What’s Next: Improving Mental Health Crisis Response

What’s Next with Nicole is a biweekly opinion column. The views expressed are solely the author’s.

TW: suicide, mania.

Arlington has begun an effort to improve mental health services in our community with dollars attached to these priorities. Taking this initial first step is significant, but we still have miles to go. Next Tuesday you can learn more about this topic at the Civic Federation monthly meeting.

Movement on mental health services all started with the overwhelming support for the Black Lives Matter movement last summer. Thousands marched, hundreds of first time speakers came to County Board hearings, and policy change was demanded. The County Board convened and the County Manager appointed a “Police Practices Group” (PPG) to recommend policy changes.

This working group narrowed their scope to four major sections: mental health crisis intervention, police civilian review board, traffic enforcement, and alternative dispute resolution. For purposes of this analysis I will focus on the mental health aspect of the recommendation.

Current State of Play

If an Arlingtonian is facing a crisis situation such as a manic episode, suicidal thoughts, or substance abuse, the response from Arlington is predominantly from the police. There is limited co-response with both a clinician and responding police officer. While it is impressive that ¾ of Arlington’s police force is “Crisis Intervention Trained” (CIT), police acknowledged during this process that their presence with flashing lights and uniforms immediately escalates a crisis situation even with the best trained officers.

There is little that is done for those in crisis after the initial police point of contact. In a situation where you experience a physical medical emergency, like a car crash, there are follow up services that are needed for treatment. Ultimately there are not currently adequate follow up services available for those in mental emergency situations.

With little support from federal or state agencies, we are left to our own devices to create a solution. This issue is too great to continue to push off a response. We have a number of best practice models to look at in other local jurisdictions and our police practices group recommendations put together a great target implementation framework.

What’s Budgeted for Improvements

In the County Manager’s budget there is a proposed $574,000 dedicated to supporting Arlington’s Crisis Intervention Center (CIC) and a medically equipped vehicle dedicated to crisis transit.

Additional staffing will be helpful to taking the CIC closer to being able to have a 24/7 response capacity, since crises takes place at all hours of the day, and provides services from a team of individuals who are adequately trained to respond to these specific types of medical emergencies.

One of those positions will be an emergency services clinician that presumably would be an additional co-responder to emergency calls, bringing our response team to a whopping two people dedicated to respond to the entire county’s mental health related calls around-the-clock.

The additional vehicle would hopefully eliminate the anxiety of flashing lights, from what have otherwise been a police or ambulance transit vehicle, while maintaining the medically necessary materials during transport time.

What’s Next

Some implementation items are process and coordination oriented, while others will require long-term funding commitments. What is included in the Manager’s Budget is able to address some of the important short-term funding oriented goals. There is still a tremendous amount of work to do though that is effectively summarized in the PPG Recommendation.

Immediate

• Establish protocol for co-response between police and mental health clinicians for emergency response.
• Plan for police to use CIC as a drop-off for when is safely feasible for individuals in crisis.
• Use data to evaluate and adjust programs as needed.
• Community outreach to those that miss appointments.

Short-Term (2 years)

• Create framework for a First Episode Psychosis program to treat young adults (15-30) at the onset of their life-long a mental health diagnosis to treat and mitigate long-term issues related to their illness.
• Empower Commonwealth Attorney to develop and implement guidelines to maximize use of pre-charge diversion while reducing public safety risk and negative impacts of court involvement and incarceration. Plan to include probation violators in the behavioral docket and drug court.
• Develop and implement a full array of substance abuse evidence-based treatment services for all ages.
• Expand services to people experiencing homelessness including additional beds and integrated services with CIC.

Long-Term (2+ years)

• Ensure the CIC is a functional 24/7/365 drop-off center for individuals, families, emergency services, and police for people experiencing crisis.
• Implement First Episode Psychosis program and Behavioral Health Docket.

Nicole Merlene grew up in Arlington County and has been a civic leader in both policy and political arenas. She has been an Economic Development and Tenant-Landlord Commissioner; Community Development Citizens Advisory Committee, Pentagon City Planning Study, Rosslyn Transportation Study, and Vision Zero member; Arlington County Civic Federation and Rosslyn Civic Association Board Member. In 2019 she sought the Democratic nomination for the 31st District of the Virginia State Senate. Professionally Nicole is an Economic Development Specialist where she works to attract businesses to the region. She lives in an apartment with her dog Riley and enjoys running and painting.