DDespite widespread promises of reform after the killing of George Floyd in 2020, police will kill at least 1,246 people in 2023, the most in more than a decade. This police violence is intertwined with a parallel public policy disaster. It is America's worst mental health system, forcing police officers to serve as de facto mental health workers. People with unmet mental health needs are 16 times more likely to be killed by police, and a quarter of those killed by police since 2015 suffered a mental health crisis It is recognized that it is.
Meanwhile, historic amounts of money are currently flowing into the mental health industry, with the United States spending more on mental health services than almost any other country. But their mental health only worsens. More than 50,000 Americans will die by suicide in 2023, and the proportion of people taking antidepressants has more than doubled in the past 20 years, with nearly a quarter of adults taking at least one type of medication. This is the highest number on record, despite taking prescribed psychiatric medication. Nearly half of adults recently reported that they believed they needed mental health treatment in the past year but had not received it. But we need to recognize that the current dominant framework for addressing mental health, which neglects preventative social support and focuses on reactive medicine, is itself the root cause of our collective ills. Very few people do.
Neither mental health nor police enforcement can be solved by simply pouring money into business as usual. Improving either requires building non-police crisis response systems while simultaneously reconceptualizing community-based systems for mental health.
Several major U.S. cities, including New York City, Atlanta, San Francisco, Albuquerque and Denver, will launch or expand programs that send mental health responders rather than police to respond to emergency calls related to mental illness. We are now working on the first part of this effort. health. These programs are incredibly effective at mitigating crises while preventing violence, crime, unnecessary arrests, and wasted police and health care costs. However, they are still severely limited by a narrow focus on crisis response rather than prevention.
In Chicago, a coalition of community organizers is taking a national movement toward non-police crisis response systems a step further by refusing to take crises for granted. If successful, the process will provide a new foundation for both community mental health and public health as a whole.
The effort coalesces around a policy call called “non-traumatic care,” which recently elected Mayor Brandon Johnson championed as a central policy for rebuilding the city's public infrastructure. Non-trauma treatment begins with the recognition that the most important part of dealing with a mental health crisis is to prevent it from ever happening. Therefore, we do not need a psychiatric or police model for mental health response, as both are based on response rather than prevention, and instead we need a public health model of community health.
This approach, which I designed in collaboration with the Collaborative for Community Wellness, consists of three interdependent parts. First, it calls on the Chicago Department of Public Health (CDPH) to create a citywide non-police mobile crisis response system to relieve police of inappropriate responsibilities as mental health workers. Second, it entails restarting a network of 19 public mental health centers operated by CDPH, and by providing grants to non-profit organizations operating on a philanthropic basis. All but five were gradually closed since the early 1990s as part of plans to privatize care services. Rather than funding a public system built on rights. These centers, including the five that were not closed and two more scheduled to open by the end of 2024, are currently serving as crisis reception and stabilization centers, as well as providing routine prevention activities and support services. It functions as a community hub.
The third element of “non-trauma therapy” is the most innovative. It revolves around hiring a large corps of community care workers made up of ordinary residents of Chicago neighborhoods with the greatest unmet social, medical, and economic needs. These care workers will be recognized by the CDPH as peer support professionals who will share tasks and work collaboratively with the mental health professionals they support, with a dignified general position (i.e. compensation comparable to that currently given to police officers). be trained and employed (with benefits, benefits, and protection). To serve our neighbors. The goal is to hire, train, and secure thousands of such workers over time.
Treatment Not Trauma therefore aims to provide a relational infrastructure for community care that aims for “mental health for everyone by involving everyone.” To do so, we embrace what underpins the efforts of some of the most successful community health workers in the United States and internationally: the principle of accompaniment. This participatory model of community-building care rejects paternalistic and remedial illusions about care. for It is a self-affirming mission that often reproduces the people our society has most excluded: the very inequalities it ostensibly addresses.Accompaniment-based systems are rather considerate and We work together to restore dispossessed communities with the resources they need to care for themselves. Such systems therefore prioritize local knowledge and practical experience in program design and leadership, as well as training and stable employment for residents of marginalized communities who care for their neighbors.
With this approach, the goal of Treatment Not Trauma's community worker force is to not only generate profit through the services provided by care workers, but also to create meaningful and empowering public services that foster community cohesion, individual capacity, and social value. It is about promoting individual and collective health by providing jobs. financial stability.
Non-trauma treatment supports a model of preventive social care that has been shown in many examples around the world to be more effective, efficient and equitable than top-down specialist medical approaches to mental health. I'm practicing it. To succeed, we need to upend the medical industry's narrow and self-serving vision of who can provide care. This vision has long over-prioritised expensive (and often ineffective) specialized mental health services, alienated and disconnected from non-professional care workers and systems. For daily social support.
“Non-traumatic care” is desperately needed in a country that suffers from the worst public health, safety and medical care of all rich countries to build a functional health and safety system. It represents a kind of bottom-up model of demedicalized public health. It also demonstrates the boldness needed to foster trust between governments and neighbors during a historical period marked by worsening social isolation, declining trust in state and civic institutions, and the extremely fragile state of U.S. democracy. It is also a public employment program. By investing in public systems that support people to care for one another, we are effectively sacrificing the future of democratic possibilities in a world of self-destructive violence, increasing policing, and authoritarianism. This means that we are also building a system to take this into account. In order to value democracy, it is essential to democratize care.
There is also an economic case for non-traumatic treatment. RI International's Crisis Resource Needs Calculator estimates that non-police crisis response programs would cost $537 million annually if implemented throughout Cook County and $279 million if limited to the city of Chicago. We estimate that this will result in savings. But after a series of short-sighted privatization plans decimated Chicago's health care infrastructure, the road to that realization begins deep in the hole of public investment.
After a 30-year defunding process, CDPH has become the nation's most understaffed and underfunded large-city public health agency, and CDPH's staff has been reduced by 60% since 2000. In contrast, the city rapidly increased its police force. Funding. Chicago currently has the highest number of police officers per capita and the second-highest police budget per capita of any large city in the United States. Direct spending on police consumes 35% of the city's total budget. Indirect spending on police (such as maintaining police assets) brings this figure closer to 50%.
To improve health and safety, Mayor Johnson and the Chicago City Council must confront a city budget that has repeatedly prioritized reactive punishment over preventive care. Until now, Prime Minister Johnson has avoided doing so. His first city budget, recently passed, minimizes increases in city-guaranteed funding and reduces the overall public health budget as federal aid expires, while significantly increasing police funding. It is a special feature. This reflects the Johnson government's growing tendency to compromise, continue, and even expand the same failed police-first paradigm that Johnson campaigned against, and local organizers are alarmed. and are increasingly concerned about the strength of Johnson's treatment efforts. It's not trauma.
The coronavirus has proven that the current technocratic, privatized model of American public health is flawed and ill-equipped to earn the public's trust. Without it, you cannot succeed. Rebuilding the public health system requires moving the system to a relationship-based model of care that focuses on direct service delivery, public work, and community systems of care that build trust. Given the deep inertia and resistance to such change at the federal level, states and cities must now find the courage to lead the way forward.
Dr. Eric Reinhart is a political anthropologist specializing in law, psychiatry, and public health.
