The Impact of Service Users' Race and Legal System Involvement on Coercive Mobile Crisis Interventions: An Institutional Racism Prevention Research Study

Background & Purpose: When police respond to behavioral health crises, results can be harmful, even fatal, for the person in crisis. In 2020, the national 988 Suicide & Crisis Hotline was created to redirect crisis calls from police to mental health professionals, including mobile crisis teams (MC). While advocates argue MC serves as a salutary alternative to calling the police, MC workers may still deploy coercive interventions, e.g., involuntary hospitalization or calling police. Furthermore, MC workers may unevenly deploy coercive interventions depending on factors such as race or criminal history. To date, the decision-making processes of MC workers is poorly understood, the potential for reproducing harm via purportedly alternative interventions has received little attention, and the risk of perpetuating institutional racism via new means remains. This study represents an effort to conduct what we call “institutional racism prevention research,” testing the impact of service users’ race and prior criminal legal system involvement (PCLI) on MC workers’ decisions to deploy coercive interventions.

Methods: We used a 2x2 factorial vignette survey design to assess the impact of independent variables (race, PCLI) on a national sample of mobile crisis workers (n = 364). Participants were randomly assigned to one of four crisis vignettes. Language for each vignette was kept the same apart from the independent variables. To assess stability of decision-making across different levels of agitation, participants were given low- and high-agitation scenarios and asked to rate appropriateness, likelihood, and supervisor’s recommendation of deploying different interventions. We transformed intervention endorsement into a binary outcome (low vs. high endorsement) for the dependent variables of involuntary hospitalization and calling police. We assessed balance between treatment groups, used Van Buuren’s passive imputation to address missing data, and conducted mixed effects logistic regression to test the hypotheses that Black service users and service users with PCLI are at greater risk of coercive intervention compared to white service users and those with no PCLI.

Results: For involuntary hospitalization, we found statistically significant increases in the probability of endorsement for Black service users with (p̂ = .37) and without PCLI (p̂ = .77) when compared to endorsement for their white counterparts (p̂ = .11 and p̂ = .04, respectively) in low-agitation scenarios. We found no differences in endorsing involuntary hospitalization when service user agitation was high. As for calling police, we found no statistically significant differences between vignettes featuring Black and white service users, with and without PCLI, across low- and high-agitation scenarios.

Conclusions and Implications: Results support the hypothesis that compared to white service users, Black service users are at greater risk of involuntary hospitalization in low-agitation crisis situations. As agitation increases, the effect of race on deciding to involuntarily hospitalize decreases. Results fail to support the hypothesis that PCLI impacts decisions to deploy coercive interventions and the hypotheses that race and PCLI impact decisions to call police. Implications include the need for anti-racism training for MC workers in relation to race and the appropriateness of experimental vignette surveys as a strategy for institutional racism prevention research.