Changing the Mental Health Emergency Response System in Washington County, Oregon

Changing the Mental Health Emergency Response System in Washington County, Oregon

At 2 a.m. on October 24, 2022, 27-year-old Joshua Wesley called the crisis hotline at his home in Washington County, Oregon (west of Portland). He had suicidal thoughts and knew he needed professional help. But instead of receiving help from a mental health provider as specifically requested, he was met at the door by a group of armed police officers. Not only did this reaction prevent Wesley from getting the immediate psychiatric treatment he needed, it also resulted in him being arrested and seriously injured by the responding officer. He ended up spending two weeks in the hospital and six months in jail.

Wesley told us that he felt he needed a qualified professional to comfort him, convince him, and give him solutions. But the police who showed up only made the situation worse by trying to handcuff him and take him away.

Wesley joined forces with the American Civil Liberties Union, Disability Rights Oregon, the American Civil Liberties Union of Oregon and the Law Offices of Shepherd Mullin to become a plaintiff in a recent lawsuit filed against Washington County and the local 911 dispatch center. The lawsuit claims the county’s emergency response system discriminates against people with mental health disabilities and puts them at risk of serious harm, including injury, arrest and incarceration. Wesley said he joined the case because he believes in helping others facing similar struggles.

Washington County has a history of inappropriate responses to mental health crises. In 2022, police were dispatched to 100% of calls coded as “behavioral health incidents” in Washington County. The county does have mobile crisis teams staffed exclusively by mental health clinicians, which are the county’s only non-police response. But while mobile crisis teams are designed to be on call 24/7, in reality they are underfunded, not connected to emergency dispatch systems, and often unavailable — especially at night, when many mental health crises occur.

Police responses to mental health crises can be dangerous, even deadly. Police officers are not qualified mental health professionals and should not be expected to assess and treat people in crisis. Beyond this, police presence may actually worsen mental health symptoms, triggering anxiety and paranoia. Most worryingly, people with untreated mental illness are estimated to be 16 times more likely to be killed by police during an encounter.

That’s what almost happened in Wesley’s case. Instead of receiving the care he sought — on-site psychiatric evaluation and treatment — he was placed in “police custody,” a form of involuntary detention, and taken to the hospital by ambulance. Wesley was not treated or stabilized during transport, and his symptoms worsened. In the hospital, Wesley remained suicidal and attempted to take an officer’s gun and use it on himself. During the incident, the officer stabbed Wesley multiple times, causing serious injuries to his chest, abdomen and head.

Wesley’s physical injuries are a constant reminder of the incident. Wesley tells us the scars left by the incident show there could have been other ways of handling the situation.

Wesley then spent two weeks recovering in the hospital. During this time, his repeated requests for mental health assistance and treatment were denied. He remains handcuffed to the bed and under near-constant police surveillance. Wesley felt that doctors no longer viewed him as a patient who needed help and treatment to recover, but instead viewed him as a criminal.

After being released from the hospital, Wesley faced criminal charges stemming from an altercation with a police officer. He spent six months in prison and missed the birth of his first and only son. He also missed holidays and time with his family during a time of great conflict.

Ultimately, it took Wesley months to get the psychiatric help he first sought in October.

When someone in Washington County is experiencing a physical health crisis, such as a heart attack or severe allergic reaction, they can call 911 and expect a response from a qualified medical professional, such as an EMT or paramedic. However, the same cannot be said for someone experiencing a mental health crisis.

The lawsuit explains how this disparity violates the Americans with Disabilities Act and the Rehabilitation Act. Mental health crises require mental health responses, not police responses, because at their core they are health emergencies.

Experts agree that mental health emergencies should be handled by mental health professionals, not police. As part of recommended best practices, the Substance Abuse and Mental Health Services Administration (SAMHSA) proposed a three-tier system that includes crisis call centers, mobile crisis teams, and stabilization centers for drop-in and drop-off visits. SAMHSA also stated that cooperation with police is “unacceptable and unsafe,” a sentiment shared by the National Alliance on Mental Illness.

Because of Washington County’s inadequate response to the mental health crisis, it discriminates against people with mental health disabilities every day. . The lawsuit seeks to improve its mental health care system. Possible solutions include fully funding mobile crisis response teams that can provide care and support to those in need when needed.

Washington County isn’t the only jurisdiction in need of a reformed system. The Justice Department investigation found similar discrimination in Louisville and Minneapolis, saying relying on police as mental health first responders can cause “real harm in the form of trauma, injury and death to people experiencing behavioral health issues.”

Wesley hopes this case will draw widespread attention to an issue that impacts many people’s daily lives. People with mental health disabilities are harmed both because of failed responses to mental health crises and because many people with mental health disabilities are reluctant to seek help for fear of armed police response. Wesley believes there is a need for important thinking nationwide about how jurisdictions respond to mental health crises. Counties and other localities should examine their systems and ask: “Is our mental health crisis response system fair? Is it safe? Is this right?”

How jurisdictions answer these questions can have a significant impact on the care and support people with mental health disabilities receive during a crisis. We must not allow discriminatory practices that cause real harm and death to occur.

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