Cities can and should play a significant role in protecting and improving the mental health of their citizens. While counties and health providers are the most common providers of mental health services, cities have been stepping up to better link residents to care and reduce harms associated with police and other governmental interactions. Such interventions are critical, with an estimated 18.5 percent of the US population living with a mental illness and 4.5 percent of the total population experiencing severe mental illness that affects one or more major life activities, according to the National Alliance on Mental Illness (NAMI). NAMI also points to an estimated 26 percent of homeless shelter residents as living with severe mental illness. Many cities also have had at least one police-involved death of a mentally ill resident in acute crisis – some many more than that. With such prevalence, cities are recognizing the need to support mentally ill residents with two main approaches: reducing harm and acting as a bridge to help.
A growing number of cities are examining their policing practices to best protect residents with severe mental illness as well as protecting responding officers. There are multiple models of mental health crisis intervention, most notably the Crisis Intervention Team approach that has been adopted in hundreds of cities since the late 1980s. Mental health outreach courts can also interrupt the revolving door cycle of mentally ill residents interacting with law enforcement by making it easier to fulfill court obligations (for example, petitioning for a reduced or waived court fee, instead of inaction leading to a warrant), as well as to get connected to help. Other cities have adopted relatively low-cost and simple interventions, such as adjustments to dispatching practices and increased awareness among officers about linkages to crisis (and continued) mental health care, to improve outcomes for mental health crisis-related calls.
Cities are also boosting their ability to act as a bridge to more intensive support services. Mayors can serve on or convene mental health roundtables to facilitate connection between city, county, nonprofit, and other stakeholders to improve care. Campaigns to normalize mental health care can increase uptake of treatment by reducing stigma. Where cities have more budget flexibility, bolstering local crisis support services is another critical step to ensuring access to treatment. Additionally, several cities adopting housing-first approaches have included mental health treatment as a priority in wrap-around service provision.
Why We Need to Move Away From Jailing the Mentally Ill, Jane Wiseman and Stephen Goldsmith, Governing, September 2nd, 2016. Read more.
First-Episode Incarceration: Creating a Recovery-Informed Framework, Leah G. Pope, et al, Vera Institute of Justice, January 1st, 2016. Read more.
Mental Health and the Role of the States, The Pew Charitable Trusts and John D. and Catherine T. MacArthur Foundation, June 1st, 2015. Read more.
A Way Forward: Diverting People with Mental Illness from Inhumane and Expensive Jails, Sarah Liebowitz, et al, ACLU of Southern California and Bazelon Center for Mental Health Law, July 1st, 2014. Read more.
Mental Health Facts in America, National Alliance on Mental Illness. Read more.
Mental Health in Local Policies, Kim Nikolaj Japing and Alfonso Lara Montero, E.U. Joint Action for Mental Health and Wellbeing. Read more.
Police-Mental Health Collaboration Programs: Checklist for County and City Leaders, Council of State Governments Justice Center and the Bureau of Justice Assistance. Read more.
Memphis, TN developed the first Crisis Intervention Team (CIT) program in 1988, and has been leading a push to spread the model ever since. CIT programs have been found to generate a 2-4 percent arrest rate for mentally ill residents, compared to 20 percent nationally, and to increase police department referrals to social services between 20 to 90 percent. Memphis’ own arrest rate for CIT calls was less than 1 percent in 2016.
An integrated city-county government, Denver, CO has made unique strides in improving mental health service provision in its city. The City developed a co-responder model that houses social workers within the police department to jointly respond to crisis calls, which resulted in just 18 arrests out of 1100 calls. Denver’s Outreach Court model has expanded access among homeless and other mentally ill residents to court follow-up as well as connections to social services.
The innovative Thrive NYC program out of New York, NY has an ambitious agenda that includes free mental health first aid training, a free 24/7 counseling line (not just for acute crisis response, as with most existing hotline options), and a stigma-busting public outreach campaign encouraging residents to seek treatment. The program also draws together existing efforts, like the state’s Assertive Community Treatment program.
Many municipalities in the Miami, FL area have adopted innovative diversion programs spurred on by a local district court judge. These programs include follow-up from peer outreach workers to encourage treatment adherence and provide support in finding jobs and stable housing.
Collecting and analyzing data related to mental illness can provide cities with clear next steps to improve their systems. Policing and emergency medicine response are two major areas to bolster data collection, as San Diego, CA has done to encourage deployment of community paramedics to mental health-related calls.
View more resources from our Winter 2017 panel on mental health.