Piloting a Peer-Driven Mental Health Crisis Response Program
CCIT-NYC seeks $16.5 million over five years for a pilot project that would send in mental health teams to crisis calls.
The program would pair one EMT and one peer de-escalator.
Contracts and guidance would be with and from community groups of color in the neighborhoods where the pilot is located. The contract itself would sit in the office of the New York City Department of Health and Mental Hygiene.
The New York Police Department (NYPD) began providing Crisis Intervention Team (CIT) training in June 2015. In the ensuing years, sixteen mental health recipients were fatally shot by the police, and four others were shot and arrested.
Not surprisingly, many mental health recipients, family members, and health providers fear calling 911 because of these and other similar tragedies. This causes many people to delay reaching out for help until circumstances have escalated to a critical stage.
Mental healthcare responses to mental health crises are universally considered the best practice. For example, the leaders of CIT international – a group consisting primarily of police, which created CIT training 35 years ago – now argue that only a mental healthcare response is appropriate for a mental health crisis. In the CIT International’s recent best practice guide, they note that even a co-response model (police and mental health workers) is an inappropriate response because it still involves the police.
Although New York City created a taskforce to determine an appropriate mechanism for responding to mental health crises, the initiatives put forth by the taskforce do not systematically address how to best respond to the 200,000+ crisis calls per year received by the NYPD. The taskforce failed to recognize that responding to mental health crises is a public health issue, and it continued to view the NYPD as the first responder for the vast majority of crisis calls.
In response to the taskforce’s suggestions, the City proposed adding only five mobile crisis teams to respond to crisis calls. However, the minimal increase in mobile crisis teams does not even come close to serving a city of 9,000,000 people and countless visitors. And critically, the mobile crisis teams cannot respond to 911 emergency calls. Mobile crisis teams also do not have a means to transport people to drop-in centers, hospitals, or other appropriate healthcare resources. If transport is required, mobile crisis team members must call 911.
In addition, mobile crisis teams at best respond to the immediate crisis at hand, and do little to ensure the mental health recipient is connected to longer-term community resources. Mobile crisis teams do not always have a peer – an individual with lived mental health experience – on staff and they utilize the no-longer acceptable “medical model,” which often focuses narrowly on medication rather than a person’s ability to recover and live well. Moreover, mobile crisis teams consist of five staff members and are relatively expensive.
New York also has Health Engagement Assessment Teams (HEAT teams) which consist of one peer and one clinician. But HEAT teams are only used by police for areas of outreach that do not involve any active risk, and, like mobile crisis teams, they cannot be deployed to 911 mental health crisis calls and they cannot transport anyone.
We propose forming a mental health crisis response team that would embody existing best practices in non-police alternative mental health crisis response. The team would consist of one peer trained as a crisis counselor and one emergency medical technician (EMT).