Crisis Response Is Too Little Too Late for People With Mental Illness

Crisis Response for Mental Illness Is Not Enough.

About a decade ago, I attended a symposium put on by my employer about the social determinants of health in Baltimore City. One of the presenters told a parable–it was one I hadn’t heard before, but I have since heard it applied to a number of social problems. I think it has particular relevance for the problems entrenched in our dysfunctional mental health care system.

The story goes: A group of campers are settling down by a riverbed when one of them sees a baby floating down the river. He jumps in the water to save the child. Just as he is climbing out, another baby floats downstream, and another rescuer jumps in. One baby after another is swept by the current, and all the campers jump in, frantically saving as many babies as they can. 

Even after grabbing passersby to join in the rescue effort, they are still outnumbered by the task. They save some, but not all. Finally, one of the men starts walking away. “Where are you going?” they ask. “You guys keep on rescuing. I’m going to look upstream to see who keeps throwing babies in the water.”

And that is a perfect description of what is happening with our mental illness care system and crisis response for people with mental illness. We read story after story about the deadly encounters between law enforcement and people in mental health crises. And then a flurry of solutions are offered: Defund the police! Train police officers how to deescalate a crisis. Send a social worker out with the police. 

Unfortunately, these solutions are the equivalent of diving in to save the baby. By the time law enforcement comes on the scene, our system has already failed the person in crisis multiple times. Police shouldn’t be expected to deal with the result of our failed mental health system. To fix the problem, we need to look upstream.

Family members of people with chronic, serious mental illness know what a feat it is to get consistent, effective care for their loved one. Trying to get an adult treatment who doesn’t want it is futile. In our country, a person has the right to refuse treatment, even if they are experiencing a psychosis that impairs their ability to make decisions about their medical care.

People seeking treatment for mental illness face a catch-22–a person may be deemed not sick enough to gain admission to a hospital, yet if that person commits a crime due to their illness, we say, “Why didn’t they ask for help?”

In truth, our system denies medical help for people with mental illness until they reach a crisis point. We have seen it again and again.  

Daniel Prude was released from the emergency room without medication or treatment only hours before his encounter with police. His family tried in vain to get him help. 

Ricardo Muñoz, who was killed by police, suffered from paranoid schizophrenia. “He was sick,” Rulennis Muñoz said of her brother. “It’s not a crime to be sick.” His family had been trying to get him help for years. He was routinely in and out of hospitals, with little follow-up care in between. 

And there is this horrific story. According to the report, “In the month before she wielded a knife against her son, [the individual] had called the sheriff’s office seeking assistance with mental health problems.” She had been discharged from the hospital for mental health treatment 10 days earlier. This unspeakable tragedy could have been prevented.

We have to stop failing people with brain illness, their families and our communities. Crisis response for people with mental illness is not enough. More and more are barreling along the current, headed for tragedy. Advocates have put forth solutions. It’s time to go upstream and fix the root cause of the problem.

6 thoughts on “Crisis Response Is Too Little Too Late for People With Mental Illness”

  1. In 1994 Dr. E. Fuller Torrey testified in a congressional hearing that serious “mental illnesses” (the quibble quotes reflect my position, not his) were brain disorders and that public policies should reflect that reality (paraphrasing). He asserted that the IMD Exclusion was illogical and discriminatory. His testimony and that of others did not result in a paradigm shift because misconceptualization and psychologization (i.e. biopsychosocial and traumagenesis) of these illnesses is nearly impossible to dislodge from the societal consciousness. Public policies governing supported housing and medical care as they relate to these illnesses are grossly dysfunctional, irrational, and unjust because they are informed by misguided notions and ideologies promulgated by the consumer/rights/anti-stigma movements and dominant factions of the psychology and psychiatry disciplines.

  2. I know this routine all too well. My sibling has Bipolar disorder I with severe psychotic features. When he’s manic he’s not in control of his mind, which slips into delusions of FBI tracing, spousal extra-material affairs, etc. I have a degree in social work and try my hardest to help but even with the training I have, I cannot help to the degree required. Last time it took six cops to wrestle him into an ambulance. He spent three days at an inpatient facility. He called us the third day and told us to come pick him up. I was livid. Just the day prior he pulled the fire alarm, fearing a fire was imminent. I talked to a nurse and explained that he needed to stay longer, they said that because he doesn’t have insurance they couldn’t keep him. I explained that I would cover the cost and they agreed to three more days. It’s unreal to me that they were going to let him go. I think of other families and those without families who are stuck in a revolving door of band-aids for serious mental health conditions.
    My heart aches for anyone who struggles with severe mental illness. Also their families who so often are forced into being caretakers, mental health experts, and are expected to handle situations way over their head. Our country needs a total mental health care overhaul.

    1. Absolutely! I am sorry you are experiencing this with your brother. Three days in a hospital is useless. I don’t understand why mental illness is not treated as other illnesses. It is a brain disease that deserves treatment. People shouldn’t have to cycle in an out of hospitals, jails, homelessness, etc. And it is so hard for families to navigate the so-called system.

  3. I am so INTERESTED in trying to help to change all this. I had to risk my child life to gain conservatorship. That should not be a part of gaining treatment. Its a horrable system that ties the hands of those who want to help.

    1. That is so wrong that you had to put your child’s life at risk to get conservatorship. The system does not allow families to help and participate in care in a meaningful way. I am sorry you had to go through that…why don’t they understand that family members just want what’s best for your loved one?

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