Mental Health Crisis Response: Why Respecting Patient Agency Leads to Better Outcomes

When Communication Changes the Outcome

Law enforcement encounters involving mental health crises are increasingly common. Many such crises end in incarceration, or involuntary hospitalization, when better communication and rapport could have brought the individual out of crisis and seamlessly connected them with treatment. These unnecessary, restrictive responses lead to over-utilization of critical emergency services, a higher cost of treatment, and fewer resources for those cases that truly require involuntary measures.

In Gainesville, FL, the police department’s Crisis Response Team and fire rescue’s Community Resource Paramedicine teams have been working together to address this problem. When they engage an individual in crisis, these teams prioritize treatment and support over incarceration, and at the 2026 NAMIHP MIH Summit, corresponder officer Brian Knapp and community paramedic Emily Meaders shared the lessons they’ve learned by applying these less-restrictive measures. They focused on an individual’s capacity to make their own decisions, the ways a responder can support someone’s agency, and how to build empathy between a responder and someone in crisis, three key elements for both resolving immediate crises and building long-term trust.

People Have the Right to Make a Bad Decision

In the context of a mental health crisis, “capacity” is a person’s ability to make decisions and consent to treatment. Capacity is based on the person’s cognitive abilities, and is usually assessed in a medical context. Over the years, officer Brian Knapp has encountered many misconceptions about capacity, and he shared a few tips for avoiding them in your own work.

It’s tempting to think of a capacity assessment as a black-and-white determination, either the person has capacity, or they don’t. Knapp emphasized that a person’s capacity can fluctuate between different circumstances and topics. A person’s capacity can also change over time, and responders should be aware that someone who lacked capacity in the past may have regained it in the present. Responders should also take care to not automatically dismiss a person’s capacity simply because they’ve been diagnosed with a mental illness or cognitive disability.

Knapp drove home one point in particular: if you think someone is making a bad decision, that does not mean they lack capacity. Unless a court says otherwise, a person has the right to make seemingly unwise choices. Respecting their agency in this way, and recognizing that they may have emotional needs or a history that goes beyond what’s immediately apparent, is both proper legal protocol and an essential element of building trust.

Always Allow for Agency

In their presentation, Paramedic Emily Meaders focused on the importance of allowing for agency during a crisis. When a responder is laying out plans for someone, even if the plans are restrictive, there’s always room to allow that person some choice and power over what’s happening. This sense of control both aids in processing trauma and builds trust.

Often this means asking the person’s preference: if you’re recommending them to a mental health facility, perhaps you can ask them which facility they prefer. If they need to travel to a facility, you can ask whether they want to take their own vehicle or ride with your team. If you have to handcuff them, you can take the time to ask if they prefer their hands in front or behind their back. Even when the choice is small, it matters.

Another tool for supporting agency is the language of Trauma-Informed Care. Recognizing that past trauma significantly correlates with mental health issues, Trauma-Informed Care shifts the focus from “What’s wrong with you?” and “What did you do?” to “Please, tell me what happened.” More open questions like these put a person in charge of sharing their own perspective, and avoid any connotations of disrespect. This language also helps build empathy and reduce stress among responders, shifting interactions away from “here’s someone stressful who’s causing problems” and towards “here’s someone in trouble who needs help”.

Meet People Where They Are

The final advice Knapp and Meaders gave was to build empathy: to see the person in crisis as a whole person with a history, not just a simple condition or situation, and to find ways for them to see you as a person who’s come to help them, not just as law enforcement or paramedics.

Of course, empathy can’t just be switched on, you need to build it piece by piece. In their presentation, Knapp and Meaders shared a few tips for building empathy during crisis encounters.

On a physical level, once you’ve verified that the situation is safe, it helps to match the person physically. If they’re on the floor, crouch down to get on their level. Even something as simple as taking your gloves off can help them see you as a person.

On an emotional level, first-person language is a way to focus on the person rather than the crisis, and using it lets them know that you see them as more than their condition. For example, rather than “we’re working with a schizophrenic”, try “we’re working with someone who has schizophrenia”. The distinction is subtle, but by emphasizing someone’s personhood, you’re inviting them to connect with you as a person.

Another way to connect, ironically, is to be quiet. As Meaders explained, many people in crisis will take long, weighty pauses when answering questions. These pauses are a space the individual needs to process the trauma they’ve just experienced. It’s often very uncomfortable to sit in this quiet tension, but Knapp encourages responders to wait it out. They’ll break the silence when they’re ready, and your rapport will be better for it.

Treat the Person, Not the Crisis

As a responder, you’ll likely see the same person in crisis again and again. It’s difficult to get them to open up; difficult to earn enough trust that you can guide them towards better health outcomes. Ironically, to help someone make better decisions in the future, it’s important to respect to their right to make bad decisions now.

Even when someone makes a different decision than you would choose, they may still have full capacity to decide for themselves. Even when a person needs specific treatment and care, they should still have some agency in determining their care plan. Even when a person has had completely different traumas and life experiences than you, they still need you to see them with empathy and understanding.

So, in their moment of crisis, show faith in their abilities. Support their agency. And make sure the interaction isn’t just a responder resolving a crisis, but one person helping another.

Community Impact

Gainesville’s collaborative crisis response model shows how law enforcement, fire rescue, and community paramedicine can work together to reduce unnecessary incarceration, involuntary hospitalization, and repeat emergency utilization for individuals experiencing behavioral health crises.

By focusing on capacity, agency, trauma-informed communication, and empathy, responders are better positioned to de-escalate crises, connect individuals with appropriate treatment, and preserve EMS, law enforcement, and hospital resources for situations that require higher-acuity intervention. This approach supports broader public health outcomes by building trust, reducing avoidable system use, and helping residents move from crisis response toward long-term stability.

Rural Health Initiatives

This model is especially relevant for rural and under-served communities, where behavioral health resources, transportation, hospital capacity, and crisis stabilization options may be limited. By equipping local responders to assess capacity, de-escalate crises, and connect individuals to appropriate care, communities can reduce avoidable emergency department visits, unnecessary transports, and law enforcement involvement.

Community paramedicine and mobile response programs help extend the reach of the local healthcare system beyond traditional care settings. This approach supports rural health priorities by using trusted community-based teams, improving access to timely intervention, and helping residents receive support closer to home whenever clinically appropriate.

Program Design & Implementation

Effective crisis response depends on more than a single encounter. It requires consistent documentation, shared workflows, coordinated follow-up, and the ability to capture both clinical and social factors that influence a person’s stability over time.

HealthCall supports these efforts by enabling multidisciplinary teams to document encounters, standardize assessments, track referrals, coordinate services, and maintain a longitudinal view of each individual’s care journey. These capabilities help programs operationalize trauma-informed and person-centered practices while preserving flexibility for local workflows.

The lessons shared by Officer Brian Knapp and Community Paramedic Emily Meaders reinforce the importance of treating the person, not just the crisis. By combining field experience, coordinated community resources, and structured documentation, crisis response teams can support better decisions, stronger relationships, and more effective long-term outcomes.