As the United States heads deeper into its third year of the Covid pandemic, Whitney Bunts says the past 25 months have been especially tough on young people. They’ve navigated quarantine, isolation, loneliness, and a series of alleged returns to normalcy that weren’t. Young people have also had to maneuver family issues and stress. There has been an increased proportion of emergency department use for behavioral health stress among children 5-11 and 12-17, which, during the pandemic, increased by 24% and 34%, respectively. Bunts is a youth policy analyst at CLASP, a nonprofit that advances policy solutions to improve the lives of people with low incomes. She says that youth mobile response can help divert young people experiencing mental health challenges from the school-to-prison pipeline.
When Bunts first started digging into mobile response crisis services as a law enforcement alternative for young people experiencing mental health challenges, it was in the role of technical assistance for Prince George’s County, Maryland. The county shared that while mobile crisis services existed for children and adolescents, it was poorly funded. “They asked us what other communities were doing and how they were funding their mobile response services,” she says. The two-year project was coming to a close when a pivotal moment in U.S. history began: the intersection between a national racial reckoning and Covid, the pandemic’s differing impacts, and the murder of George Floyd by four Minneapolis police officers on May 25, 2020.
Communities were becoming increasingly aware of the need for mobile mental health services and alternative, non-law enforcement responders. The very topic Bunts had been researching. “That’s when we realized the memo should be an external facing document,” she says. She also started researching the history of youth mental health and the criminal legal system. The resulting report is called Youth Mobile Response: An Investment to Decriminalize Mental Health. In the report, Bunts highlights the mobile response services for young people in three states: Connecticut, Oklahoma, and Oregon.
Bunts’ work was, in part, fueled by frustration. Despite counties nationwide compiling workgroups to trace how people with mental health challenges enter the criminal legal system and Congress’ landmark passing of the National Suicide Hotline Designation Act, youth mental health remained on the back burner.
She points out that the pandemic hasn’t affected everyone the same way. Instead, it has disproportionately affected Black and Hispanic families, making it more likely that they become ill and die of the virus. It’s important to note that vulnerabilities to the virus aren’t inherent to a person’s race but “because of the disadvantages U.S. systems have created,” as psychiatrist Rochelle Head-Dunham, executive and medical director for the Metropolitan Human Services District in New Orleans, told us in October 2020. She shared that policy is “both the problem and solution.”
During the pandemic, marginalized families have also experienced food insufficiency, difficulty paying for housing and household expenses, and higher unemployment. These hardships fell after the enactment of the American Rescue Plan but have persisted. “Covid has disproportionately affected Black and Brown young people, and youth mental health needs have spiked,” says Bunts, “but nobody was talking about the intersection between youth mental health, race, and the criminal justice system.”
The school-to-prison pipeline, she says, results from systemic racism and biases in the education system and faculty members who aren’t sufficiently trained to identify student mental health challenges or what to do if they do. “Schools rarely know how to deescalate a crisis,” she says, “and they don’t fully comprehend the needs of young people.” As a result, Bunts points out that schools frequently default to zero-tolerance policies.
Dr. Sharon A. Hoover, co-director of the National Center for School Mental Health at the University of Maryland School of Medicine, told #CrisisTalk in 2019 that zero-tolerance policies are both ineffective and discriminatory. Black and Hispanic children are more likely to be disciplined, largely contributing to the school-to-prison pipeline. An incident that garnered media attention was when an officer in Queens, New York, handcuffed a 12-year-old student and took her to the local police precinct. The principal called the police to report the child’s offense: doodling on her desk. Alexa Gonzalez had written in green marker: “I love my friends, Abby and Faith. Lex was here. 2/1/10.”
Last year, a Los Angeles Times article highlighted that teachers aren’t trained to identify or adequately respond to students’ Covid mental health trauma. While the pandemic has increased the need for school mental health, Bunts points out that the “youth mental health crisis” isn’t novel. “They were struggling before Covid happened,” she says. Trauma is a barrier to learning, but schools nationwide haven’t known how to address it, so many didn’t and haven’t. Instead, they continue to default to discipline. For example, when a 17-year-old in California, Peter, began sleeping on the roof of his high school, the administration’s response was to suspend him, warning that if he came back to the school, they’d involve the police.
He and other students and teachers filed a class-action lawsuit against the Compton Unified School District. They argued that students have a fundamental right to school-based mental health support, and the district didn’t adequately train teachers to help children struggling with trauma. They won, setting a critical precedent and alerting school districts nationwide that they were responsible for addressing their students’ trauma. Some communities had begun to improve their school mental health services when the pandemic hit, says Bunts, but most hadn’t.
She points out that many schools have a police presence but are without in-school mental health services. “Millions of students are at schools with a police officer but no counselor, no social worker, and no school psychologist,” says Bunts. This increases the likelihood of criminalization instead of understanding students and meeting them where they are.
Bunts believes that mobile response services can bridge education and behavioral health systems. “Systems in the U.S. are so siloed, and there’s insufficient partnership and interaction between them,” she says. “That’s especially true for education, which is so set on being independent of every other structure.” Mobile response teams can help by providing schools with a non-law enforcement alternative when students are in distress—these partnerships can also help schools better understand their students’ mental health needs and fill in gaps at schools that lack sufficient resources. “If a school doesn’t have a mental health social worker, they would still have someone to call if a child needs help,” she says.
As a first responder model, Bunts says a non-law enforcement mobile response can provide rapid care to young people—youth and young adults—experiencing mental health symptoms, a traumatic event, or a crisis in their community. Bunts’ report includes Connecticut’s statewide mobile crisis intervention services and Oklahoma’s statewide youth crisis mobile response and stabilization system. The two-person mobile response teams in Connecticut and Oklahoma comprise behavioral health workers. In the report, she also dives into the Crisis Assistance Helping Out on the Streets framework in Oregon, commonly called CAHOOTS, which launched in 1989, where teams include a medic—a nurse, paramedic, or EMT—and a behavioral health crisis worker.
Oklahoma funds youth crisis mobile response through state and Medicaid dollars, while Connecticut supports mobile crisis services through federal block grants, Medicaid, commercial insurance, state funding, and philanthropy. The city funds CAHOOTS services in Eugene, and Springfield uses braided state and city funds. Bunts notes that the intervention program also receives donations, Medicaid funding, and a small percentage of federal funds.
Section 9817 of the American Rescue Plan Act of 2021 allows states to use a Medicaid funding bump to expand home- and community-based services. Some states, like Washington State, are using these funds to establish and grow their youth and adult mobile crisis services. In Washington, funding will ensure that by the end of the 2022 fiscal year, each region in the state will have at least one adult and one children-and-youth mobile crisis team that can respond to incoming 988 calls, texts, and chats. States are also turning to section 9813 of the Act that allows enhanced federal Medicaid funding for qualifying community-based mobile crisis intervention services, which began on April 1.
The ability of youth mobile response to stabilize young people and divert them from the criminal legal system is impressive. For example, in Connecticut, partnering schools reached out to mobile crisis intervention services instead of law enforcement, resulting in a decrease in school arrests ranging between 40 and 100 percent, depending on the school. The service also has robust data collection, helping schools better understand their students’ needs and focus on prevention, allowing them to be proactive instead of reactive.
As states prepare for 988, the three-digit number for mental health, substance use, and suicide crises telecom companies must direction to the National Suicide Prevention Lifeline by July 16, Bunts hopes state and local leaders pay attention to young people and not assume their resilience means they don’t need rapid and equal access to support. “988 has the potential to be transformative,” she says. “But if we just implement it with no real consideration or emphasis on a young person’s experience, we will continue the system we already have, which criminalizes and dehumanizes young people for their mental health needs.”