An important focus for states trying to improve their crisis response systems is ensuring those services meet the needs of diverse groups. To be effective, crisis response must be available to anyone, anytime, anywhere. This includes availability to populations that are traditionally overlooked in planning, yet who we understand to be especially vulnerable to harm. The federal agency SAMHSA surveys states’ progress toward meeting these goals, helping to identify areas of improvement as well as shortfalls and areas for growth.

In SAMHSA’s 2023 summary report on behavioral health crisis systems nationwide, 21 states reported that their crisis systems “recognized” racially and ethnically diverse communities and acknowledged their overrepresentation in the mental health and correctional systems. However, disappointingly few states were able to “describe how crisis services systems will be tailored to address the unique needs of diverse racial and ethnic communities” (SAMHSA, 2023c). Oregon is one state that has articulated some plans in this area, including the development of a workgroup focused on improving crisis services for Black, Indigenous, and people of color (BIPOC) communities. Likewise, Wisconsin is implementing a peer-run “warmline” to support diverse populations across the state; peers will identify as Latinx, Black, or Hmong. Virginia also reports efforts to improve relationships between the various organizations in the crisis response system to ensure BIPOC leadership and participation in services and research.

The city of Minneapolis has launched efforts to provide mobile crisis teams ready to respond to underserved populations and people of color, with particular recognition of the stigma that may be associated with their services in certain communities. Watch the short video link in figure 5.17 to hear from one Minneapolis crisis responder.

https://youtu.be/AH_d3fwOBHs

Eighteen states claim engagement in activities related to improving crisis services for Native Americans and/or Alaska Natives. Most of these states are collaborating with tribal communities and governments to ensure that services are culturally relevant and meet the unique needs of tribal populations. Alaska reported a need to address access challenges where roads are lacking and travel is limited to air or water. Access is key to making sure people in these communities who need services do not have to be transported hundreds of miles away from their homes, families, and cultural traditions (figure 5.18).

A minority of states (16, including Oregon and Washington) provide crisis services specifically targeted to individuals in the LGBTQIA+ community. More states reported efforts to address crisis needs in elderly populations, and almost all states currently have specific crisis services in place for children. For children, states have been seeking to expand crisis services in schools and to grow the crisis workforce (including peers) for children and youth. One National Suicide Prevention Lifeline site in Oregon provides youth- and young-adult-specific text services through the Youthline. Mobile Crisis Response is also available for children and youth in Oregon.

Use of Force in Crisis Encounters

Dire risks are associated with excessive use of force against people with mental disorders. Police also use force in many situations that draw less attention but remain quite harmful. NAMI takes the position that police should seek to avoid the use of force entirely against people experiencing problems due to mental disorders, arguing that the use of any force is especially harmful to this vulnerable group. NAMI urges law enforcement leaders and policymakers to “prioritize policies that prevent use of force when law enforcement is responding to a person in a mental health crisis to reduce trauma and tragedy” (NAMI, 2024).

Use of force by police officers, in any case, must occur only when necessary; this is a demand of our Constitution and laws. Should police, as NAMI asserts, go a step further and seek to avoid all use of force against those experiencing mental disorders? Policy enacted by the Portland Police Bureau (PPB) seems to endorse this position, urging restraint in the use of force with this particular group. PPB’s general use of force policy states:

The Bureau recognizes that members may need to use force in the performance of their duties. In these circumstances, the community expects and the Bureau requires that members use only the objectively reasonable force necessary based on the totality of the circumstances (City of Portland, 2023).

However, PPB policy goes on to specifically recognize mental disorders as a moderating consideration weighing against the use of force:

Members shall attempt to avoid or minimize the use of force against individuals in actual or perceived mental health crisis or those with mental illness and direct such individuals to the appropriate services, where possible (City of Portland, 2023).

Unfortunately, despite positions and policies to the contrary, people with mental disorders nationwide are not spared the use of force more often than others—rather, they are at higher risk of experiencing police use of force than other groups. People with serious mental illnesses (such as schizophrenia) are more than ten times as likely as others to experience the use of force in law enforcement interactions as people without those diagnoses (NAMI, 2024). NAMI attributes this disparity to a number of underlying problems, including officer misinterpretation of unusual behavior and unexpected responses to commands that may be demonstrated by people with mental disorders. Accordingly, it is vital that police engage in training that teaches them about mental disorders and emphasizes de-escalation—the use of skills to slow events and decrease the risk of physical confrontation. Also critical is the development of police department culture that seeks to minimize the use of force, as communicated by its leaders and its policies, and demonstrated by officers in performing their duties (NAMI, 2024).

Additional special populations that many states consider specifically in crisis planning include veterans, people living in remote or rural areas, and people with co-occuring mental health disorders (e.g., gambling or substance use disorders in addition to mental health needs). Targeting these populations, and all of those discussed in this section, to better understand and meet their needs is critical to an effective crisis response system that avoids the overuse of force and the criminalization of mental disorders.

Licenses and Attributions for Crisis Services for Special Populations

Open Content, Shared Previously

“Crisis Services for Special Populations” by Anne Nichol is adapted from National Guidelines for Behavioral Health Crisis Care and Snapshot of Behavioral Health Crisis Services and Related Technical Assistance Needs Across the U.S., both by SAMHSA. Modifications by Anne Nichol, licensed CC BY 4.0, include editing, condensing, and expanding upon the content.

Figure 5.18. American Indian and Alaska Native People by Centers for Disease Control and Prevention is in the Public Domain.

All Rights Reserved Content

Figure 5.17. Mobile Crisis Services in Minneapolis by cityofminneapolis is licensed under the Standard YouTube License.