NASW-Illinois Chapter Diversity, Equity, and Inclusion Committee (NASW-IL DEIC) Subcommittee on Treatment Not Trauma
The mental health crisis in America is at an all-time high. The number of individuals receiving and needing mental health services have skyrocketed during this pandemic. The current demand on mental health care proves that there needs to be a more thoughtful and innovative approach to the intervention and delivery of mental health services. We as the NASW-Illinois Chapter Diversity, Equity, and Inclusion Committee’s (NASW-IL DEIC) Subcommittee on Treatment Not Trauma strongly agree that mental health clinicians are the best choice and resource for effective intervention in mental health crises, which is consistent with best practices. The NASW-IL DEIC Subcommitee on Treatment Not Trauma also supports the statewide passage of the Community Emergency Services and Supports Act (CESSA) and the Treatment Not Trauma Ordinance for the City of Chicago as our state and city are in desperate need of a model that serves to protect and safely intervene in mental health crises rather than the current inhumane and thoughtless approaches in crisis response.
“People with untreated mental illness are 16 times more likely to be killed by law enforcement…reducing the likelihood of police interaction with individuals in psychiatric crisis may represent the single most immediate, practical strategy for reducing fatal police encounters in the United States.” —Treatment Advocacy Center
CESSA
On August 25, 2021, Illinois Governor J.B. Pritzker signed the Community Emergency Services and Supports Act (CESSA) into law, which requires emergency response operators to refer calls seeking mental and behavioral health support to a new service that can dispatch a team of mental health professionals instead of police, marking a significant change from current policy.
CESSA stands for Community Emergency Services and Support Act. It is a bill created by racial justice advocates at Access Living in partnership with the family of Stephon Watts. CESSA addresses the health needs of people who are not violent and who are not violating the law by sending support instead of police.
CESSA requires these calls be referred to the Department of the Human Services-Division of Mental Health (DMH) for immediate assistance, which can include dispatching mobile mental health units. The DMH program is set to roll out statewide no later than July 2022.
CESSA helps create a new approach to emergency response to fill a critical gap in Illinois’ capabilities, aiming to cut back on unnecessary lock-ups and reduce police violence, particularly in Black and brown communities. Black and brown disabled people make up at least half of those killed by police.
The City of Chicago and the Need for Treatment Not Trauma Ordinance
In 2021, the city of Chicago budget was 1.7 billion allocated to police while only 9.3 million was allocated to public mental health. The city of Chicago spends 37% of its total unrestricted budget on the city’s police. This is more than the city tax dollars spent on affordable housing, children’s services, fire services, public health, workforce development, and water utilities combined. The disinvestment in public mental health has functioned to destroy the lives of individuals, loved ones, and communities of those struggling with mental health. Under former Mayor Rahm Emmanuel’s administration the huge shift in disinvestment in mental health care occurred, resulting in the closure of 9 public mental health clinics in the city of Chicago. The impact of this decision has grossly devastated our communities and lost many their lives at the hands of police.
The city of Chicago has failed to provide adequate funding and resources to its residents in providing access to mental health care for those most vulnerable and disenfranchised. The outcomes of Chicago police intervention have shown us that they lack the skill set which mental health clinicians are trained, to safely intervene in mental health crises. Untreated mental health conditions are a major factor in police confrontations, and people with mental health problems face significantly higher death rates during interactions with police. Most notably is the story of 19-year-old African American college student Quintonio LaGrier and his neighbor Bette Jones, both of whom were killed 5 years ago by a Chicago police officer while LaGrier was experiencing a mental health crisis.
There have been numerous other incidents where individuals suffering from mental health crises and their seek for help has ultimately cost them their lives. The following individuals have unjustly lost their lives at the hands of Chicago police during a mental health intervention: Philip Coleman, 38, Quintonio LaGrier 19, James Anderson, 33, Raul Barriera, 21, Bette Jones. Stephon Watts, 15, and perhaps most notably, Laquan McDonald, 17, whose death garnered national attention.
The Treatment Not Trauma Ordinance proposes a co-responder model based off the CAHOOTS model that allows for mental health clinicians to effectively intervene without the presence of police. The research on the effectiveness of the non-police co-responder model is unequivocal. The CAHOOTS program in Oregon, on which the Treatment Not Trauma proposal is based, responded to over 24,000 calls in 2019 with a nurse, an emergency medical technician (EMT), and a mental health crisis worker. This team was able to non-violently “assess the situation and provide immediate stabilization in case of urgent medical need or psychological crisis, assessment, information, referral, advocacy, and, when warranted, transportation to the next step in treatment.” If needed, they could contact the local police department for support, but they have only had to do that .006% of the time. Moreover, from a financial standpoint, CAHOOTS estimates that the co-responder model “saves the city of Eugene an estimated $8.5 million in public safety spending annually.” Other large US cities like Denver and New York have recently implemented similar co-responder models with similar results.
One of the greatest misconceptions is that mental health clinicians fear doing crisis intervention work; however, mental health clinicians including social workers, psych nurses, and therapists have been committed and thoroughly trained in their professions to address such needs. Social workers and mental health clinicians receive extensive education and training in assessment, intervention, and effective nonviolent de-escalation techniques to address mental health crises. The notion that this approach puts mental health clinicians at a greater risk for harm is simply a fallacy not based on real data and statistics. The truth is that only three to five percent of violent acts can be attributed to people living with mental illness, making police presence not a necessity in intervention.
CAHOOTS Model
The mobile response service proposed by CESSA and Treatment Not Trauma Ordinance is based on the CAHOOTS model that operates in Eugene, Oregon, and dispatches teams of medics (either a nurse or an EMT) and a crisis worker (who has at least several years of experience in the mental health field) to calls requesting help for mental and behavioral health emergencies.
The CAHOOTS (Crisis Assistance Helping Out On The Streets) model was developed in 1989, by the White Bird Clinic and the city of Eugene, Oregon, to address the needs of underserved communities that were experiencing crisis related to mental health symptoms. This program hoped to address the problem in a non-violent manner, giving treatment that would enhance the way mental health in the community is viewed.
This program is part of the police department as far as budget is concerned but does not include police department personnel. This is a 2-person team collaborative of crisis worker and EMT or nurse. The key component is the crisis worker so that de-escalation is in place should the person served become agitated. This team is called to a house or mental health facility and treated for the crisis on the spot and assessed to see where care may continue. CAHOOTS-styled programs are activated in Denver, Oakland, Olympia, Portland, Maine, and parts of California and New York.
Reference: “CAHOOTS: A Model for Prehospital Mental Health Crisis Intervention” by Ben Adam Climer and Brenton Gicker for Psychiatric Times
Proven Program Models
There are an increasing number of examples of innovative programs in other states that Illinois can learn from as we consider establishing more effective alternative mental health crisis intervention strategies. These programs are distinguished by a move away from police response and a move towards utilizing social workers, mental health professionals, and paramedics/firefighters in responding to behavioral health, substance abuse, and health-related needs/calls.
Health One – Seattle, WA
The Seattle Fire Department (SFD) has a Mobile Integrated Health response unit that is equipped to respond to determine an individuals’ mental health, clinical, housing, or other needs. Comprised of firefighters and case managers who are linked to local social service providers, the goal of Health One is to reduce the number of non-emergent calls to the fire department and subsequently connect individuals in need with the appropriate level of care and service.
STAR Program – Denver, CO
The Denver STAR Program pairs a mental health clinician or social worker with a paramedic. This team is a third alternative (in addition to the police or ambulance/fire services) as a response to 911 calls so that nonviolent individuals can be placed into the care of a mobile health care team rather than police officers being sent to the scene. In the first six months of the program, launched in 2020, the STAR Program resolved 748 mental health incidents (averaging six calls a day) that involved no force, arrests, or jail. With many of these calls related to unmet social needs, the team vehicle is equipped with food, blankets, and other resources to ensure that immediate non-healthcare needs can also be addressed on site.
Portland Street Response – Portland, OR
Portland Street Response (PSR) is a pilot program that responds to lower-risk behavioral health requests through both 911 and a non-emergency number. The team is comprised of four professionals, including a licensed mental health crisis therapist, a firefighter EMT, and two community health workers. PSR is dispatched when a report comes in that a person may be experiencing a mental health crisis (including intoxication and/or drug-related cases) and is outdoors or in a publicly accessible space. The PSR team is not sent if there are indications of a weapon, violence, or other situations where police might be more appropriate. In some cases, however, it is the police who request PSR support. The program has a call/data dashboard where the public can view the program’s performance.
Street Crisis Response Team – San Francisco, CA
San Francisco’s Street Crisis Response Team (SCRT) began its pilot program in November 2020 as a collaboration between the San Francisco Department of Public Health, the San Francisco Fire Department, and the Department of Emergency Management. The goal of this cross-sector program is to provide an appropriate non-law enforcement response to behavioral health crises, including responding to 911 calls with behavioral health or medical response; delivering de-escalation services; diverting individuals in crisis away from emergency departments and criminal settings into behavioral health treatment; and providing appropriate linkages and follow-up care for people in crisis.
Conclusion:
We are currently in the biggest public mental health crisis in our nation. With the addition of the pandemic and its effects on the lives lost and economy, many individuals are left scrambling to seek the mental health services help they need. Now is the time to pivot in our approach of how we see and care for those living with mental illness. Now is the time to be thoughtful and innovative in our rebuilding and restructuring to meet this great need. Lawmakers have the opportunity to do what is fair and just for those unjustly marginalized and mistreated. The Treatment Not Trauma Ordinance is the most proven and effective approach in mental health crisis response, and we are asking for our members to petition the members of city council and their state lawmakers to pass this ordinance and implement CESSA in respect to the constituents and communities they promised to serve.
RESOURCES:
Treatment Not Trauma: https://www.collaborativeforcommunitywellness.org/treatmentnottrauma
REFERENCES:
The programs listed above were cited in the following article by the Brookings Institution: “How the American Rescue Plan Act will help cities replace police with trained crisis teams for mental health emergencies.” https://www.brookings.edu/research/how-the-american-rescue-plan-act-will-help-cities-replace-police-with-trained-crisis-teams-for-mental-health-emergencies/
Here's What Happens When Social Workers, Not Police, Respond To Mental Health Crises - Honolulu Civil Beat
https://pubmed.ncbi.nlm.nih.gov/29853001/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769782/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769782/
https://www.apa.org/monitor/2021/04/ce-mental-illness
“CAHOOTS: A Model for Prehospital Mental Health Crisis Intervention” by Ben Adam Climer and Brenton Gicker for Psychiatric Times
The NASW-Illinois Chapter Diversity, Equity, and Inclusion Committee (NASW-IL DEIC) works to promote the NASW programs and efforts that encourage awareness, respect, and appreciation of diversity in the social work profession and our society. Its particular focus includes race and ethnic diversity, social justice, women advancement, and sexual orientation (LGBTTQQIAAP) issues.
The National Association of Social Workers (NASW) is the largest membership organization of professional social workers in the world, with over 120,000 members. The NASW-Illinois Chapter is one of the association's largest chapters representing over 20.000 licensed Illinois social workers and school social workers, with over 5,000 active members. NASW strives to advance social work careers, grow social work businesses, and protect the profession.