After the murder of George Floyd and the local uprisings that ensued, L.A.'s city and county leaders promised to develop a new unarmed mental health crisis response system.
That was more than two years ago now. So how is LA doing on its promise to respond to psychiatric crises without law enforcement?
A pilot program that the L.A. City Council cleared the way for in 2020 has yet to launch. A separate effort that launched earlier this year is struggling to find the staff needed to respond to crisis calls around the clock. And families still say response times when a loved is in the throes of a psychiatric crisis are unacceptably long.
'Please Don't Kill My Son'
Deborah Smith said she knows firsthand how things can turnout when law enforcement is the first response to a mental health crisis. Her son, Nick, lives with schizophrenia and is cycling between incarceration and living on the streets.
On one particularly bad night in 2018, Nick was delusional and hit his dad’s phone with a pipe. The family called for help and Deborah says L.A. County Sheriff’s deputies showed up and surrounded the house, guns drawn.
“That night, I thought he was dead," Smith said. "I thought, 'I’m never going to see him again, he’s going to go down in bullets'... I remember screaming at the deputies saying ‘please don’t kill my son, he’s mentally ill.’”
Nick ended up in jail that night. And it wasn’t the only time Deborah had to call for help.
A Death In The Family And A Mental Health Hold
Nick had a happy childhood growing up in the San Gabriel Valley, Deborah said. He loved skateboarding: he was especially proud of a longboard he built himself. He liked listening to the bands you’d hear on KROQ in the late 90s.
And more than anything, he loved fishing. “You could stick a pole in his hand and he would soak bait for days on end,” Smith recalled.
Hard times hit the Smith family when Nick’s grandparents got sick. They moved in and Nick gave up his room as a teenager. The grandpa had a heart attack and Nick held his hand as he slipped away.
“Nick was on his first mental health hold within four months of that,” Smith lamented.
After years of struggling, Nick was eventually diagnosed in his early 20s with bipolar disorder and later schizophrenia.
Over the years, Deborah has seen a law enforcement response to her son’s mental health emergencies. But she’s also reached out to the unarmed mental health crisis response teams run by the county Department of Mental Health.
For more help:
- Find 5 Action Steps for helping someone who may be suicidal, from the National Suicide Prevention Lifeline
- Six questions to ask to help assess the severity of someone's suicide risk, from the Columbia Lighthouse Project
- To prevent a future crisis, here's how to help someone make a safety plan
- Los Angeles County Department of Mental Health’s 24/7 Help Line (Spanish available): 800-854-7771
- East Los Angeles Women’s Center 24/7 crisis hotline (Spanish available): 800-585-6231
Crisis Text Line: Text HOME to 741741 for 24/7 crisis counseling
Help Is Not 'Guaranteed'
There are currently 33 of these Psychiatric Mobile Response Teams -- or PMRT. The two-person teams are made up of DMH clinicians. According to the department, those units are currently handling an average of 1,700 calls a month.
According to DMH data, about 24% of the more than 15,000 PMRT calls last fiscal year that had response time tracked took more than an hour to dispatch.
In Smith’s experience, the response times have ranged from two hours to an entire day.
“No matter how much you ask for the help, getting the help is not something that is guaranteed. You’re left scared out of your wits, going ‘What do I do now?’” she said.
Smith’s fears are understandable. According to the LAPD, of the 37 department shootings in 2021, “more than half involved individuals experiencing a mental health crisis.”
More than two years ago, the L.A. City Council voted to develop an unarmed model of crisis response that would divert non-violent mental health calls away from police.
“Today is an opportunity for us as a city to make a giant first step in putting in place professional unarmed response dealing with individuals that suffer from mental health challenges,” Councilmember Herb Wesson proclaimed at a council meeting in October 2020.
The unit is still non-existent, although the city has selected contractors to head up the effort.
Meanwhile, a patchwork of other efforts across the city and county of L.A. struggle to meet the demand for psychiatric crisis response.
Staffing Struggles And Families In ‘Beyond Bad’ Situations
Earlier this year, the county Department of Mental Health launched a new unarmed response called the Therapeutic Transport Van program. They currently dispatch out of five fire stations across the county. Each unarmed team is made up of a driver, a licensed psychiatric technician and someone who has personal experience with mental illness.
Miriam Brown, deputy director of Emergency Outreach at DMH, said the goal is to have the teams running 24/7, but she’s having a hard time finding mental health professionals who are willing to work late hours under taxing conditions.
Call 988 — The Mental Health and Suicide Crisis Lifeline.
Cal (800) 854-7771 — The L.A. County Department of Mental Health's Help Line
“We have lost some of our staff that had done crisis work to other programs that are offering telework,” Brown told LAist.
DMH says between January and September, the therapeutic transport teams handled nearly 1,200 calls. And as of mid-November, the program had eight vacant positions. According to an October report, 28 percent of the positions at the L.A. County Department of Mental Health are vacant.
This comes as the LAPD earlier this year said its mental health teams made up of a DMH clinician and an armed officer responded to only about one-third of mental health calls it received between January of 2021 and this summer. The department is requesting to add more of those armed teams.
Brown said DMH will continue to support the LAPD’s efforts, but added, “The community is really calling for civilian teams so that’s where the focus has been.”
This year, DMH started contracting with behavioral health agency Sycamores to bring on more crisis teams. Some of those outsourced staffers are already out in the field and will be added on an as needed basis, according to an email from DMH.
For people like Devora Von Sternberg, whose son lives with severe schizophrenia, the help can’t come soon enough. In her experience, unarmed crisis teams can take hours, even a day, to respond.
“At that point in time, you’re already beyond a bad situation. So what do you do? I guess you have to call 911,” Von Sternberg said.
She says the current landscape of crisis response has families like hers feeling “helpless.”
What Should Mental Health Crisis Response Look Like?
In 2019, Taun Hall’s son, Miles, was fatally shot by Walnut Creek police while he was going through a mental health crisis.
Hall and her family told the police that Miles lived with a mental illness and wasn’t violent. Still, Miles was killed when he needed care the most.
Three years later, his mother has become a powerful voice to remove law enforcement from mental health calls and rethink crisis response. But Hall says there’s still much work to be done.
“You know, I still have people calling me all the time, just asking me, ‘Okay, my son is having challenges, what do I do?' I feel like there’s still not a lot of options to give people,” Hall told LAist.
Hall championed a bill that Gov. Gavin Newsom signed earlier this year —- better known as the Miles Hall Lifeline Act — which, through a phone line surcharge, will add more than $50 million a year for mental health crisis response.
But how do you rebuild the system of care for behavioral health crises when, for decades, that responsibility has been dumped on the police?
For one, start with the input of people who live with a mental illness, said Jen Wang, senior director of national policy at mental health non-profit Fountain House.
“When you call, is it that you want someone to show up within 15 minutes, or 30 minutes? Is it that you want a social worker to show up? What is the actual ideal?” Wang said. Fountain House is currently doing outreach with people who live with a serious mental illness to answer questions like these.
The Vera Institute of Justice earlier this year released a toolkit for equitable alternatives to police response. It recommends, among other things, hiring a crisis response workforce that reflects the community it serves.
Daniela Gilbert is director of redefining public safety at Vera. She says it’s also crucial to pay this fledgling emergency workforce fairly.
“So that the skills and value of people responding to these crises is commensurate with how we compensate other first responders,” Gilbert offered.
So what kind of people and expertise would be best fitted to help someone suffering through a crisis?
'It’s OK, I Care'
Sitting in an armchair in his living room, Ben Adam Climer explains why he’s done crisis work for the better part of a decade. He spent about five years working as a behavioral health first responder with the CAHOOTS program out of Eugene, Oregon, which sends out a medic and crisis worker on calls.
“So many people are in that space where they feel like no one cares,” Climer said. “To be able to be the person to come to them and say, ‘no, it’s OK, I care,’ I enjoy being able to do that, immensely.”
For many, CAHOOTS has become the exemplar of how to do crisis response. A CAHOOTS staffer told NPR that out of about 24,000 calls in 2019, the team had to ask for police backup less than 1% of the time.
They’ve seen interest from jurisdictions all across the country — including L.A. — as they try to stand up their own programs.
Climer currently works as a consultant in California. He’s helped Huntington Beach, Garden Grove and other cities launch their own unarmed responses.
Climer said, in some cases, the expertise of a licensed clinical social worker or therapist might be better used for follow up care, rather than crisis response.
“It’s also just really, really hard to hire people who did four years of undergrad, two years of graduate school, two to three years of internship for their licensure, and then ask them to go drive around on a Friday night at 2 a.m. checking on people who are sleeping on a sidewalk,” Climer said.
Liz Sutton, a licensed clinical social worker in L.A., regularly helps people in mental health crisis. But they agree their level of training isn’t always needed to de-escalate someone in crisis. And Sutton believes the response should be 24/7 everywhere, since mental health or substance use crises happen in the middle of the night, too.
And more grassroots efforts are also sprouting up.
‘Individual People Can Make a Change’
As an organizer with the Alternatives to Policing Project, Sutton says they’ve helped train some 250 people on how to help someone in crisis, overdose prevention and more. Sutton acknowledges L.A.'s leaders have promised a re-imagined response, but added:
“Even if that’s not able to happen quickly, because it’s part of the bureaucracy and everything takes a hundred years, individual people can make a tangible change by just not calling the police.”
According to the Treatment Advocacy Center, people with untreated serious mental illness are 16 times more likely to be killed during an encounter with the police than other civilians.
Gilbert, at the Vera Institute, said these calls to remove law enforcement from mental health crisis response are not coming under neutral circumstances.
“Because the status quo is causing harm. And that harm is disproportionately experienced by Black people and other people of color in the U.S,” Gilbert said.
A recent Vera study of 911 calls in nine U.S. cities found that many “involve underlying substance use or mental health issues, homelessness, poverty, or other well-being concerns that police are ill-equipped to handle.”
It’s part of the reason Gilbert hopes the move towards civilian mental health crisis teams will be just one step in a bigger plan to narrow the scope of police response to community calls for other things too, from welfare checks to conflict resolution.