How do vulnerable people fall through the cracks?
August 1, 2018
Our visual design team has been busy this month! One project we completed is a mental health report for the District of Columbia Business Improvement District Council. The DC BID Council is an association of Washington, D.C.’s ten Business Improvement Districts.
BIDs help manage and enhance city neighborhoods. They provide cleaning and safety, help businesses thrive, and recruit new businesses to their areas. BIDs also market their neighborhoods, organize events, provide homeless outreach, and beautify public spaces. The DC BID Council helps D.C.’s ten BIDs to collaborate on city-wide issues.
One of the DC BID Council’s current projects is a report on how homeless people with mental illness are falling through the cracks. With our team’s signature custom graphics, MOYA designer Elisabetta Fanelli created a visual report to facilitate the message on how to make their findings accessible.
What happens to vulnerable people in crisis in Washington, D.C.? Often helpers—including first responders, businesses, and concerned citizens—encounter a broken system. Because of this, people in crisis may:
not receive services
be hospitalized and then discharged
be arrested and released
be jailed without access to any mental health help at all
When they’re called for a person in crisis, police must assess if the person is at risk. An FD-12 authorizes police to transport the person to the Comprehensive Psychiatric Emergency Program (CPEP). But sometimes police won’t do this if they know they’ll see the person back out on the street within hours or days.
If the person is transported, then CPEP staff only have 72 hours to decide what to do. They can ask for a hearing for involuntary commitment. They can take the person to the hospital. Or, due to a lack of beds or staff discouragement, they can release the person. The DC BID Council found that extremely vulnerable people can cycle through this process up to seven times before accessing sufficient treatment.
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If a person in crisis is instead sent to ER, there can be another set of problems. Some ERs aren’t equipped to serve people with severe mental illness. People will just get out of the ambulance and walk out. Or else a person will be treated and released to outpatient services.
Unfortunately, the DC BID Council found that there’s a shortage of subsidized housing for people leaving hospital. The Department of Behavioral Health has less funding than it needs, and the billing system restricts access to mental health services to only seven days after discharge. This is yet another area where a person in crisis can fall through the cracks.
If the person has a caregiver or guardian, then the caregiver can also choose involuntary commitment or release. Involuntary commitment requires a commission hearing, which takes time and unpaid work by doctors. Sometimes there are no staff, beds, or transport available, so the person is released.
Finally, if a patient does get a commission hearing, then there are three possible outcomes:
Release with voluntary treatment
Inpatient commitment lasts for a year. But there can be a lack of a transition strategy. After one year the person must be released or have another commission hearing.
Outpatient commitment is a court-ordered treatment plan. With support the person may reintegrate successfully. But barriers exist here, too. These can be no housing plan due to D.C.’s severe housing shortage, a lack of enforcement, or insufficient skilled services.
If they’re released with voluntary treatment, a person may reintegrate and heal. But this person, too, can cycle back towards crisis. For example, patients aren’t eligible for discharge services if they have substance abuse, developmental disabilities, or brain injury.
After identifying these many cracks in our system, the DC BID Council’s mental health report recommends some solutions:
that first responders be trained in de-escalation and helping people avoid unnecessary hospitalizations;
that enough community behavioral health teams are providing services in the least restrictive environment; and
that enough low-barrier housing options and services are available to support recovery and healing.