Overhauling The District's Crisis Response To Center On A Public Health Approach
DIVERT
Police are not equipped or trained for crisis response, nor should they be. Police have often dismissed an individual's mental health concerns, involuntarily hospitalized or criminalized someone, or could not direct them to the actual services they needed. Police should not be involved when responding to a crisis unless asked by mental health responders as a last resort.
OVERHAUL
The District's response to those experiencing mental health crises must center a public health approach with adequately trained and resourced mental health professionals and services. This also reduces the need for expensive police intervention.
It's beyond time to invest in a crisis response system that is trauma-informed, culturally competent, and inclusive to promote genuine community safety, comprehensive care, and collective wellbeing. In addition, the Black, Latinx, disabled and senior community members must be connected with the health and wellbeing resources equipped to address their individual needs.
INVEST
Our Vision
D.C. needs a more compassionate and effective crisis response system that puts people first. With an interconnected and inclusive network in place, the D.C. Crisis Response Coalition aims to prioritize public and patient safety, protect civil liberties, and prevent the unnecessary loss of life and resources. By working towards a crisis response system that delivers the care and support that District residents with mental health disabilities deserve, the coalition is leading the charge for change.
A Comprehensive and Integrated Crisis Response Network
D.C. CRISIS RESPONSE COALITION POLICY PLATFORM
When someone in D.C. experiences a physical health emergency, like a fall or an asthma attack, calling 911 results in EMTs or paramedics promptly providing emergency aid. But when someone in D.C. experiences a mental health emergency, like thoughts of suicide or hallucinations, calling 911 usually results in a response from Metropolitan Police Department (MPD) officers, rather than trained mental health specialists. Local mental health practitioners and MPD officers themselves report that when officers arrive, they generally either do nothing or handcuff the person in crisis and take them to a mental health emergency room in a squad car.
Whether or not someone calls 911, mental health emergency rooms are the primary places in D.C. for individuals to receive care for a mental health crisis. Yet those facilities have long waits and provide invasive interventions that may in fact exacerbate individuals’ trauma. Many mental health emergencies could be resolved at a community-based facility where folks could talk with a peer support specialist or a counselor, but few places in D.C. offer such services.
These deficiencies illustrate some of the ways that D.C.’s crisis response system fails to provide the level of care recommended by the Substance Abuse and Mental Health Services Administration (SAMHSA), the federal agency responsible for research and public health initiatives related to behavioral health. According to SAMHSA, the minimum components of an effective crisis response system are:
Someone To Talk To: A crisis call center staffed with mental health professionals who respond to and triage mental health emergency calls;
Someone To Respond: Mental health professionals who can respond to emergencies without police and address crises that the call center cannot resolve telephonically; and
A Place To Go: Crisis receiving centers that provide medically appropriate care to people experiencing different levels of mental health emergencies and, crucially, connect consumers to ongoing care.
The D.C. Police Reform Commission recommended that the District take swift, bold action to develop these types of services. While D.C. has taken some positive steps, much work remains. This policy proposal builds on the Police Reform Commission’s recommendations and outlines a path toward providing the 129,000 D.C. residents with a mental illness the care they deserve.
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Recommendations/Demands
A. Bolster and Promote the Services Provided by the 988 /the Access HelpLine
1. Publicize 988 and the services it offers widely, including in public places and medical and mental health facilities.
2. Provide enough training and staffing so that 988 callers who need a referral to outpatient services receive a ‘warm handoff.’ 988 staff should stay on the line with callers while contacting providers and not hang up until the caller begins coordinating an intake appointment. When call volumes preclude this, 988 staff should follow up with callers to ensure that they obtain an intake appointment within 72 hours of the call. Callers should not be told to schedule intakes themselves or to just show up at the provider’s office.
3. Endorse allowing 988 to geolocate the location of the caller to determine if they are in or out of the District. (More precise geolocation has privacy and consent concerns.)
B. Divert More 911 Calls to 988
1. Create a clear and comprehensive list of the mental health calls routable to 988
a. DBH, FEMS, MPD and community representatives should streamline and reduce the 500+ event codes for 911 calls.
b. Expand the types of calls that can be classified as mental health calls and be referred to 988/the Access HelpLine for a non-police response
2. Re-train and re-invest in OUC operators to ensure they route calls to appropriate entities
a. Train OUC operators to recognize mental health calls. Enlist DBH and community members to train OUC more generally on which calls genuinely require police and which are addressable by CRT, FEMS, or other non-police responders.
b. Eliminate the blanket prohibitions on routing mental health calls from 911 to 988 when the calls involve people under 18 or individuals not known to the caller.
c. Train OUC operators on when events such as ‘disorderly conduct’ or ‘trespass’ are actually mental health calls and should be routed to non-police responders.
d. Ensure OUC operators have resources they need to perform their jobs, including sufficient staffing, fair wages, and access to mental health services to help them process the daily trauma they hear.
3. Increase integration between OUC and 988
a. Ensure interoperability between 988 and OUC’s Computer Aided Dispatch (CAD) system. Ensure 988 dispatchers can alert the nearest CRT responder and design efficient travel routes.
b. Create a secure digital registry with real-time availability of all mental health crisis and respite beds in the District, accessible by both 911 and 988 operators.
4. Set clear progress goals and collect data to track them
a. Ensure OUC routes a significant share of 911 calls to 988, specifically:
i. By 2024, OUC should refer at least 25% of all mental health calls to 988.
ii. By 2025, OUC should refer at least 50% of all mental health calls to 988.
iii. By 2026, OUC should refer at least 75% of all mental health calls to 988.
b. Engage the D.C. Auditor and community representatives to review random samples of OUC calls to identify any systemic problems in routing decisions.
c. Collect, and regularly publish in anonymized form, data on mental health calls, including:
i. The time and location of the call;
ii. The facts that led the OUC staffer to treat the call as a mental health call;
iii. Where the call was referred (e.g. FEMS, MPD, or 988) and why;
iv. Whether any personnel were dispatched to the scene; and
v. Whether a voluntary or involuntary transport to higher level care occurred
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Recommendations/Demands
A. Make Mental Health Specialists The Default Front Line Responders to Mental Health Crises.
Recommendations/Demands
1. Give CRTs and ChAMPS the resources needed to act as the default front line responders for mental health crises.
a. CRT and ChAMPS should serve as the default, initial front line responders for mental health emergencies, responding to (1) all welfare checks and (2) all requests for assistance for a person’s mental health where (a) the person in crisis does not possess a firearm and (b) the caller has either (i) stated that the individual does not pose a threat to other persons’ physical safety or (ii) has failed to provide a concrete basis for concluding that the individual poses such a threat. The vast majority of mental health emergency calls likely meet this standard. For instance, in its most recent analysis, DBH found that between FY2019 and FY2022, a person had a firearm in less than 1% of reported mental health crises calls to which crisis intervention officers (MPD’s officers with the most mental health training) responded.
b. Provide CRTs and ChAMPS the funds needed to respond to high priority mental health emergencies within 5 to 9 minutes, the same goal D.C. sets for EMTs and paramedics to respond to high priority physical health emergencies. Ensure that CRTs and ChAMPS have the resources needed to respond promptly to lower priority calls too.
c. Oppose the Mayor’s proposed FY2023 reduction of funds to CRTs and ChAMPS.
d. Increase skills training for CRTs and ChAMPS members so that they can respond quickly to mental health emergencies using a trauma-informed approach.
2. Empower trained peer supports and increase incentives to work in D.C.
a. Establish protocols allowing trained peer supports to fill key positions in the crisis response system.
b. Pay peer supports fair wages, create pathways to advancement, train managers on best practices to retain employees, and evaluate hiring protocols for trained peer supports to remove any unnecessary barriers.
c. Recruit more licensed behavioral health professionals by passing Bill 25-0055, the Pathways to Behavioral Health Degrees Act of 2023.
B. Reduce the Trauma and Indignity of Crisis Care
1. Allow people with mental health disabilities to specify how front line responders should treat them in a crisis, as the Police Reform Commission recommended.
Encourage local mental health providers to talk with patients about writing psychiatric advanced directives—i.e. instructions on how to approach them during a mental health crisis, including what de-escalation tactics to use and what loved ones or medical providers to call. Ensure CRTs and ChAMPS have access to psychiatric advanced directives.
2. Minimize the hardship involved in involuntary transports for psychiatric evaluations.
a. Provide Mental Health ambulances, as other countries do, equipped with comfortable seats, that CRT and ChAMPS can use to meet with people in crisis and, when needed, transport them to respite centers and stabilization beds.
b. Require CRT and ChAMPS to publish protocols for the circumstances under which they contact MPD so that the public can evaluate those protocols and individuals can make informed decisions about calling for assistance.
c. Amend MPD General Order 308.04 to require MPD officers to receive approval from a CRT clinician (for adults) or ChAMPS clinician (for young people) before initiating an involuntary transport or handcuffing an individual involuntarily transported. The District should ensure that a CRT and ChAMPS clinician is available to provide advice via video call 24/7 and require those clinicians to confer with the individual’s mental health provider, if such a provider is identified in the CRISP database and is available.
C. Protect People with Mental Health Disabilities from Needless Arrests
1. Create a pilot to divert non-violent, low-priority 911 calls involving trespass or disorderly conduct to conflict resolution specialists, such as D.C. Peace Teams, and appropriately fund the community-based program contracted to provide the services.
2. Follow the D.C. Police Reform Commission’s recommendations to increase use of the pre-arrest diversion program, an initiative permitting police to provide people with behavioral health challenges who committed low-level offenses treatment in lieu of arrest.
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Recommendations/Demands
A. Expand Non-Hospitalization Options for People to Receive Care When a Crisis Occurs
1. Crisis beds refer to community-based beds where people can stay for a week or two and receive professional mental health services. Presently, only 16 crisis beds are available to DBH consumers in the District.
a. By 2024, increase crisis beds to at least 24.
b. By 2025, increase crisis beds to at least 35.
c. By 2026, increase crisis beds to at least 50.
2. Extended Observation Unit (EOU) beds refer to beds located in the community where people can voluntarily receive mental health services for shorter periods, usually 23 to 72 hours. The District has only a small number of beds providing care similar to that of EOUs, but they are all located at the Comprehensive Psychiatric Emergency Program. Because of the hospital setting, these beds are more likely to increase trauma and impede stabilization than community-based EOUs.
a. By 2024, create at least 6 new community-based EOU beds.
b. By 2025, increase the number of community-based EOU beds to at least 15.
c. By 2026, increase the number of community-based EOU beds to at least 30.
3. Respite facilities are quiet places where people can visit or stay temporarily shortly after a crisis, or when they are at risk of a crisis. People receive informal support, such as meeting with peers and group therapy. Respite facilities can help individuals avoid hospitalization and sustain their recovery. The District has no such facilities.
a. By 2024, establish a respite facility with at least 10 beds.
b. By 2025, add another 10 respite facility beds, increasing the total number of beds to 20.
c. By 2026, add 15 additional respite beds, increasing the total to 35.
4. Data collection. The District should collect data on the percentage of mental health crisis calls resolved on-site, the percentage routed to a hospital, and the percentage routed to the community facilities listed above. The District should also create a community feedback mechanism to assess and promote efficacy.
5. Incorporate considerations for special populations in the implementation of crisis care.
a. Reserve a third of the newly created crisis beds, EOUs, and respite beds for young people under 18.
b. Ensure facilities consult with trans and gender nonconforming people about housing assignments to ensure they feel safe in their placement. Provide all-gender restroom and shower facilities. Require that staff receive training on trans-inclusive care. For facilities that provide overnight housing, create at least one single occupancy room for LGBTQIA+ individuals who feel unsafe in a shared sleeping environment.
c. Accommodate people who use drugs, including individuals with substance use disorders and related disabilities, in the construction of the facilities discussed above by permitting people to receive treatment even if they aren’t sober, creating specific programming for people who use drugs, hiring people trained to care for people with dual mental health and substance use disorder diagnoses, and including separate wards to avoid triggering other individuals in the program who may be in recovery from such disorders. Further, the District must move toward creating facilities for people who use drugs that feature safe consumption components.
d. Establish protocols, including the provision of childcare services, that allow parents experiencing medium-level mental health emergencies to bring their children with them to crisis beds, EOUs, and respite centers if the children cannot otherwise receive care from a caregiver whom the parent approves.
B. Increase Access to Mental Health Care After the Crisis
1. Perform a fidelity audit of existing ACT programs to assess current compliance and identify areas for improvement.
2. Increase funding for ACT so that caseloads are lower.
3. Increase training and oversight mechanisms for ACT teams so that new and existing funds result in higher quality care.
What's the problem with
mental health crisis response
in the District?
People in D.C. experiencing a mental health crisis are more likely to receive a response from police officers than trained mental health specialists when they call 911. Mental health practitioners report that officers typically handcuff the person in crisis and take them to a mental health emergency room in a squad car, which may exacerbate their trauma. Long waits and invasive interventions are common in mental health emergency rooms, and few community-based facilities offer the necessary services. As a result, many residents with mental health conditions in D.C. do not receive treatment, and the city's reliance on police to address behavioral health crises only further traumatizes those they seek to help.
The D.C. Police Reform Commission recommended that D.C. take swift and bold action to develop services such as a crisis call center staffed with mental health professionals, mental health professionals who can respond to emergencies without police, and crisis receiving centers that provide appropriate care to people experiencing different levels of mental health emergencies. However, much work remains to be done. The District must ensure a consistent, individual-centered response to crisis response, which people can rely on to lead to treatment and care.
The federal Substance Abuse and Mental Health Services Administration (SAMHSA) reports that only 42% of District residents with a mental health condition currently receive treatment. To address the issue, the District should consider investing in models such as case management services, co-responder teams, the crisis intervention team model, EMS- and ambulance-based responses, mobile crisis teams, and officer notification and flagging systems.
D.C. should make mental health specialists the default first responders for mental health crises, as they are far more effective at deescalating crises than police officers. Additionally, 911 dispatchers should rely on conflict resolution specialists for calls that require neither law enforcement nor mental health specialists. D.C. should invest in intermediate services to reduce the pressure on the hospital system, and ACT programs should be funded sufficiently to provide adequate care and oversight to ensure effectiveness.
D.C. Crisis Response Coalition Press Conference
This press conference is from April 26, 2023, at the John Wilson Building. Here, the D.C. Crisis Response Coalition launched its policy platform and answered questions from the media.
The District should consider doing the following for an effective D.C. Crisis Response system:
Someone To Respond:
Mental health professionals who can respond to emergencies without police and address crises that the call center cannot resolve telephonically
Someone To Talk To:
A crisis call center staffed with mental health professionals who respond to and triage mental health emergency calls
A Place To Go:
Crisis receiving centers that provide medically appropriate care to people experiencing different levels of mental health emergencies
The District's crisis response system must be flexible enough to meet everyone's needs, regardless of race, ethnicity, disability, gender identity, sexual orientation, or involvement with the criminal legal system. By investing in an effective crisis response system, D.C. can address the root causes of crime and instability in the city, such as job opportunities, drug treatment programs, and more effective crisis response, and provide the level of care that residents with mental health conditions deserve.
What is the D.C. Crisis
Response Coalition?
The D.C. Crisis Response Coalition is an initiative led by the community that brings together people who have been affected by mental health crises, service providers, experts in crisis response, mental health, and disability, policy experts, and advocates who are dedicated to creating a strong crisis response system in the District. The goal is to create a system that does not rely on policing and criminalization. Our ultimate goal is to overhaul the District's response to those experiencing mental health crises from one that centers on policing and incarceration to one that centers on a public health approach with adequately trained and resourced mental health professionals and services.
D.C. Crisis Response Coalition North Star
Together, we cultivate care.
We are advocating for a responsive mental health crisis system that improves the D.C. community. What this means:
We advocate for policies, funding, and practices that ensure long-term support and resources for individuals and communities navigating crises. This involves creating legislative pathways to sustainable, healthy lives post-crisis and dismantling barriers to social services, thereby reducing the cycle of harm and promoting systemic change by removing police and punitive responses to mental health crises. By prioritizing mental health, immediate care resources, and community-based solutions, we aim to overhaul the District’s crisis response system to uplift every resident, especially those at the intersection of systemic challenges.
As we engage in this crucial work, we do so through the lens of healing, restorative justice, and non-carcerality. Through this commitment, we seek to build power with the people of D.C., which will strengthen our shared goals and allow our impact to match our intent.
Members of the Coalition
