Our Proposal

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.

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The Need

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.

The Solution

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).

What is the role of the peers?


During all stages of the pilot (planning, design, implementation, maintenance, evaluation), peers from low-income Black, Latinx and other communities of color within the areas in which the pilot is taking place, who do not have a governmental interest, will be included in the discussions and given the ability to weigh in on key decisions, including the hiring and training of peers, dispatch personnel and other personnel. During the planning for the pilot, multiple forums will be held in the pilot communities, at times that allow working people to attend, in order to provide input on the pilot.




Where would the pilot be located?


In order to provide complete coverage to a given geographical area, the pilot will be located in two police precincts with the highest number of “emotional health crisis” calls (formerly derisively referred to as “Emotionally Disturbed Person” or “EDP” calls): Midtown South’s 14th Precinct with 4,356 mental health crisis calls in 2018 and Brooklyn’s 75th Precinct with 5,428 mental health crisis calls in 2018. The selected precincts are among those with the highest number of mental health calls per capita.




What would the peer-driven mental health crisis response teams look like?


The new mental health crisis response team would embody existing best practices in non-police alternative mental health crisis response, and consist of one peer trained as a crisis counselor and one emergency medical technician (EMT). Having a peer on the team is essential. As a person with lived experience, a person who has “been there” can best relate to the fear of an outsider responding in a moment of crisis, and can prove that recovery works. An EMT worker is needed as many crisis calls may involve physical health issues which are masked by the mental health crisis. The Office of Consumer Affairs in the New York City Department of Health and Mental Hygiene (DOHMH) will contract with non-governmental agencies which will deploy the mental health crisis response teams. The mental health crisis response teams will consist of peers who have worked with people in crisis, such as those who have worked in crisis respite centers, and also have experience in deescalating crises. It would be desirable for the peers to either have lived or worked in the areas in which they are hired to serve. The teams must operate 24/7, 365 days a year, in three consecutive shifts per precinct (8 a.m. to 4 p.m., 4 p.m. to 12 a.m., and 12 a.m. to 8 a.m.), with two teams in place for the day and evening shifts, and one team for the overnight shift. Since each team consists of two people, the staffing need for the pilot requires 38 total FTE’s for the two precincts for all shifts. In addition, the pilot requires one Project Director, two Supervisors and one Administrator. The pilot also requires two vans per precinct so that the team can transport individuals to drop-in centers, safe havens, the new support and connection centers, urgent care centers, or hospitals.




What type of training will the pilot provide?


The agency with which DOHMH contracts, operating with consensus from peer-driven organizations and peers from low-income Black, Latinx and other communities of color, who do not have a governmental conflict of interest, will be responsible for training all mental health crisis response teams, NYC Well staff involved in the project, as well as all 911 operators who will likely still be responsible for directing some of these calls.




How will the pilot be monitored?


The oversight board will: • hire an independent evaluation entity which will evaluate the pilot •review data from the pilot project •suggest changes to the pilot •meet at least quarterly •Issue and publicly list all meeting agendas •Issue and publicly list all minutes •ensure all meetings are open to the public •pay stipends to those members who are not receiving a salary for participating in oversight board activities There will be one oversight board for all pilot precincts.




Who will monitor the pilot?


The pilot will be monitored by an oversight board whose membership will be decided upon after soliciting recommendations from peers within low-income Black, Latinx and other communities of color. Such a board must include independent peers from low-income Black, Latinx and other communities of color who do not have a governmental conflict of interest. These peers will constitute 51% of the board. Additional board members might include staff of NYC Well, the support and connection centers, the crisis respite centers, DOHMH, the New York State Department of Health (DOH), the New York State Office of Mental Health (OMH), the New York City Department of Homeless Services (DHS), the New York City Human Resources Administration (HRA), the New York City Fire Department (FDNY) and other Emergency Medical Service (EMS) providers, the Office of the Comptroller, the Community Board for the relevant precinct, the Public Advocate, the relevant Borough President, and members of the City Council and the New York State Legislature from the relevant precincts. The oversight board will be empowered to request and obtain data from law enforcement agencies necessary to carry out this pilot. Law enforcement agencies will not at any point have access to identifying data related to participants in the pilot.




How long will the pilot last?


The pilot will last five years, thereby allowing sufficient time for start-up and evaluation. If after 18 months the data reveal the pilot is having a positive impact based on established metrics, two additional pilots will be funded at that time.




What would the average response time be for the mental health crisis response teams?


The average response time for the mental health crisis response teams will be the same as the current average response of police to non-mental health crises – or less time.




How would people call for the mental health crisis response team?


The pilot will establish a new number dedicated to mental health crisis calls such as “WEL” or 988, which anyone can call. The calls would go to NYC Well’s hotline and will be staffed by NYC Well staff who would automatically send the calls to the mental health crisis response teams. Since NYC Well operators will be dispatching mobile crisis teams in the next few months it will be cost-effective to have NYC Well also dispatch the mental health crisis response teams.




Which entity will run the pilot?


DOHMH will contract out with a non-governmental agency which will run the pilot.




How much will the pilot cost?


The pilot will cost roughly $3.5 million to $4.0 million annually for the two proposed precincts. Costs are estimated. Notably, Eugene, Oregon, which is the size of one New York City police precinct, uses a similar mental health crisis response model which includes two workers and has an annual budget of $1.9 million. The pilot requires training and data collection/evaluation (see below), which is not part of the Eugene budget, but is pivotal to determine how the pilot is working and what changes need to be made to it. Additional costs above those in Eugene will also be incurred by the pilot in order to keep salaries commensurate with the cost of living in New York City.




How will the pilot be publicized?


NYC Well and all other City and State agencies which comprise the oversight board will work closely with CCIT-NYC and other advocates to develop an extensive list of agencies, community organizations, and individuals who will receive direct notice of the pilot. In addition, NYC Well will utilize its best efforts to obtain extensive media coverage of the pilot, and will prominently promote the pilot via social media and other campaigns to raise awareness amongst the public in the identified precincts.




How will the pilot be funded?


Primary funding will come from New York City’s budget. New York City should also reach out to New York State for funding, possibly from money allocated statewide for CIT but never used for New York City.




How will data be collected?


Data will be collected and analyzed by an independent evaluation entity every three months once the pilot is operational. The data will be provided to the oversight board which will also have the right to request additional data, as needed. The data evaluation entity must protect the privacy and autonomy of those receiving services from the mental health crisis teams. Data from this project will not be admissible in criminal cases. Summaries of the data collected, as well as the management and privacy plans, will be made transparent and accessible to the public.





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