Developing a Community-Based Emergency First Responders (EFR) Program

BACKGROUND INFORMATION ON CIVILIAN EMERGENCY FIRST RESPONDERS

Introduction

In the best of times, local communities struggle to meet the health needs of highly vulnerable people, including those who struggle with mental health or substance use disorder, poverty, or housing insecurity, or otherwise lack access to traditional health care resources. Because most communities do not have the kind of services necessary to assist someone experiencing a mental or behavioral health crisis, law enforcement has served as the default first responder. Police officers are not drug counselors, social workers, or health care professionals. They are trained to aggressively enforce criminal codes and thus their response to individuals experiencing a mental or behavioral health crisis or who otherwise appear agitated or upset all too often leads to the arrest and incarceration of these individuals. Particularly when a person is suffering from a mental or behavioral health crisis, police confrontations regularly involve force—and often deadly force. This not only depletes public safety resources, but also makes communities and officers less safe when law enforcement must take the place of trained experts.

Many vulnerable populations lack access to traditional health care resources. According to a 2016 report by the CDC, nearly 1 in 5 patients (17%) don’t have a regular place to access health care. These individuals need solutions that will come to them. Communities should mobilize health care resources to identify and prevent health care crises for vulnerable populations. To that end, crisis response teams should remove law enforcement from their strategies and instead build teams with medical and crisis workers who respond to emergency calls that indicate mental and behavioral health issues.

Across the country, different jurisdictions have enacted policies that have addressed the problem in various ways; however, to date no jurisdiction has enacted all the pieces. Included in this packet are examples of what different jurisdictions have done.

A model program should ensure the following:

Responses to 911 calls for mental health and substance abuse crisis should be diverted to a non-law enforcement crisis response team. Another non-911 number should be made available that goes directly to the crisis response team.

• The crisis response team should be composed of non-law enforcement mental health experts, including crisis-trained social workers.

• The crisis response team should be trained on the use of narcan, and carry narcan with them.

• 911 staff should receive mental health and substance use disorder training, and have clear guidance on when to direct the crisis response team to respond to a call.

• Emergency call centers should be staffed with mental health experts.

• If there is a non-911 number, it should be widely and consistently publicized.

The crisis response team should respond to all calls for help involving mental health crises or indications, along with substance overdose, including:

• In hospitals, when a person is refusing physical restraints, medication, or their physical health is being put at risk. The crisis response team can then make the decision to call the police.

• All domestic calls where the caller indicates the person is having a mental health crisis.

• All calls indicating an overdose or potential overdose shall be responded to by the crisis response team and appropriate medical health providers.

• Crisis response teams may request law enforcement support in cases where there is a clear and imminent threat to a person present at the scene.

Mobile Response Team

• The crisis response team should strive to prevent crises before they occur and engage with vulnerable populations to provide referrals for preventive care.

Crisis Response Team Oversight

•  The crisis response team is managed by the city, county, or state outside of law enforcement.

• The crisis response team will be responsible for collecting and producing data on call responses, including all calls responded to and outcomes.

• Law enforcement will be responsible for collecting and producing data on any call response for which the decision was made not to transfer the response to the crisis response team.

Funding

• The crisis response team shall be fully funded by money diverted out of (not through) the police and/or sheriff department budget.

• Appropriate law enforcement staff reductions should be made once the crisis response team is in place.

• Localities should ensure that these teams are staffed by full-time employees and eventually become employees of the city or county. Volunteer teams, as is happening in some jurisdictions, may be a necessary first step but are not an adequate long-term solution to the problem.