One of the greatest disparities in health care is the way in which our society addresses behavioral health emergencies. There is no greater tragic “tale of two systems” than the disparity between our medical crisis system and our behavioral health crisis system. While a 911 call for chest pain results in an ambulance response with trained emergency medicine technicians, a call for suicidal ideation often triggers an armed law enforcement response. With police as the default first-responders, individuals in behavioral health crisis account for a quarter of police shootings and over 2 million jail bookings each year. These disparities are amplified for people of color. Black Americans are 2.6 times more likely to be killed by police than non-Hispanic Whites, but for Black Americans with mental illness, the risk is nearly ten-fold.
Fortunately, there is now The Roadmap, which aspires for transformative change. The Roadmap goes beyond wishing for incremental tweaks in a terrible and inequitable system of behavioral health crisis care, and instead, it advocates for an ideal behavioral health crisis system, one that seeks to achieve the same standards of access and excellence as our medical crisis system.
For too long we have settled for a patchwork of poorly coordinated, inadequately resourced services that don’t meet the needs of individuals and families struggling with behavioral health emergencies. A crisis system, like the Emergency Medical System, must be more than a single program or collection of services, but rather a coordinated system with a governance and accountability structure that ensures needs are met effectively and efficiently. The Roadmap states: “A behavioral health crisis system is an essential community service (like police fire and ambulance services) from which we should expect the same level of quality and consistency as we do for medical emergency response.”
Like with the medical emergency (EMS) system, our vision is that “every person receives the right response in the right place every time.” It should be able to serve everyone regardless of payer, age, or acuity, including those with co-occurring substance use disorders, development disabilities, and involuntary legal status.
The Roadmap complements other reports that have defined core elements of the service continuum (e.g. SAMHSA’s Best Practice Toolkit and its “someone to call, someone to respond, somewhere to go”) but goes much further in outlining the details of such a system and describing the ‘roadmap’ for how to get there.
To achieve this ideal, The Roadmap describes three interacting design elements, along with measurable indicators for each: 1) Accountability and Finance, 2) Service Continuum and Capacities, and 3) Clinical Best Practices. The Roadmap also includes a Report Card that communities can use to measure their current status and plan progress, and outlines 10 Steps for community leaders and advocates to help everyone get on the road to success.
The next several years pose a golden opportunity for determining the future of behavioral health crisis care in the US. This is the perfect time for concerned community members to get involved. Everyone knows someone who has had adverse experiences with our current behavioral health crisis system; it’s time for all of us to be part of the change. The Roadmap will help us get there.