In March, Joe Prude called Rochester police when his brother, Daniel, appeared to be experiencing a mental health emergency. Daniel’s encounter with police left him needing resuscitation, and he was taken to a hospital. He was removed from life support after a week. The incident serves as yet another reminder of the grave risk that interactions with law enforcement pose to people living with mental illness, particularly if they’re Black. Yet so many of us are taught to view police as the first point of contact during a mental health crisis. If you have a mentally ill family member who appears to be having an episode, what can you do instead of calling the cops?
Like so much of healthcare, it depends on where you live, says John Snook, executive director of the Treatment Advocacy Center, a nonprofit that seeks to eliminate barriers to mental illness treatment. “I often say that we’re running 50 different experiments all across the country.” Some places offer a full continuum of services, allowing you to get the care you need depending on how you're doing, whether it's someone to talk to, a space to decompress, or a hospital bed.
"Then you have a lot of places... that just don't have anything," Snook says, where "families are told, 'There’s nothing we can do unless you loved one is dangerous. The reality is, when they’re violent, the police are going to come."
Seven states require someone to show an “imminent threat” of serious injury or death to themselves or others to qualify for involuntary hospitalization, Sabah Muhammad, legislative and policy counsel for the Treatment Advocacy Center, wrote in a Washington Post op-ed. Yet she points out that presenting an imminent threat can legally justify police using deadly force. Indeed, people with untreated, severe mental illness have a 16-fold higher risk of death at the hands of police than other members of the population, according to the Treatment Advocacy Center.
Here are steps Snook recommends taking before and during a mental health crisis that don’t involve contacting the police.
Know the laws in your state
Researching your state’s laws and treatment options now can help ensure you’re prepared in an emergency. The Treatment Advocacy Center lists information about who can receive mandatory psychiatric treatment and how to initiate the process for each state, Snook says.
Reach out to your local National Alliance on Mental Illness (NAMI) affiliate
Unfortunately, the process of getting help for a family member experiencing a mental health crisis varies widely from one local jurisdiction to the next, and you likely won’t find it on a website. “You have to have somebody who knows the system” — like the folks at NAMI, which has hundreds of chapters across the country — and start engaging in conversations with them about it, Snook says.
He recommends NAMI’s Family-to-Family class, run by family members of people living with mental illness, which not only provides emotional support, but covers the nuts and bolts of how to navigate the mental health system in your community. “That’s probably the best place to start.” Ideally, you’d reach out in a non-crisis situation, but you can contact them in an emergency, too.
Work with your family member to create a psychiatric advance directive
A psychiatric advance directive is a legal document that outlines the mental health treatment your loved one wants in case they become incapacitated and can no longer provide informed consent, according the National Resource Center on Psychiatric Advance Directives (NRC-PAD). Basically, it says “when I’m sick, I prefer these medications, these sorts of facilities, I do not want to be taken to this facility,” for example, Snook says. “The hospitals really do try to lean on what your advance directive says.”
It can also help minimize the risk of horror scenarios, like a hospital releasing your loved one at a homeless shelter because they weren’t able to share your contact information with the health provider. NRC-PAD lists state-by-state information on regulations and laws regarding these documents, as well as advance directive forms you can fill out and print. Again, do your homework. In some states, you may need to use a slightly different document, such as a health care power of attorney, according to Mental Health America.
Reach out to your local Crisis Intervention Team (CIT)
Technically, a CIT is a division of law enforcement, but they partner with mental health providers and hospital emergency services, according to NAMI. Snook also notes that CIT members undergo additional specialized training to handle mental health crises. Ideally, you’d reach out to local law enforcement and ask if you can talk to any CIT members before an emergency. “That helps you build that relationship so that if you get into a crisis you can have a name, a person you can call,” Snook explains.
If your family member is having a mental health crisis, and you haven’t had the opportunity to do this prep work, at least mention — immediately and explicitly — that you’re calling law enforcement because of a mental health crisis. “The more information they have, the better,” Snook says. And “you can say, ‘I’d love to get the mental health crisis intervention team.’”
That said, last Friday, Salt Lake City police shot 13-year-old Linden Cameron, who has Asperger syndrome, even after his mother requested help from the CIT, seriously injuring him.
The sad reality is that, in the U.S., you have to assume a loved one with serious mental illness will come into contact with law enforcement at some point, Snook says, reflecting deeper systemic problems with our mental healthcare system. For now, you can educate yourself and build relationships that prepare your family member for an emergency, and at least reduce their risk of a dangerous police encounter.