robust crisis continuum, CIT officers are worried about what will happen to people with mental illness if leaders strip down to essential services and mental health crisis services aren’t deemed so. Maj. Cochran said that law enforcement knows what that looks like, and they don’t want to go back. “You want to separate the person in crisis from law enforcement as quickly as possible because the longer a person is attached to the criminal justice process, the more likely that person is going to end up in the criminal justice system.” That means having a system in place to do so and ensuring that it’s not taken away; otherwise, “the person is going to end up in the county jail or emergency room because there aren’t other options.”
Maj. Cochran said that’s where we are right now with COVID-19: “Our country has to take care of its people.” He said the pandemic is causing the ground to shift beneath communities, which means people need “to wake up and act like a community.” He says, if we don’t address those issues of crisis care, “CIT officers are just being nicer and kinder but can’t get people to the services they need.” That’s why, he notes, leaders must see how crisis services can play a critical role in keeping communities healthy by diverting people in crisis from where the spread of illness is most probable: jails and the emergency room.
All of us need to monitor our self-wellness during this stressful time, but we need to assist people who are shut up in isolated environments, including children. We have a responsibility not only to ourselves but also to take care of others in the community. And we have to protect hospitals, so they can focus on helping people with the most severe symptoms get through this illness.