A few weeks ago, my spouse’s attention was drawn to a young man on the street corner below our nearby grocery — he was highly agitated, had fly-about hair and was speaking loudly to himself. As my spouse parked her car, the man walked toward the store, then situated himself a few paces from the entrance and continued to gesture. My spouse went in the store to shop; when she returned to her car, she saw the man enter the store.
Would these events and observations have caused you concern?
I venture that, for most people (including me), the answer would be based on prejudices or personal experiences rather than any purposeful training. This is because our society has yet to adopt — let alone agree on — objective, constructive responses to those who exhibit odd or unstable behavior in public, especially when those people are strangers.
The U.S. Forest Service has a cartoon bear with a ranger hat to remind us about wildfires and how to prevent them. But the Department of Health and Human Services has yet to deploy its own mental-health mascot, Serenity The Swan. (We can only suppose that she is waiting in the wings.) Given our nation’s conflicted mental-health objectives, Serenity would have little coherent to say to us in any case. Meanwhile, we — the troubled souls and those concerned about them — have largely been left to figure things out on our own.
My spouse described her encounter to me when she got home from the grocery store, and we discussed the situation a while. I asked, had she thought about calling 911, and she replied no. She said, it didn’t seem like an emergency and “people can be a little crazy.”
• • • •
The next day, our neighborhood’s Nextdoor site lit up with comments to a posting about a “mentally disturbed man with a dark and menacing energy” walking around a nearby park and “looking for his axe and ranting about Lucifer and strange stuff.” Being that none of my Nextdoor neighbors have ever heard a mental-health message from Serenity The Swan, they were free to fill the void with their own public service pronouncements:
- This encounter is a prime example why no one should be out and about without some sort of weapon close at hand. Mace, pepper spray, a walking stick, or something more lethal, whatever you’re comfortable with.
- I saw him in the parking lot of Fresh Market yesterday. He appeared to be having an animated conversation with someone who was not there. There is a lot of mental illness out there these days.
- A perfect example of what defund police should be about. A social worker and police were needed there.
- He is a registered sex offender known to police and first responders in the neighborhood. He has had mental illness since his teens but those who know him believe he’s currently unmedicated. We believe he’s homeless. He rides a child’s bike and carries an axe.
- He rides a child’s bike and carries an axe? For real. And he is allowed to do that. That is just crazier than he is.
I could not help myself and made a comment:
- A 9-1-1 call would have been appropriate, if you didn’t already.
Because 911 is all I know. This prompted a couple of replies which I could not discount:
- Or a nonemergency call to law enforcement if you’re concerned but not dealing with a life or death emergency.
- Just a heads up, the police will not respond unless violence [is] occurring. The police do not have enough manpower now. We have sketchy people all over the place.
Let’s be clear — until now, I hadn’t given much thought to how I should report weirdness that falls short of being an emergency. (As if I am a reliable judge of that.) I do not have the non-emergency numbers of our local police departments in my cellphone. I have no evidence whether calling 911 in such situations is a positive, a negative, or a waste of time. I had never researched whether there is a mental-health-related alternative to 911 where we live and, if so, who would respond. I know that if we do have such an alternative here, its existence has been well-concealed.
• • • •
I hardly need to point out how the ubiquity of firearms in the U.S. has poisoned the way we deal with overtly disturbed people. The gun-fetish interpretation (Scalia, June 2008) of the Second Amendment severed all ties between the words well regulated and arms, which has allowed very troubled people to inflict constitutionally-condoned mass harm.(1) After causing such harm, they are at liberty (!) to dispatch themselves with their own guns or relegate the dispatching to the police.
Not that the police want that job. No police officer (except maybe Polk County, Florida, Sheriff Grady Judge) wants any part of suicide-by-cop duty. Tragic as these events are, there seem to be plenty of them thanks to firearms. The flood of guns on the streets only adds to the fear and uncertainty of police officers as to the lethality of the objects they encounter in the course of doing their jobs.
The prevalence, hence future probability, of random gun violence has trained ever-fearful Americans, police and civilians alike, to treat “unstable” people as threats to be avoided, or to subdue and arrest, rather than as sufferers to be helped — assuming the community has the resources to help them.
Our fear is only made worse by how people with mental-health problems are presented on the news. A 2016 study by Johns Hopkins University found that “when the news media portrayed a specific individual with mental illness, that individual was most frequently depicted as having committed an act of interpersonal violence.” The study also concluded that “the news media’s … emphasis on interpersonal violence is highly disproportionate to actual rates of violence among those with mental illnesses. [This] may exacerbate social stigma and decrease support for public policies that benefit people with mental illnesses.”
Clearly, we have learned to associate the mental-health issues of others with the prospect of danger to ourselves. So what shall it be? Do we want our social/governmental response to take care of the matter or take care of the person?
• • • •
Which leads us to the 911 call and the response it may elicit. Our county website has this to say about “right and wrong” uses of the 911 system: A call to 911 should always be a call for help! Use 911 for life-threatening incidents. This includes:
- If someone is hurt.
- If you see someone taking something that belongs to someone else.
- If you see someone hurting someone else.
- If you smell smoke or see fire.
Neglecting for now the fact that “someone taking something that belongs to someone else” is usually not life-threatening, these 911 guidelines seem to exclude unstable behavior that falls short of being a crisis. Sort of what the Nextdoor commenter said to me.
But doesn’t a person who may endanger themselves or others justify a call to 911? Maybe not! The new concern, based on highly-publicized interactions(2) between the police and the mentally-precarious, is that calling 911 may not be “helpful” in such situations, and for good cause: Research Triangle Institute found that, of 159 officer-involved fatal shootings in North Carolina from 2015 to 202o, “about one-fifth involved someone who displayed signs of mental illness.” National data follows the same trend.
The advocacy and research group Mental Health America echoes such concerns in its 2017 policy statement:
Unfortunately, we do not have appropriate systems in place to respond to mental health and substance use crises. Among the wide-spread problems are: the lack of alternatives to calling 911; the lack of training for 911 personnel; the lack of alternatives to dispatching law enforcement personnel in response to mental health and substance use crises…
As a result, persons experiencing a mental health or substance use crisis may end up in confrontations with law enforcement personnel which have tragic outcomes, [or may] be transported to a jail and subjected to ongoing involvement in the criminal justice system when these outcomes are unnecessary, are harmful to the person, and do not lead to increased public safety.
If only there were a mobile mental-health crisis response unit that we could call, instead of involving law enforcement… But wait! Someone has thought of this already! I think.
• • • •
North Carolina has a statewide information and referral service called “NC 211” which is operated by United Way of North Carolina. Callers are referred to the local organizations “best equipped to address their specific health and human services needs including food, shelter, energy assistance, housing, parenting resources, healthcare, substance abuse, as well as specific resources for older adults, persons with disabilities, and much more.”
The only reason I know about 211 is that I was once a volunteer tax-preparer for a local non-profit financial counseling center. We would let our clients know about 211 when we did their taxes. But 211 otherwise gets little airtime around here — in fact I’d be surprised if 2.11 percent of the locals know 211 exists.
Nonetheless, I knew about it — so I visited the NC 211 website to see whether 211 might be the better number to call to report disturbing behavior. That is how I stumbled upon RHA Health Services, which calls itself a “leading provider of high-quality supports and services for people with a variety of behavioral health needs in North Carolina.” I then read that RHA has a “mobile crisis” team offering “on-site response, stabilization and intervention for people of all ages who are experiencing a crisis due to mental health disturbances, developmental disabilities, or addiction.” That sounds… helpful.
I decided to call the local RHA office to ask: would it be appropriate to call RHA, rather than 211 or 911, the next time I am concerned about the erratic behavior of a stranger? Here is a summary of my converstaion with the friendly RHA rep who answered my call:
• The first question the representative asked me was, who suggested I should not call 911? I replied, social media. She paused, but she did not take pains to correct me.
• She then said that, generally, individuals do not contact RHA directly unless the person who needs help is a family member or someone they are responsible for. This is because the services that RHA delivers are by consent, i.e., someone needs to authorize them.
• As to the specific case I mentioned, the agitated stranger in apparent need of help, the RHA rep suggested that the non-emergency police number would be the best one to call. She assured me that the city and county have trained crisis intervention personnel, and that law enforcement reaches out to RHA as appropriate. (I must take her word on this.) But even so, she added, some people decline the mental health services offered to them.
• • • •
NC Policy Watch, a North Carolina public policy think tank, recently questioned whether police officers, even with special training, are the appropriate first responders to mental health situations:
Although North Carolina law enforcement agencies have been using Crisis Intervention Training, or CIT, for more than 15 years to learn to respond to people in mental health crises, there’s now a growing belief that it’s unwise for police to respond to every emergency call, especially those involving mental health issues or homelessness. Cities in North Carolina are looking at practices in use around the country where non-police alternatives resulted in fewer arrests.
As such, members of the North Carolina House introduced a bill in May that would fund pilot programs in Charlotte, Greenville and Greensboro, to provide “alternative responses to citizens in crisis” and better facilitate “the response of behavioral and medical health personnel to nonviolent situations deemed appropriate by the city police department.” While it is good to see movement on this front, House Bill 802 is just one of 177 bills (!) awaiting action by the Appropriations Committee. Who knows what its fate will be?
While we wait, may I suggest that, unless your county has put a better system in place, we should all look up the non-emergency phone numbers of our local police departments and store those numbers in our cell phones. You know, just in case.
That said, it would be even better if we had a three-digit number for mental-health calls, the analogue of 911 for law enforcement and emergency calls. What’s that, Serenity? You say there is one? Yes, sort of. Last October, the U.S. Congress passed (and the president signed) The National Suicide Hotline Designation Act of 2020. This bill established 988 as the national suicide prevention lifeline, effective July 2022. It is unclear to me whether 988 will be reserved for strictly life-threatening situations or, as I hope, will also serve as a de-escalated alternative to 911 for mental-health distress calls.
We will have to see how this develops in each of the little states we live in.
(1) A 2018 study by Silver, Fisher and Horgan of over 100 U.S. mass shootings from 1990 to 2014 found that “half of the offenders had a history of mental illness or mental health treatment but less than 5 percent had gun‐disqualifying mental health records.”
(2) Just a handful of examples: Terrence Coleman, Boston, MA, 2016. Ricardo Hayes, Chicago, IL, 2017. Saheed Vassell, Brooklyn, NY, 2018. Miles Hall, Walnut Creek, CA, 2019. Daniel Prude, Rochester, NY, 2020. Chris Craven, Mooresville, NC, 2021…