Vinnie Cervantes, Organizing Director of the Denver Alliance for Street Health Response, noticed something strange about Denver’s famous 16th Street Mall. While public officials and police encouraged tourists to “linger” on the street, they often cracked down on unhoused people “loitering” there. “The only distinction between those two things is whether or not people have money to spend,” says Cervantes.
That distinction underlies the way the United States treats unhoused people and people with mental illness. Many of us have walked down the street in our towns or cities only to find someone in the middle of a mental health crisis. Considering that, as of 2017, 18.9% of American adults experience mental illness, with 4.5% of American adults having a serious mental illness, this person may be our family member, or ourselves. What can we do when we encounter a community member in crisis?
Many of us have been taught to look away from a suffering neighbor, whether out of fear, or a sense of powerlessness. If we do reach out, the only help most of us are able to access is 911 and the police. Rather than receiving treatment, however, people with mental illness are frequently criminalized as a result of these encounters. As a result, as of 2014, 20% of incarcerated Americans had a serious mental illness. Sometimes, encounters with police can prove fatal: people with untreated mental illness are 16 times more likely to be murdered by officers than those without.
As a result of long-standing violence against people living on Denver’s streets, Cervantes’ group partnered with other community organizations to create the Support Team Assistance Response (STAR) program. In response to 911 calls concerning mental health crises or homelessness, the program dispatches a van with a mental health clinician and a medic, rather than a cop.
STAR represents one model that community organizers have turned to for inspiration in the wake of the ongoing Black-led uprisings against systemic racism and police abuse. Since late May, following Minneapolis officers’ extrajudicial killing of George Floyd, protestors around the United States have been calling for the defunding and abolishment of the nation’s police departments. For Cervantes, STAR is part of a movement toward defunding police and putting money toward community wellbeing instead. “Having a treatment-focused approach to public safety is so needed,” he says.
Americans With Mental Illness Lack Long-Term Support
At the root of the criminalization of mental illness is the United States’ long-term disinvestment in basic mental health care. As of 2017, only 66.7% of those with serious mental illness had received any kind of psychological care in the past year.
Care is often simply too expensive for people to access, even with insurance. In a 2013 survey, half of people who had a mental illness said that they couldn’t afford basic treatment, like therapy. This is a particular issue for Americans of color, especially indigneous and Black Americans. Because of systemic racism, resulting from the historical trauma of slavery and colonialism, roughly 20% of Black and indigenous people of color havee a mental illness, while experiencing up to three times the rates of poverty as white Americans.
As a result of structural racism and community disinvestment, America’s prisons have become the country’s largest inpatient psychiatric care providers. Of course, prison is not a place where humans thrive — and it’s certainly no place to help people with mental illness. Rampant human rights abuses, including lack of adequate food and medical care; frequent sexual abuse; and use of solitary confinement mean that prisons often cause trauma, rather than heal it.
Partly as a result of these deplorable conditions, up to 21% of incarcerated people have PTSD.
People With Mental Illness Are Vulnerable
In order to improve the way we treat community members with mental illness, we need to change both public policy and our society’s underlying ableist mindset.
Our society is deeply unequal, rife with racism, ableism, class exploitation, sexism, and homophobia. The bigoted beliefs that result from these systems don’t just impact us on the policy level. They affect us on the level of our emotional reactions, shaping how we see and interact with other people.
Many of us are taught to regard people with mental illness as scary or threatening, especially if they are experiencing psychosis or are behaving in a way that departs from social norms. “We need a community narrative that confronts those feelings and that stigma,” says Cervantes.
In reality, people with mental illness are more likely to be harmed or to harm themselves than to commit violence against others. People with severe mental illness are ten times more likely than those without mental illness to be victims of violent crime, including domestic violence and assault.
This vulnerability shows up in several ways. Having a mental illness makes people far more likely to experience poverty and homelessness; the trauma of poverty and homelessness often triggers mental illness. As a result, more than 30% of our chronically homeless neighbors experience mental illness. Similarly, people with mental illness are more likely to use drugs, often as a form of self-medication to cope with untreated symptoms, which increases their chance of involvement with the criminal justice system.
When you see an unhoused community member in crisis or behaving in a way that makes you uncomfortable, you are not witnessing a “bad” person who needs to be imprisoned. You are likely witnessing, instead, a person reacting to years of underresourcing, discrimination, and marginalization. Your discomfort is not ultimately caused by that person. Your discomfort is caused by a system that has brutalized your fellow human being.
Some Cities Are Creating Alternatives to Police Responses
Denver’s STAR program isn’t the first of its kind. It was modeled after a similar program, CAHOOTS, a Eugene, Oregon program which has, since 1989, responded to mental health crises with counselors and medics, rather than police. For around one percent of the city’s $238 billion police budget, the program answers 17% of the department’s calls.
For Cervantes, programs like CAHOOTS and STAR shift our conception of public safety away from police and punishment and toward “meeting basic human needs.” Rather than arriving on the scene of a call and immediately assuming an unhoused person or person in crisis is the source of the problem, STAR counselors ask how they can help that person. “They can talk to somebody or navigate an issue,” says Cervantes. “Most of that is seeing if people are okay.”
If that person is experiencing an acute mental health crisis, counselors can take them to a treatment center. If the person is experiencing homelessness, counselors can connect them with shelter resources. If the person uses drugs, they can connect with treatment or harm reduction resources. Cervantes describes one particularly traumatic encounter in which an unhoused person simply needed water to avoid dying of dehydration.
Tellingly, most of the calls STAR has received since its opening pertain to trespassing — largely due to an unhoused person attempting to find shelter. For Cervantes, this indicates a need to invest in community well-being more broadly. His organization advocates for greater investment in substance use treatment, affordable housing, restorative justice programs, and programs supporting people who have been incarcerated.
Take Action In Your Community Today
“As we start to create these programs or think about alternatives to policing, they really should be community-run, community-owned,” says Cervantes. While programs like STAR have yet to take root in most American cities, you can advocate for a more humane and effective response to mental illness and homelessness in your community starting now.
You can attend protests, educate yourself and your loved ones on mental illness and mass incarceration, and hold local politicians accountable for reinvesting funds in mental health and housing support. You can also directly engage in more caring ways with your neighbors, and learn basic de-escalation skills.
People who experience homelessness are valuable members of our communities. If there are unhoused people living in your neighborhood, treat them with the respect you would any neighbor. Say hello, look them in the eye, and wish them a good day.
If an unhoused neighbor asks you for support, pause and look them in the eye when you answer, even if your answer is no. If you do want to help out, remember that your neighbor is the best judge of what they need, so don’t be afraid to ask them. If that person asks for money, and you are comfortable or able to give it, give without strings attached—remember that it’s not your job to judge other people’s spending habits. If you don’t want to or can’t offer them money, ask what else they might need. Food? Socks? A prepaid calling card? A connection to any kind of service?
Listening to our neighbors with an open heart affirms their dignity, and our own.
Learn about local resources
We often rely on police for help because we are simply unaware of alternative options. Get to know what resources are available in your locality for people experiencing homelessness, mental illness, or drug use.
What homeless shelters are around? Are there clinics that offer free mental health care? What organizations are doing mental health outreach or harm reduction for people who use drugs? Find out if your local shelter or harm reduction center has an outreach number for people who may need assistance. You can also volunteer at a local organization to build those connections, lend your skills, and help educate yourself.
De-escalate tense situations
You can learn some basic de-escalation skills to help support yourself and other community members in moments of crisis. If a loved one or a stranger is experiencing a mental health crisis, it’s important to stay calm and react in as non-threatening a manner as possible. People in crisis are often scared; when they do lash out, it’s usually in self-protection against a perceived threat.
First, if someone is in crisis, you can ask onlookers to disperse. A group of people watching or filming someone in crisis can feel extremely threatening and violating for that person. Unless those onlookers are actively helping, or are loved ones of that person, you can ask them to move along in order to prevent the situation from escalating.
Next, try to make your voice and body language as calm and reassuring as possible. Don’t confront the person, yell at them, or try to overpower them; the only time it’s okay to use a raised voice or physical violence is if you are being directly, immediately physically attacked. Speak in simple, soothing sentences. You can directly ask the person what they need and if they would like you to call for help. You can also always leave the space if you feel unsafe or if you feel you lack the tools to help.
Finally, it’s important to know when to exit a situation. If you are feeling bothered by the mere presence of an unhoused person or someone with a mental illness in a community space, that’s your problem, not theirs. They may not be able to leave their location, but you can. Instead of escalating the situation by calling the police, simply walk away.
Community Is For Everyone
Our society’s status quo approach to mental illness — to punish those who are unable to receive care — is not working. Currently, says Cervantes, when we see people in distress, “We want to get rid of that person or dispose of them.” Yet, as many prison abolitionists have pointed out, when someone is incarcerated, they don’t disappear. Instead, they are sent to a place where their trauma often compounds, leading to further violence.
Rather than attempting to discard people whose behavior is merely symptomatic of our society’s broader issues — racism, gender-based violence, wealth inequality — we must solve those root problems.
In one of the richest countries in the world, we have more than enough resources to support the well-being of everyone in our communities, unconditionally and without exception. Hopefully, with the example of the current uprisings, and programs like CAHOOTS and STAR, we will now have the popular will to do so. “We as a community — whether that’s non-profits, neighborhoods, or individuals — really do have the power,” says Cervantes.