Ethical Practices for Mental Health Detainment

Walworth County, Wisconsin – A Man’s Constitutional and Civil Rights may have been violated when he was forcefully detained by a Police Officer, after the man peacefully called 911 for Assistance. 25 months later, the arresting Officer then stated for the first time, under oath, that there was no evidence of a crime, and no reasonable cause for suspicion, to place the man in handcuffs, search the man’s body without his permission, and lock the man in the backseat of his squad car.

Interestingly, the Officer, never called for backup, although he claims the man was making him nervous.

The Officer, then testified that he put his hands on the man because he had serious concerns about the man’s mental health. In the State of Wisconsin, for a person to be detained for mental health reasons, the Police Officer must believe the person is not capable of providing basic necessities for themselves, and that they are a danger to themselves, and that they are a danger to others.Those are serious mental health concerns.

The American Bar Association states that if a person is detained by a Law Enforcement Officer for serious mental health concerns, they must either be referred to a family member and released without prosecution, or they must be transferred to a mental health facility.

PART I: THE CRIMINAL JUSTICE SYSTEM AND THE MENTAL HEALTH SYSTEM
Standard 7-1.1. Terminology

(d) “Mental health treatment,” appearing throughout the Standards as “treatment,” includes but is not limited to the appropriate use of psychotropic medications, habilitation services, assertive community treatment, supported employment, family psychoeducation, self management, and integrated treatment for co-occurring mental disorder and substance abuse.
(e) “Mental health facility” refers to a facility designated for treatment of individuals with mental disorder, such as public and private mental and medical hospitals, community mental health centers, and crisis intervention units, but not including jails or prisons. A “forensic” mental health facility is a secure government facility reserved for individuals who have been charged with or convicted of crime.

The Officer, then testified that he did not take the man to receive mental health services, at a mental health facility; he immediately took him to jail.

The Officer, never communicated orally or in writing to the man, during the encounter, that the man was being detained for mental health reasons of any kind. The Officer took 25 months to convey this information to the man, after the man contested his right to the privacy of his body to be searched.

The Department of Justice’s Guidelines for Mental Health, clearly state that Government entities should provide behavioral health crisis response services in parity with the services provided to those experiencing medical emergencies.

If a person is detained for mental health reasons, they must be provided with mental health services. If a person is detained for Medical reasons, they should receive Medical help, right?

The State Appointed Defense Attorney, representing the man, stated there are no medical reports in this case. The Attorney has also stated that he believes the man should be given a fine in the matter. The Attorney said, he doesn’t know what the Court is trying to accomplish here. The Attorney, has also stated that he does not believe the man is a criminal.

What if the man had been dehydrated, had a concussion, had been poisoned, was on drugs, had a UTI, or any other combination of possibilities, that could have caused his mental health to have been altered? There are no blood and urine samples from a Medical Health facility, like a hospital ER at a minimum, to rule out other potential causes for the state of the man’s mental health. The County of Walworth, Wisconsin did not provide the man with an opportunity to receive these Medical Services at a Mental Health Facility.

The man was placed in handcuffs, he was locked into the backseat of the Officers squad car, with no way to obtain medical attention for himself.

How can the medically detained man’s statements be used as credible evidence of anything, if he had been poisoned or suffered a concussion prior to calling 911? Without medical tests and reports, how can the man obtain a fair and just defense, during any future trial on the matter?

The American Bar Association has written a Criminal Justice Standards on Mental Health, which outline ethical standards for law enforcement encounters where an Officer detains a person with mental disorders:

Standard 7-2.4. Custodial processing of persons with mental disorders by law enforcement officers
(a) When arrest of an individual with a mental disorder is based exclusively on minor non-violent criminal behavior, law enforcement officers should follow one of the following options:
(i) in cases where the law enforcement officer reasonably believes that the mental disorder did not contribute to the crime or is not serious, processing the person in the same manner as any other criminal suspect;
(ii) facilitating a voluntary disposition under Standard 7-2.2, or
(iii) immediately transporting the person to an appropriate facility for evaluation and treatment under Standard 7-2.3.

However, in this case, the man called 911 because he felt his life was in danger, he told the Officer this before he was detained. The man was arrested and charged with conceal & carry. The man was trying to explain to the Officer why he felt the need to be able to defend himself. The Officer did not give the man an opportunity to explain his situation.

The Officer placed the man in handcuffs for what he claims was a mental health detention because the man’s story was illogical. The man was detained by the Officer before there was evidence of a crime, or reasonable cause, or reasonable suspicion of a crime. A reasonable person would need to have had serious concerns about the man’s mental health, to strip the man of his Constitutional Rights.

Most importantly, the man tells the Officer that he had a weapon to defend himself, and that he believed someone was harassing him and trying to harm him. A reasonable person would believe the man’s mental health (he believes he is being followed and his life is in danger) being the cause of the crime he is arrested for, carry & conceal (to protect himself from the people following him).

The man felt the need to call 911 because he feared for his life. A coordinated and professional hit was attempted on his life a mere 3 days before his arrest, after he left Florida, on his trip north to Wisconsin to relocate his valuables to a safe location. An unknown new white sedan followed the man into an empty parking lot in Asheville, North Carolina around midnight when the man pulled off of the interstate. The parking lot was abandoned and no one was parked there. The man pulled into the lot, and the white sedan pulled in after him. The man parked his car, got out, and noticed there were 3 men in identical Guy Faukes masks, hooded sweatshirts and jeans, getting out of the white sedan in a rush. One of the men went to the trunk of the sedan, popped the trunk, and reached inside for a weapon. The other 2 masked men headed straight towards the man on foot at a high speed. The man jumped back into his car, and fled the scene. A witness with the man confirmed this in the police report.

In the man’s possession when he was arrested for conceal & carry, he had dress clothes on hangars, real estate blueprints of subdivisions that he had worked on in Wisconsin, his computer and the files he kept confidential for his data & patent business, amongst a number of other paper documents that he deemed needed to be kept in a secure location. The man was planning to sell the property he owned in Florida, where these items were stored. In advance of selling the property, which he did shortly after being arrested, he was delivering the valuable items to family and friends in Wisconsin for safe keeping.

Therefore, it is unlikely the Officer, would successfully claim 7-2.4(a)(i) as a Defense – because it is reasonable to believe that the mental disorder did contribute to the crime, and reasonable to believe the man’s mental disorder was serious.

The Officer stated on footage during the mental health detainment, that the man was “96 TO THE MAX! The Officer, testified under oath – that “96 TO THE MAX” is a military phrase meaning an individual is having a VERY SERIOUS mental health crisis.

The Officer, then stated under Oath that he detained the man because he did not believe the man could take care of and provide for his own basic needs, which would also suggest that the Officer believed that his concerns about the man’s mental health were serious.

The Officer then testified that he detained the man because he believed the man was a threat to himself, and a threat to others, which would again reasonably suggest that he believed that the man’s mental health concerns were serious.

Interestingly, for a Police Officer in the State of Wisconsin to place an individual under an emergency medical detainment, there are 3 conditions that must be met: (1) The person is not able to take care of themself and provide for their basic needs. (2) The person is a threat to themselves (3) The person is a threat to others.

The District Attorney, verbally offered the man a plea deal with a lesser sentence on the night prior to a hearing on the matter of why the Officer placed his hands on the man and detained him. The District Attorney, then denied an orally agreed upon plea deal the morning of the hearing, stating that her office had spent too much time on the motion they wrote for the hearing to uphold her offer.

At that search hearing, the Arresting Officer then testified under oath, that he believed all 3 of the facts required to have legally detained the man for a mental health disorder in the State of Wisconsin, to be true.

No objections to the Officer’s decision to deny the man mental health and medical services were raised by the State Appointed Defense Attorney. No concerns were raised with the Officer’s decision not to provide mental health and medical services, by the Judge, or District Attorney, during the official hearing. The Court set the case for a criminal trial.

In this open case, in Walworth County, Wisconsin, the man was never transferred to a mental health facility or provided with medical services, instead he was taken directly to jail – where he was interrogated and charged with a serious crime of identity theft that was claimed to be discovered during the interrogations that took place immediately at the jail. So far, the District Attorney has not supplied full transcripts of the hour long interrogation performed where one of the other Officers involved claims he unearthed evidence of an identity theft crime. She has however, certified that she has previously turned over all evidence of statements made by the man and the Officer who interrogated him.

The Court has held the man on bond for 27 months. They want the man to move to and serve jail time in Walworth County – where he has never lived. He doesn’t live in Wisconsin, he lives 800 miles away.

The District Attorney has required the man appear 14 times in Court thus far; the first 12 hearings spanning over 24 months – before the District Attorney or the Arresting Officer notified the man orally or in writing, that the man had been detained for mental health reasons.

While being out on bond for 27 months, the man has obtained government building permits, finished the development and construction of multiple commercial and residential development projects, successfully obtained a patent in the United States for a construction invention – that he was told by Siemens – Federal Government Technology Division, is a game changer and can change the direction of the world.

He has also been in a stable long term relationship with a mental health crisis professional, ironically. No, they didn’t meet through her job, they met on one of her day’s off from work. They live together 800 miles away from Walworth County, Wisconsin, where the man owns a home. They plan to get married and start a family together.

Upon hearing that he had been detained for mental health concerns, the man then immediately called the headquarters of the largest Mental Health Advocacy Group in Wisconsin – NAMI Wisconsin, located in Madison, Wisconsin. The group’s Board of Directors consists of the Chief of Police of Sun Prairie, the Mental Health Director of Milwaukee, along with other prominent advocates in the mental health industry who work to improve the Mental Health laws of Wisconsin.

A representative of the Organization told the man during their conversation, that their organization was receiving a large number of reports in Wisconsin that Law Enforcement Officers were detaining people without a Constitutional Right to do so, and then later claiming the detention was for mental health reasons.

This is a rising statistic of concern, according to their representative. Their representative confirmed that in the other reports, the Officer’s also did not transfer the individual to a mental health facility or provide medical services. The Advocacy Group confirmed that these other individuals Rights were also violated, and this type of law enforcement behavior is on the rise in the State of Wisconsin.

Walworth County, Wisconsin does not appear to be following Federal guidelines either, which are in place to protect the Civil Rights of Citizens of the State of Wisconsin, who are forcefully taken into the Police’s custody under an emergency behavioral health detainment, and who are subsequently not transferred to receive behavioral health services.

The Department of Justice says on their website: “Case studies have demonstrated that when communities respond to individuals in crisis with law enforcement responses like arrest, court, and jail services, taxpayer costs are significantly higher than when crisis response services are utilized pre-booking.“

DEPARTMENT OF JUSTICE AND DEPARTMENT OF HEALTH & HUMAN SERVICES
Guidance for Emergency Responses to People with Behavioral Health or Other Disabilities

In Response to

Presidential Executive Order 14074 – Advancing Effective, Accountable Policing and Criminal Justice Practices to Enhance Public Trust and Public Safety

Section 14 – Promoting Comprehensive and Collaborative Responses to Persons in Behavioral or Mental Health Crisis

I. Introduction
On May 25, 2022, the President issued Executive Order 14074, Advancing Effective, Accountable Policing and Criminal Justice Practices to Enhance Public Trust and Public Safety. Section 14(a) of the Executive Order directed the Attorney General and the Secretary of Health and Human Services to consult with stakeholders and to issue guidance regarding best practices for State, Tribal, local, and territorial officials on responding to and interacting with persons with behavioral health or other disabilities. This document provides that guidance. It outlines the application of federal disability rights laws in this area, as well as best practices for responding to crises experienced by people with disabilities, including people with behavioral health disabilities, intellectual and developmental disabilities (IDD), or other cognitive disabilities, who are deaf or hard of hearing, or who are blind or low-vision. Pursuant to the Executive Order, the guidance addresses response models, including co-responder teams and alternative responder models; community-based crisis centers and the facilitation of post-crisis support services; and the risks associated with administering sedatives and pharmacological agents such as ketamine outside of a hospital setting to subdue individuals in behavioral or mental health crisis. Federal resources, including Medicaid, that can be used to implement established and emerging best practices are also discussed.

2 The Department of Justice warns that when a Community delivers minimal treatment for some people, often those who have not been engaged in care, fall through the cracks; resulting in multiple hospital readmissions, life in the criminal justice system, homelessness, early death and even suicide.”

4 Law enforcement is too often viewed as the only available entity to respond to emergency calls involving individuals with behavioral health disabilities. Often these situations require public health responses that law enforcement authorities lack the capacity to address, and indeed should not be expected to address. As a result, many individuals experiencing behavioral health crises interact with the criminal justice system when what they need is mental health or substance use disorder services. Research has shown that as many as 10 percent of all police calls involve a person with a serious mental illness.

5 Other estimates indicate that 17% of use of force cases involve a person with a serious mental illness, and such individuals face 11.6 times the risk of experiencing a police use of force faced by persons without a serious mental illness.

6 Further, while representing only 22% of the population, individuals with disabilities may account for 30% to 50% of incidents of police use of force.

7 In recent years, people with mental illness have accounted for between 20% and 25% of individuals killed by law enforcement.

8 These interactions are not only harmful and potentially deadly for people with disabilities; they also impose monetary costs on taxpayers. Case studies have demonstrated that when communities respond to individuals in crisis with law enforcement responses like arrest, court, and jail services, taxpayer costs are significantly higher than when crisis response services are utilized pre-booking.

LEGAL FRAMEWORK

Title II of the Americans with Disabilities Act (ADA) prohibits public entities from discriminating against individuals with disabilities, excluding them from participation in the public entity’s “services, programs, or activities,” or denying those benefits on the basis of a disability.

9 Public entities, including emergency response systems and law enforcement agencies “must make reasonable modifications” to their ordinary practices when “necessary to avoid discrimination on the basis of disability unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity.”

It would not have fundamentally altered the nature of the service, program, or activity of the City located in Walworth, County to provide the medical needs of the man. There was a Hospital located directly across the street from the Jail, where the man was taken. The man would have paid for the medical services provided by the Emergency Room at the Hospital. The man was not transferred to get medical services, though, nor was he given the opportunity to be transferred there by the Arresting Officer, and his fellow Officers.

In Olmstead, the Supreme Court held that Title II of the ADA prohibits the unjustified institutionalization of people with disabilities. The Court further held that public entities must provide community-based services to people with disabilities when (a) such services are appropriate; (b) the affected people do not oppose community-based treatment; and (c) community-based services can be reasonably accommodated, taking into account the resources available to the entity and the needs of others who are receiving disability services from the entity. A public entity need not provide community services if doing so would “fundamentally alter” its service system.

Public entities may run afoul of the integration mandate if they lack sufficient community-based crisis services to prevent needless institutionalization of people with disabilities.

Community-based crisis services play a key role in preventing needless institutionalization, law enforcement encounters, and incarceration of people with disabilities. These services, including mobile crisis services and crisis stabilization services–such as staffed crisis apartments, peer crisis respite centers, and community-based crisis stabilization units–divert many people with disabilities from admission to psychiatric hospitals, emergency departments, and jails.

People with disabilities are more likely to interact with police and more likely to be arrested than their non-disabled counterparts. Police response tailored to the needs of people with disabilities and in compliance with disability rights laws can improve outcomes for both law enforcement and individuals. Jurisdictions should not assume that the proper response to a crisis is always to send law enforcement, but instead should assess reasonable modifications to their usual practices where appropriate to afford equal opportunity to people with behavioral health and other disabilities. What modifications are reasonable in a particular jurisdiction depends on a variety of factors, which may include the existence of mobile crisis services, and other resources that may be available.

b. Diversion to behavioral health services whenever appropriate
i. Jurisdictions should encourage use of the 988 Suicide and Crisis Lifeline, including through text or chat functions, and other behavioral health
resources instead of relying exclusively on 911 for response to behavioral health-related calls, and should develop systems to divert appropriate 911 calls to these resources. A key function of the 988 Suicide and Crisis Lifeline is to assess for imminent risk.
ii. Where appropriate, law enforcement and dispatch should divert calls to behavioral health responders when they encounter someone demonstrating a need for behavioral health support who is not an immediate threat.
iii. Law enforcement should develop working relationships with diverse local behavioral health providers and other providers of community services for individuals with disabilities. This may include the formation of a crisis intervention committee with a mission to build an effective regional crisis incident response that considers resources, training, local legal standards, and community expectations.
iv. A comprehensive array of crisis response services should be developed including call centers, mobile outreach, and community-based crisis services.

d. Trauma-informed approaches and recovery
i. Understanding and considering the pervasive nature of trauma in human experiences allows service providers and first responders to promote interactions and services that support healing and recovery rather than those that may inadvertently re-traumatize individuals.
ii. Trainings and policies should emphasize understanding, respecting, and appropriately responding to the effects of trauma at all levels.
iii. Crisis response should be based on least restrictive standards that minimize the potential for adverse events.
iv. Crisis response should maximize autonomy and utilize recovery-based approaches.

e. Round-the-clock resources
i. Crisis services should be available throughout a jurisdiction, at all times of day, and on weekends.
ii. Crisis providers should connect people to ongoing community-based services that can support them after the crisis passes.
iii. Crisis stabilization settings should allow visitors 24 hours a day to support individuals in their recovery and communicate, coordinate, and optimize natural supports.

f. Coordination across systems
i. Law enforcement and mental health agency leadership should work together to examine how people with behavioral health disabilities and
other disabilities are coming into contact with law enforcement and/or being incarcerated so that gaps in the service system can be identified and addressed.

III. Best Practices, Policies, and Training Components

Programs, policies, and trainings focused on interactions with individuals in crisis or with disabilities should give the jurisdictions and law enforcement members the necessary information and tools to:

a. Call Handling, Dispatching, and Off-Ramping
Contacts with law enforcement can begin with a 911 call or text or a community contact between law enforcement and a person with a disability. In either case, assessment of the situation and a decision about the services that will best address the situation is key to an effective contact and successful outcome. These assessments and processes should identify opportunities to appropriately divert people from law enforcement contact and to facilitate access to the type of support that they need.

i. The new national 988 Suicide and Crisis Lifeline number offers a single number for people to call when they are having a behavioral health crisis.
The 988 and 911 systems need to be closely coordinated to provide the right response for each situation. Because many calls to 911 are calls for behavioral health services or support, public safety answering points in many jurisdictions can divert a substantial portion of these calls to 988 to receive an appropriate clinical response. This type of rerouting reduces the burden on law enforcement of responding to calls that can most effectively be handled by behavioral health clinicians and increases the likelihood that people get the support they need in a crisis. Emergency medical responders or law enforcement, sometimes in collaboration with behavioral health professionals, will still respond to situations where the person in crisis or others are at imminent risk of physical harm. Local 911 and 988 centers should establish protocols for transferring calls, as well as coordinating between text-to-911 and 988 text and chat functions, based on established criteria.

a. Mobile Crisis Teams
i. Mobile crisis services are generally provided by a team of people including a mental health clinician and, frequently, a peer support provider.
ii. The team responds in real time to the location of the person in crisis, engages the person, assesses the person’s needs, intervenes to de-escalate the situation, and connects the person to ongoing behavioral health services that can prevent future crises.
iii. If law enforcement is the first responder to an incident in a jurisdiction with mobile crisis services, law enforcement should also be able to request mobile crisis services for the individual if they determine that behavioral health treatment would be more appropriate than law enforcement engagement.
iv. The success of these teams is dependent on developing multi-disciplinary partnerships, providing cross-system training, sharing data across systems, and identifying follow up care for referrals from the teams.
v. Services should be provided where the person is experiencing a crisis (home, work, religious institution, park, school, group home, assisted
living facility, nursing home etc.) and not be restricted to select locations within the region or particular days/times. If situations warrant transition to other locations, mobile crisis teams should connect individuals through in-person transfers of care, coordinate transportation where needed, and provide 24/7 access for optimal coverage.
vi. Best practices include incorporating trained peers with lived experience and expertise in recovery from mental illness and/or substance use disorders (SUD) and formal training within the mobile crisis team; and responding without law enforcement accompaniment, unless special
circumstances warrant inclusion. Peers may support individuals’ justice system diversion and following a crisis.
vii. Most community-based mobile crisis programs utilize teams that include both professional and paraprofessional staff, ideally in teams of two. For example, a master’s or bachelor’s level clinician, including psychiatric nurses, may be paired with a trained peer support specialist with the backup of psychiatrists, psychologists, advanced practice registered nurses or other master’s level clinicians who are on-call, as needed.
viii. Mobile crisis services should strive to be available 24/7 and can be provided to adults, children, youth and families. Service requests should be simple and coordinated, with preferred response times by the mobile crisis team under one hour (2 hours in rural settings). Effective models also provide follow-up access to mental health and /or developmental disability support providers within 48 hours either via telehealth or in-person services.
ix. Mobile crisis teams should have the capability to make referrals to outpatient care and to follow up to ensure that the individual’s crisis is
resolved, or they have successfully been connected to ongoing services. Some crisis interventions may also include the development of strategies for identification of triggers, safety planning, advance directives, including psychiatric advance directives (PADs), and related illness management to reduce future risk of crises.

i. Co-responder teams include an officer trained to respond to mental health crises and a co-responder. The co-responders vary in training. For example, some may be peer support specialists while others are mental health clinicians.
ii. Research has shown that in jurisdictions with co-responder models as compared to law enforcement responses, law enforcement officers are more likely to divert individuals from the formal justice process.

c. Crisis Intervention Training (CIT)
i. Crisis Intervention Training (CIT) programs provide training to law enforcement officers with the goal of improving outcomes of law
enforcement interactions with people experiencing behavioral health crises. CIT trained officers can provide a specialized police response to individuals experiencing a behavioral health crisis in situations where police presence is needed.
ii. Success is dependent on the training the officers receive, and is most effective when law enforcement, mental health providers, individuals living with mental illness, and family and community leaders work together.

Crisis Stabilization Services facilitate resolution of crises over a short period, usually ranging from a few hours to several days. Crisis stabilization services can be delivered in a variety of settings including staffed crisis apartments, peer crisis respite centers, and community-based crisis stabilization units.

b. SAMHSA has recognized the importance of peer support workers in crisis settings, and its National Guidelines highlight the use of peer crisis respite programs. These programs are typically staffed by individuals with lived experience with psychiatric disability, although clinical staff may be involved to support assessments.
c. Community-based crisis stabilization units can be freestanding or part of a larger facility. In accordance with the ADA’s integration mandate and the Olmstead decision, crisis services must be offered in the most integrated setting appropriate unless doing so would fundamentally alter the service system. These facilities provide initial screening and assessment, and short-term and longer-term stabilization in a non-hospital environment. They should accept drop-offs and walk-ins on a 24/7 basis.38 These settings provide law enforcement and mobile crisis teams with a safe location to bring individuals in crisis, often instead of bringing them to jail or the emergency room. These settings can effectively
engage family and informal caregivers by supporting a 24 hour a day visitor policy.

De-escalation best practices are an important component of how a jurisdiction approaches these interactions.
a. Law enforcement agencies should have policies, trainings, and mission/value statements that prioritize the need to de-escalate interactions whenever possible.
b. Recently, research involving the University of Cincinnati, the Louisville Metro Police Department, and the International Association of Chiefs of Police, produced evidence that implementation of the Integrating Communications, Assessment, and Tactics (ICAT) training program from the Police Executive Research Forum (PERF) produced a significant reduction in officer use of force following de-escalation training.
c. Agencies should:
i. Link policies to evidence-informed training;
ii. Expect all supervisors to support a culture of de-escalation;
iii. Reward successful de-escalation efforts;
iv. Hold officers accountable to their de-escalation policies and training; and
v. Enhance public reporting and transparency.

b. Assertive Community Treatment: Assertive Community Treatment (ACT) is an individualized, highly coordinated, team-based approach that helps people with serious mental illness who are most at risk of psychiatric crisis, hospitalization, and criminal justice system involvement succeed in the community. It is one of the oldest and most widely researched evidence-based services for people with serious mental illness. ACT teams are comprised of a multi-disciplinary group of professionals, typically including a psychiatrist, a nurse, an employment specialist, a housing specialist, a SUD specialist, a peer support specialist, and other mental health professionals such as social workers, counselors, or
occupational therapists.44 Services are delivered in community settings where the support is needed, rather than in offices or clinics. The team is available 24 hours/day, 7 days/week, for as long as needed. ACT reduces the use of inpatient services, increases housing stability, leads to better substance-abuse outcomes, and yields higher rates of competitive employment.

c. Peer Support Services: Peer support services are provided by peer support specialists who have navigated their own recovery process and who, through shared understanding, trust, respect, and empowerment, help others experiencing similar situations. Specific peer support services include peer respite, peer bridgers, and hearing voices groups. Peer support workers can play a variety of roles, including counseling; advocating for people in recovery; sharing resources and building skills; building relationships and community; mentoring; and helping individuals envision a different life, set goals, and make decisions.

a. Assess needs
i. The first step every jurisdiction should take in designing a crisis response system–or to evaluate their current system–is to use any available data to assess the need for crisis services and the intersection with the justice system.
b. Understand resources
i. Jurisdictions should identify and document all existing crisis response resources along with any potential additions to the system. This process
should consider resources available across the relevant stakeholder groups. Through this process, jurisdictions can identify existing gaps and prioritize the use of resources to fill them.
c. Create a local plan
i. As noted throughout the available best practice guides and research, any crisis/special needs plan must be directly informed by local factors and stakeholder input. Models that have worked in other jurisdictions must be adapted to the needs, personnel, geographic characteristics, demographics, resources, and other specific factors of the individual community developing its approach to responding to people experiencing a behavioral health crisis.
e. Promote alternatives to arrest where appropriate and consistent with public safety
i. Research consistently finds that the criminal justice system does not address the underlying needs of individuals with behavioral health
problems, and it can often intensify the crisis and traumatize or retraumatize people, with little to no reduction in potential criminal conduct.
ii. Jurisdictions should develop response models and trainings that incorporate evidence-based de-escalation principles and person-centered
practices that help minimize arrest and incarceration in these instances except where necessary to ensure the immediate safety of the community.
f. Prevent and limit use of force in encounters with people with disabilities
i. Ultimately, the goal of implementing these tools, training, and policies is to increase trauma informed services and supports to eliminate harm to individuals encountering law enforcement/first responders, including the use of seclusion and restraint, which also minimizes the risk to law enforcement officers/first responders, and community members.

a. Government entities should provide behavioral health crisis response services in parity with the services provided to those experiencing medical emergencies.
b. Law enforcement should be trained in legal standards for imposing transport holds and other actions in the mental health context, and on how to work cooperatively with other crisis response professionals.
c. Jurisdictions should ensure that alternative response models and diversion facilities are open to all and serve individuals encountered by all types of crisis responders.
d. Jurisdictions should ensure that all individuals involved in a potential crisis response receive at least basic CIT training, along with annual refresher training. These trainings should be scenario-based and interactive in nature.
e. Jurisdictions should ensure that all individuals involved in a potential crisis response receive cultural competence training with regular evaluation.
f. Jurisdictions should assess and adapt their current data collections processes and tools to ensure they are routinely collecting and analyzing data on the availability of, use of, and outcomes of the different response/service options.
g. Jurisdictions should include de-escalation policies and trainings as central to all positions across the emergency response continuum–from call taker to patrol officer/first responder, alternative responders, and follow-up service providers.

Disability Rights Texas – Your Legal Rights Under Emergency Commitment
Published: August 16, 2018

When and Why You Can Be Committed Under Emergency Detention

Where You Must Be Taken

After the peace officer detains you, you must be immediately taken to the nearest appropriate mental health facility for an evaluation. This evaluation will determine whether you can be held longer or whether you must be released. Some facilities may want the peace officer to first take you to an emergency room for a medical clearance evaluation. However, unless you request or require medical attention, you should be taken straight to a mental health facility. You do not have to consent to a medical clearance evaluation.

You must be placed in the nearest appropriate inpatient mental health facility or, in some cases, you may be placed in an alternative approved facility.

After You Have Been Taken To an Inpatient Facility

You have the following rights after you have been taken to an inpatient mental health facility following an emergency detention:

Mental Health Care, Not Jail

Excerpts: Mental illness is not a criminal offense. And even when officers understand the need for care instead of arrest, they need better support to make it possible. It is reported in my county that officers take people to jail instead of the treatment center because it is faster and requires less paperwork.

Crisis Response, Not Policing

Just as medical professionals respond to medical emergencies, mental health professionals should respond to mental health emergencies.

The police are trained to protect the population from criminals. They are not medical professionals and, unless they have had very specific training, like CIT, they do not know how to deescalate a situation and make sure a person gets the mental health care they need. It takes a special skill set to calm and treat someone experiencing a mental health crisis, and the police are often not equipped for that kind of response.

It is possible for us to work with law enforcement to bring about change. They are allies in this work. However, the main premise of policing as we know it needs to be evaluated and the systems that perpetuate abuse in policing need to be dismantled. And we can do it with the will of all people — white, Black and Brown, and our leaders. We must not give just lip service to change. We must act with conviction and speed.

Systemic Change, Not Injustice

The men in my group should not have been arrested. But they were. Now they have lost their housing, jobs, relationships with family, places in community, good records and self-respect. In my group, I try to restore their dignity. I try to let them know that they have value and are cared for, that their mental health challenges do not have to stigmatize them for the rest of their lives.

PBS Wisconsin: ‘You’re treated like a criminal’: Wisconsin eyes fixes for emergency mental health
Published: January 26th, 2023

Excerpts: Mental health crisis services in Wisconsin operate on a county-by-county basis, yielding wide disparities in care. With few exceptions, counties lean heavily on law enforcement to detain people during mental health emergencies — in which a person is considered a threat to themselves or others — and transport patients to receive care.

“The system we currently have right now for emergency detention in Wisconsin is broken,” said Wisconsin Attorney General Josh Kaul, a Democrat who in 2019 convened a summit focused on solutions. “And we need to find alternatives.”

Officers seem to agree. Most respondents to a 2019 Wisconsin Department of Justice survey of police chiefs and sheriffs said that mental health interventions requiring detention ate up too much time. Of 354 respondents, 96% said that additional mental health facilities and transportation options outside of law enforcement would likely improve the process.

Law enforcement officers first respond to mental health crises across most of the state. But trained medical professionals can defuse a mental health crisis in most cases, while law enforcement may escalate threats due to a lack of training, according to the American Psychological Association.

Some of Wisconsin’s more populous communities, including Madison and Milwaukee, are shifting such duties to trained civilians.

Madison’s Community Alternative Response Emergency Services (CARES) program responded to 935 calls in its first year of operation and resolved most situations on scene, according to a report released in November 2022. CARES provided in-person help and transportation in 31% of instances, and just 3% of calls required police transfers.

Across much of Wisconsin, law enforcement and others who respond to mental health crises face a binary choice between emergency detention or no intervention at all, said Kaul. But investing in short-term inpatient facilities, psychiatric emergency rooms and receiving centers could give responders useful middle ground.

In Madison, that includes University Hospital’s 20-bed psychiatric inpatient wing where patients who may not require a longer hold can receive care for just a few days.

“A lot of people in crisis can turn around and feel markedly better in 24 to 48 hours, it does not require a lengthy inpatient stay,” Tony Thrasher said.

Republicans nix Evers proposals

In his previous budget, Wisconsin Governor Tony Evers proposed funding a variety of services that mental health advocates and law enforcement representatives support. He sought $12.3 million over two years to build up to two regional crisis centers — each with crisis urgent care capabilities, a temporary observation center, a 15-bed stabilization facility and at least two inpatient psychiatric beds.

Evers also proposed $5 million to create five regional crisis stabilization facilities for adults voluntarily seeking care. The centers would offer 16 crisis stabilization beds for “less traumatic” and more “community-based care in the least restrictive setting,” according to his proposal.

Republicans leading the Joint Finance Committee stripped each proposal from the budget that Evers ultimately signed.

The committee did include $10 million for “regional crisis services or facilities” in its supplemental budget, but those funds have yet to be released. State law requires agencies designated to receive such funds to request their release and justify the need. In this case, that’s the Department of Health Services.

The department has twice requested meetings with the joint committee for this purpose, once in January 2022 and more recently in December. The committee has yet to hold a meeting, an Evers spokesperson told Wisconsin Watch on Dec. 19.

“(2) FEDERAL ADVISORY COMMITTEE ACT.—Except as provided in this section, the provisions of the Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the Committee.

“(2) NON-FEDERAL MEMBERS.—The Committee shall also include not less than 14 non-Federal public members appointed by the Secretary of Health and Human Services, of which—

“(A) at least 2 members shall be an individual who has received treatment for a diagnosis of a serious mental illness;

“(B) at least 1 member shall be a parent or legal guardian of an adult with a history of a serious mental illness or a child with a history of a serious emotional disturbance;

“(C) at least 1 member shall be a representative of a leading research, advocacy, or service organization for adults with a serious mental illness;

“(i) a licensed psychiatrist with experience in treating serious mental illnesses;

“(ii) a licensed psychologist with experience in treating serious mental illnesses or serious emotional disturbances;

“(iii) a licensed clinical social worker with experience treating serious mental illnesses or serious emotional disturbances; or

“(iv) a licensed psychiatric nurse, nurse practitioner, or physician assistant with experience in treating serious mental illnesses or serious emotional disturbances;

“(E) at least 1 member shall be a licensed mental health professional with a specialty in treating children and adolescents with a serious emotional disturbance;

“(F) at least 1 member shall be a mental health professional who has research or clinical mental health experience in working with minorities;

“(G) at least 1 member shall be a mental health professional who has research or clinical mental health experience in working with medically underserved populations;

“(H) at least 1 member shall be a State certified mental health peer support specialist;

“(I) at least 1 member shall be a judge with experience in adjudicating cases related to criminal justice or serious mental illness;

“(J) at least 1 member shall be a law enforcement officer or corrections officer with extensive experience in interfacing with adults with a serious mental illness, children with a serious emotional disturbance, or individuals in a mental health crisis; and

“(K) at least 1 member shall have experience providing services for homeless individuals and working with adults with a serious mental illness, children with a serious emotional disturbance, or individuals in a mental health crisis.