New York City receives 200,000 mental health-related 911 calls each year. In addition to the Emergency Medical Technicians who respond to those calls, the NYPD is dispatched—whether the person in distress is perceived to be a physical danger or not.
This often only serves to escalate the crisis. Someone in distress will not feel safer when confronted by people who are authorized to restrain them, or take them somewhere without their consent or drug them, or who could be authorized to kill them. It’s not possible for a mental health crisis responder to create an atmosphere of safety and trust with a patient while still threatening that patient’s autonomy.
Historically, crisis intervention training programs for first responders have not been successful in reducing the number of disabled people killed by police. Their focus is on rapidly transporting patients and controlling life threats, rather than localized, non-directive, one-on-one patient care. This is why community organizers and advocates have long demanded that police be removed from the city’s mental health crisis response teams.
Patients who are considered non-compliant or resistant will still be restrained and forcibly transported. Police will still be sent on calls at dispatchers’ discretion.
Beginning in February 2021, 911 calls involving a mental health crisis in NYC’s 25th and 47th precincts will be met with EMTs and mental health professionals—not police. “One in five New Yorkers struggle with a mental health condition,” said Mayor Bill de Blasio in his announcement of the new pilot program. “For the first time in our city’s history, health responders will be the default responders for a person in crisis.”
At first glance, the pilot program appears to be good news. In practice, however, it would seem to play out in a very familiar way. Patients who are considered non-compliant or resistant to treatment will still be restrained and forcibly transported. Police will still be sent on calls at dispatchers’ discretion, and will still be able to monitor data from those calls.
This pilot of a non-police response program in East Harlem and the north Bronx comes after a summer of uprising against systemic police violence that disproportionately targets Black people, and especially disabled Black people. Groups like Free Them All for Public Health and RAPP have advocated for the release of incarcerated people in response to the pandemic, as well as for non-coercive, non-carceral, holistic alternatives to policing. Communities United for Police Reform released a budget analysis showing how much of NYC’s yearly budget goes to the NYPD—and how these resources could be used in ways that also reduce the need for policing, treating mental health crises as a community health issue, not a criminal one.
Shortcomings like those in NYC’s pilot program, combined with the mandatory reporting requirements of any social workers and clinicians who are dispatched, force abolitionist organizers to view responders in those programs as instruments of “soft policing”—a concept that describes the ways in which many social programs can lead to loss of autonomy and increased surveillance.
Non-Police Models for Community Care
The vast majority of people experiencing a mental health crisis are not violent. Oregon-based non-police response program CAHOOTS reported receiving 24,000 calls for service last year and only needing support for 300 of them. That’s less than 2 percent of crisis calls that were beyond the capacity of mental health responders to address.
People’s resistance to care is typically not irrational. It is the responsibility of crisis responders to be mindful of their approach, establish respect for the autonomy of the person in crisis and not be thrown off by an initial posture of aggression or defensiveness, such as the presence of a small weapon.
If someone is resisting support, it means they do not feel safe or comfortable with the type of support being offered. The correct response is one that is non-directive, giving people in crisis options and respecting any boundaries that are communicated.
People in mental health crisis often experience sensory sensitivity, which is part of the reason advocates want people in crisis to be supported in environments other than hospitals. Fluorescent lighting, strong smells, and lots of people and noises can lead to extreme distress. Harm reduction items that can be carried around for addressing sensory sensitivity include eye masks, earplugs or unscented hygiene products.
NYC Health + Hospitals has not yet taken any steps to mitigate these issues, instead opting to override the autonomy of people in crisis through medications and physical restraints.
Dismantling Structural Ableism
Across the disability justice movement, the centering of people with lived experience has broad appeal. On-site support is a time-intensive process for responders and not always paid for by health insurance, but also often prevents the need for people to go to the emergency room at all.
A disability justice framework must recognize that the issue is not altered states, but structural ableism—the ways these systems are designed without the input of disabled people, and so fail to meet their needs—and environments which threaten the autonomy of disabled people and exacerbate their symptoms.
The only way to address ableism in our healthcare systems is to redesign them.
Low wages for peer workers, understaffing and the refusal to redesign systems around meeting access needs (which are diverse and can conflict with one another) or support disabled people to lead their own course of care are all examples of structural ableism.
The only way to address ableism in our healthcare systems is to redesign them. In the meantime, communities will continue to organize their own care models, and those with technical knowledge should work to support them. Project LETS, an abolitionist, peer-led organization for neurodivergent people, offers training around prevention and crisis planning for self-organizing peer support groups. Depressed While Black works to get Black psychiatric patients access to culturally affirming care items.
The city has historically not allowed peer responders to manage program development, often paying them low wages that keep them in precarity without providing adequate mental health support. Hiring for the city pilot will come from NYC Health + Hospitals, without oversight by the communities being served.
The budget for the city’s program will be taken from existing Fire Department (FDNY) EMS resources. This announcement comes after 400 FDNY EMTs were laid off this summer, and after the city denied requests for an increase in funding for PTSD counseling and an increase in pay for EMTs. Taking the money from the fire department for a program that is replacing a policing function, rather than taking it from the police, is an illustration of this administration’s priorities.
“The physical and psychological safety of FDNY EMS responders must be the first priority,” FDNY EMS Local 2507 President Oren Barzilay said in a statement. These calls, he said, are “identified as high-risk to the responders, due to the uncertain mental and emotional conditions of the subject.” Given that less than 2 percent of mental health crisis calls in CAHOOTS, one of the oldest non-police response program in the US, constitute “high-risk”—and that those responders have no problem calling for additional support when needed—Barzilay’s concerns seem unfounded.