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Diverting Mental Health Crisis from Law Enforcement: Creating Different Points of Access

Children’s Mental Health
Racial Truth and Reconciliation

Photo by: Office of Gov. Ralph Northam

In 2018, Marcus-David Peters was a 24-year old high school biology teacher and a recent graduate of the Virginia Commonwealth University. Peters was driving down Interstate 95 and was later found in a mental health crisis. He was shot three times by a police officer. His sister, the family, and community members organized in support of an alert system that would divert law enforcement involvement in mental health crisis and continue to re-iterate that Marcus David-Peters needed help and not death when he was experiencing his crisis.

With the help of advocates, activists, and the family of Peters, The Mental Health Awareness Response and Community Understanding Services (MARCUS) Alert System bill passed and directed the Department of Criminal Justice Services (DCJS), the Department of Behavioral Health and Developmental Services (DBHDS) and other stakeholders to submit a plan for the establishment of a Marcus alert system to the general assembly no later than July 1, 2021. Voices for Virginia’s Children is a stakeholder on the MARCUS Alert work group to address implications of trauma-informed care, equity, and justice as it relates to how children and youth might be impacted as the new processes are implemented.

The goal of the Marcus-David Peters Act is quite simple on paper: to provide behavioral health responses to behavioral health emergencies. This is in direct correlation with the need to reduce negative outcomes that involve the use of force in law enforcement interactions, whether this is influenced by racial biases in law enforcement or involving an individual experiencing a behavioral health crisis related to mental health, a development disability, or substance use. The Act can be found here. While simple on paper, the Marcus-David Peters Act is more complicated than an investment in behavioral health crisis services, because it takes a comprehensive, systems-wide approach to decreasing Virginia’s reliance on law enforcement as the innate response to behavioral health emergencies.

These plans presented July 1 describe the initial roll out focused on adults. It is helpful for professionals and families to understand the intentions and design of these systems because we want to ensure that when children become involved the processes are not traumatizing and are designed to avoid unnecessary law enforcement involvement. These are some things we will continue to monitor during implementation.

National Models and Best Practices

The MARCUS Alert follows a national model known as The Crisis Now Model and the Sequential Intercept Model, which follows four core elements for transforming crisis services. You can view a more detailed look at Virginia’s crisis system through this one-pager.

Currently, the MARCUS Alert work group has submitted a state plan for the implementation of the MARCUS David-Peters Act. Five initial areas will pilot the series of protocols and mobile crisis or community care teams community coverage by December 2021. View the five partners on the DBHDS website.

Here is a high-level timeline beyond July 1, 2021:

By July 1, 2021, every locality shall establish a voluntary database that will be made available to the 9-1-1 alert system and the Marcus alert system will provide mental health information and emergency contact information for response to an emergency or crisis.
By December 1, 2021, the Department should establish five Marcus alert programs and community care or mobile crisis teams, one located in each of the five Department regions. The initial five areas of coverage must implement all aspects of the plan including protocols and team coverage.
From July 1, 2021 until January 1, 2022, DBHDS and DCJS shall coordinate a public service campaign and announce the establishment of community care teams and MARCUS Alert systems across the state.
By July 1, 2022, every locality shall have established protocols for law-enforcement participation in the Marcus alert system.
By July 1, 2022, every locality should have established local protocols that meet requirements developed by DBHDS for diversion of certain 9-1-1 calls to crisis call centers and the participation of law enforcement in the Marcus alert system.
By July 1, 2023, the Department shall establish five additional Marcus alert system programs and community care or mobile crisis teams, one located in each of the five Department regions. Community services boards or behavioral health authorities that serve the largest populations in each region, excluding those community services boards or behavioral health authorities already selected under subdivision 1, shall be selected for programs under this subdivision.
By July 1, 2024; July 1, 2025; and July 1, 2026, with the final deadline of July 1, 2026, the Department shall continue to expand additional Marcus alert systems and community care teams in geographical areas served by a community services board or a behavioral health authority

An additional bill directs the Department, in its development of the crisis call center, community care teams, and mobile crisis teams, to comply with the requirements of the National Suicide Hotline Designation Act of 2020. This produced a 9-8-8 Call Center to serve as a universal mental health and crisis hotline system.

By July 16, 2022, a new federal law will require that states use the three-digit code 9-8-8, which will serve as a single access point to the National Suicide Prevention Lifeline and the crisis care continuum. Virginia will use this as the access point for mobile crisis services.
By December 2021, four crisis Medicaid reimbursement rates for mobile crisis response, follow-up stabilization, 23-hour observation, and per diem for Crisis Stabilization Units are planned for implementation.

Other system transformations are quite complimentary to the MARCUS Alert as well. To learn more about other mental health and behavioral health transformations, view this one-pager.

While all of these recommendations are not immediately included in the first year of the MARCUS Alert’s implementation and some are considerations for future policy, Voices for Virginia’s Children suggested the following key recommendations:

Community care teams should serve youth as law enforcement involvement is not recommended on the community care teams in comparison to a mobile crisis team. Voices also suggests separate youth mobile crisis teams designed for youth specifically;
Community care teams should include a peer specialist, interpreter, community advocate, and child-serving mental health professional;
Analyze the level of threat of the person in crisis in consideration of child and adolescent development;
Establish an infrastructure for language access and a culturally diverse and appropriate workforce;
Establish a continuum of care through care navigation and case management services;
Mandatory trainings should include equity-centered concepts, including implicit bias training, trauma-informed care, child and adolescent development, disability and individuals with developmental disabilities trainings;
State and community accountability with decision making power from those most impacted;
A budget for community engagement with those most impacted, buy-in, and decision-making power, in particular, communities of color;
Unintended consequences, such as child welfare or juvenile justice system involvement, should be taken into consideration

To learn more about the implementation of the MARCUS David Peters Act, visit the Virginia DBHDS website for more information. The full draft of the state plan for implementation is available on the site.

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