The City of Knoxville and Knox County recently commissioned a task force to look at alternate responses to people experiencing a non-violent mental health crisis. Rather than using police officers who are generally untrained in mental health problems and already overburdened, local advocates are promoting a program that pairs unarmed crisis workers and health care practitioners to avoid inadvertently escalating the problem and get people the help they need. In this episode, we talk with Dr. Eboni Winford of Cherokee Health Systems about the issues that led to the task force's creation.
WUOT’s Carole Myers: There is a scarcity of mental health providers to effectively respond to the increasing number of individuals experiencing a mental health crisis. One thing we know is that we need behavioral health specialists and medics to respond to non violent emergency calls, not police officers. What are we dealing with when we say a non violent mental health crisis. What is the problem?
Eboni Winford: Oftentimes, people who are having mental health crises, it may be psychosis, it may be mania, it could be thoughts of being better off dead. Very rarely, is it violence against anyone else. And what we find is that if we can meet basic needs like wound care, food support, a bus pass, the crisis goes down exponentially, and that's what I would consider a non violent mental health crisis.
You say, if we can do these things, what if we can't?
My heart hurts as a clinician who has to assess for safety with patients, and in Knoxville, you can call mobile crisis, and they're amazing. They do an amazing assessment over the phone, but the typical response is that a police officer shows up first. And I've had instances where the patients, or the individual who could really benefit from, again, a meal, wound care, stabilization, they end up in the back of a police car, and that's how they’re escorted to the hospital for health care. And it always makes me wonder, what if we responded to heart attacks that way we criminalize mental health? We make mental health a burden and we place physical health, the value of it, over and above mental health.
Someone is experiencing a non violent mental health crisis, and a police officer shows up and they're escorted to the hospital. That's kind of the immediate. What are the more long term effects of responding to people in this way?
We don't have enough hospital beds, so if the person meets the threshold of being a danger to themselves or danger to someone else, or being unable to say, ‘you know what, I will not hurt myself or someone else’, we call that contracting for safety. If they're not able to contract for safety, we don't have places to send them, especially if they are uninsured or underinsured. Oftentimes, we find that individuals will wait in the emergency room or in the emergency department for days on end while we see if there's a bed available. I know Knox County doesn't have enough resources or beds available to house or to treat those who need that higher level of care, so the ER becomes a de facto mental health inpatient setting, which means they're not getting the care that they could benefit from if that's the level they need.
Let's talk about that. What could we do here where we live, Eboni?
There is a better way, and it's the alternative response way. We have two models that we've been looking into, and one is Denver STAR. The other is Portland, Oregon's Cahoots program. And both of those programs demonstrate that if you meet the immediate needs of the person of a non violent crisis, wound care, food, water, by sending an EMS and a trained crisis worker on site, you reduce the need to even require or to need hospitalization or the higher level of care. So having a shortage of beds is not as big of a problem anymore, because you don't need it. You can take care of the person in their community.
This transcript has been lightly edited for content.
