Community Power is Key in Addressing Behavioral Health Equity - Isabella Health Foundation

Community Power is Key in Addressing Behavioral Health Equity

As health equity advocates work to address the inequalities laid bare by COVID-19, new community-driven initiatives around the country are bringing a racial and social justice approach to mental health and crisis intervention.

The pandemic-related spike in mental health crises is well-documented, with communities of color and other marginalized groups facing disproportionate impacts from COVID-19. At the same time, the national crisis around police violence continues: in 2021, police shot and killed over 1,055 people—the highest total since at least 2015, according to The Washington Post—and state legislatures voted on over 400 bills aimed at reducing police violence. Between 14 and 25% of police shooting victims in recent years were individuals experiencing known mental health problems, according to the Post.

To address the structural drivers behind both of these crises, behavioral health experts and criminal justice advocates are working to build community-driven programs that focus on early intervention—and in some cases, they’ve won the backing of local governments and law enforcement.

In Minneapolis, where intense struggles for racial justice and abolitionist solutions have continued since the murder of George Floyd, a project called Relationships Evolving Possibilities (REP) is building alternatives to police systems by training local networks in peer-to-peer mental health support. In the Bay Area, the MH First Oakland project has set up a non-police response hotline that offers ​​mobile peer support and interventions, with the goal of “decriminalizing emotional and psychological crises and decreasing the stigma around mental health, substance use, and domestic violence, while also addressing their root causes: white supremacy, capitalism, and colonialism.”

The idea of a mental health hotline has also gained traction as a state-backed solution, with recent legislation on track to establish 988 as the nationwide hotline for behavioral health crises in July of this year. But the rollout of such programs remains up to local authorities and legislatures and depends largely on the approaches they adopt—and the level of community involvement.

One leader in this regard is a program in Virginia known as the Marcus Alert system, an effort to bring equity to both the criminal justice system and behavioral health crisis services, with local leaders securing support from local governments and authorities.

Marcus-David Peters, a high school teacher in Richmond, was shot and killed by police in May 2018 when they came to the scene as he was experiencing a mental health crisis. The incident prompted a surge in efforts by mental health and racial justice activists to call for concrete steps to bring equity to the state’s justice system and to adopt tangible solutions to end such police killings. In November 2020, they successfully pushed the Virginia legislature to adopt the Marcus Alert law, creating a 988 line and setting up pilot programs in five areas across the state.

The program is based on an approach called Equity at Intercept 0, which focuses on building community power and resources to launch behavioral health interventions where they can be most effective—before someone is arrested or breaks the law. Equity at Intercept 0 is part of what’s known as the Sequential Intercept Model, a framework that identifies five points where people struggling with mental health or substance problems may come into contact with the criminal justice system. The model offers a framework for developing community-driven solutions to serve people involved in the justice system who experience mental and substance use issues. It allows community stakeholders and authorities to map how people interact with the criminal justice system and to identify gaps, resources and potential strategies.

In Virginia, the work around Intercept 0: Community Services has been led by a group of community leaders, mental health advocates, academics and public health experts—including Dr. Katharine Hawkes of the Isabella Health Foundation. Together, they designed programs and recommendations rooted in a health equity approach, aimed at meeting the needs of Virginians of color and other minority groups. They laid out plans for the Marcus Alert’s Equity at Intercept 0—Virginia’s approach to the dual crises of inequality in mental health services and ongoing police violence. The model includes establishing do-no-harm mobile crisis services, increasing equitable access to behavioral health services, developing standards for providers, improving safety through empowerment and decreasing adverse outcomes from mental health responses.

As the Sequential Intercept Model spreads around the country, successful examples like this offer local leaders, professionals and other community members the chance to learn about evidence-based practices—to see what’s been tried, what works and what may not. In July 2016, Congress passed one of the largest behavioral health bills in years and highlighted the model as a key tool to help make the justice system more equitable. The Helping Families In Mental Health Crisis Act, part of the 21st Century Cures Act, specifically allocated funding for the Sequential Intercept Model with the goal to “develop a shared understanding of the flow of justice-involved individuals with mental illnesses through the criminal justice system…identify opportunities for improved collaborative responses…[and] bring innovative and effective programs to scale along multiple intercepts”.

In Virginia, the programs under Equity at Intercept 0 that are already rolling out include peer-run crisis lines and “warm” lines for behavioral health, mobile crisis teams, jail diversion and treatment programs and co-responder teams made up of behavioral health professionals and law enforcement. Statewide surveys and focus groups with those interacting with mobile crisis services as well as the overall crisis system are planned to understand the effects of these changes. This represents a key step in building solutions to follow through on the promises of the Marcus Alert system: one study by Pew Research Center in 2021 surveyed the capacities of 233 call centers around the country and found that very few had staff or resources dedicated to behavioral health and less than half had mobile teams that could respond to mental health crises.

But these interventions depend on follow-through and continued commitment from authorities and local government; even Congress stated that the Sequential Intercept Model was “a starting point”. Adopting these solutions is part of a long-term effort and commitment to strategic interventions, in the hope of reducing incarceration, lowering recidivism and introducing sustainable alternatives to criminalizing the lives of those with mental health and substance problems.

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