On October 26, 2020, Philadelphia police fatally shot Walter Wallace Jr., a 27-year-old Black man, after his family had called for an ambulance because he was having a mental health crisis. Wallace, who had a history of such episodes, held a knife. The killing set off angry protests in the city. It also spurred conversations about the intersection between structural racism in policing and the often inadequate way that cities handle emergency response to mental health situations. 

In January, a panel of Temple faculty and guest experts discussed these issues in a video webinar kicking off the College of Public Health Alumni Association’s Diversity, Equity and Inclusion Committee’s "Health Equity and Social Justice Spring Speaker Series." The “Cultural Competency to Structural Competency: Actions to Address Structural Racism” panel was moderated by Mark Salzer, professor of Social and Behavioral Sciences and director of the Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities. He was joined by Temple graduate Keris Jän Myrick, co-director of the Mental Health Strategic Impact Initiative, a mental health policy think tank, and Evan Figueroa-Vargas, a program analyst at the Philadelphia Department of Behavioral Health and Intellectual disAbility Services.

Edited excerpts from the conversation:

Mark Salzer:  Last October 26, Walter Wallace Jr. was shot and killed by Philadelphia police officers. Mr. Wallace was a Black man who was experiencing a mental health crisis. Such shootings, sadly, happen far too often across the country and raise the specter, again, of structural racism in our behavioral health system.  What comes to mind when you think about the killing of Walter Wallace Jr.?

Keris Jän Myrick:  You know, when I show up as an African-American, sometimes my complexion is somebody else's complication. There's already things imposed on people's belief about what I can do, and how I can do it. Add a diagnosis onto it, and it's kind of like a double bind. Add gender on to it, and it's a triple bind. We have to understand the interplay, and then how does that work within the system?  When a mental health emergency comes up, who do you call? You call 911. You call for an ambulance. But as soon as it's understood that it's mental health, the regulations say bring the police. And there's fear when we know the police are coming to support someone in a mental health crisis who's an African American male. Why is there only one response, 911 and police?  

Evan Figueroa-Vargas: The first word that comes to mind was preventable. Another word that comes up for me is traumatic. It’s traumatic not only for Walter Wallace Jr. and his family, but for his immediate neighborhood, for people who watch these videos online. Quite frankly, calling 911 is not always going to be the best go-to option. Unfortunately, what ends up happening is that as our children grow up in these communities, they become desensitized, and they begin to accept these traumatic events as the norm as the way the police treat people of color, as the way things are in quote-unquote “the hood,” and that is unacceptable. You know, people do overcome mental health challenges, substance disorder challenges. The notion that people don't get better, they need to be locked up, or put away, I push back against those ideas. Thinking that people are quote-unquote crazy and will continue to be for the rest of their lives is absolutely absurd.

Mark Salzer:  People with mental health issues are like everyone else, no different. Same hopes, dreams and desires. It’s easy to start “othering” people with mental health issues as being somehow different.

Keris Jän Myrick: There’s also othering within mental illness, because there's mental illness and then this thing called SMI, serious mental illness. This is where understanding the structure comes in. Who decides what's SMI? The state does. And if you go state to state, it may differ which diagnosis may be categorized as serious mental illness. I think the term is a misnomer. But it starts to have a sense of “this is the way things will always be, you will always be quote-unquote seriously mentally ill,” rather than thinking about how people may have a mental health condition,  a struggle with emotional distress and trauma. And there are times when that struggle is severe.

Mark Salzer: There is a police shooting of a person in mental health crisis, one report said every 36 hours. The rates are definitely higher than average for people of color. If I had a family member in crisis, I would not think twice as a white person to call 911. But I do know that many people of color have concerns. What are the alternatives?  What are the solutions? 

Keris Jän Myrick: We have 988, which is newly passed federal legislation. So 988 will become the number people can call when a behavioral health crisis is a present, and you might need some extra support. It's not in play everywhere yet. There are some areas where it works, and some areas where it doesn't. When you're talking about structural things, every state can pull together a 980 system that will work for the state and also work for people of color.

Evan Figueroa-Vargas: In Philadelphia, if you call the mobile crisis outreach team [215-685-6440], they will come out and assess the situation and get your loved one to their care. If you are considering dialing 911, there’s a special unit here in the city of Philadelphia you can ask for, officers who have been trained in mental health, first aid, and there's some additional specialized training that Philadelphia police officers can take to be able to respond to certain situations.

Mark Salzer: What are some of the issues that you believe are at the crux of structural racism in behavioral health systems?

Evan Figueroa-Vargas: President Biden said we have never fully lived up to the founding principles of this nation, that all people are created equal and have a right to be treated equally throughout their lives. Not all individuals have the same access to resources. We see where individuals only access behavioral health treatment and resources when they come into negative contact with the criminal justice system. Someone may not have an ID, or they might not have transportation or other resources to be able to enroll into the behavioral health system. But, tell you what, when you're arrested, when somebody calls 911 and you're arrested, they provide free transportation. You don't need an ID. You become involved with the criminal justice system, and you access the behavioral health system that way. Once you are booked and identified in the behavioral system, it might be easy to get in. But I can assure you that it is extremely difficult to work your way out of that system. Anybody who has been arrested, anything from a misdemeanor to a felony, that can follow you around for years to come, decades to come.

Mark Salzer: I was really struck by that observation that many people of color, their first entry into the behavioral health system is through the criminal justice system. That’s just very clearly not the right way to do things. What do we need to do to have that not be the first contact?

Evan Figueroa-Vargas: When we historically look at behavioral health providers, we typically look at these facilities being in Center City, Philadelphia, operating nine to five. If I had my way, I would make services available in the heart of the community, where the need is. And have these operate around the clock. People typically don't go into crisis from nine to five. People don't tend to withdraw and contemplate entering substance-use disorder treatment from nine to five. These are thoughts people have around the clock. So we need to make sure that we have access points at every corner of the city and across the nation.

Keris Jän Myrick: Speaking truth here, we have to understand some of the structures and policies that have us sitting where we are today. Why is it that we can't have these 24-hour kind of systems where people are?  Are there policies around that? And generally, yeah, there are. We have to get at those policies, and those regulations or legislation, to almost force the system to be responsive to the community needs. A lot of community needs are preventative in nature. What I love about public health is how do you go at the prevention, to impact people's health and wellbeing way early on? A lot of times, we're trying to kind of fix things at the back end, versus really working much more proactively at the front end.

Mark Salzer: One of the things that we've talked about is coming up with solutions by talking to people who are affected by the system. Why is lived experience important for addressing structural racism and other forms of oppression in behavioral health?

Keris Jän Myrick:  Asking people who have been through it to help design it, we call that human centered design. Some of the struggle we have with doing this is once you're given that diagnosis of a mental health condition, there's some perception of your capacity. Like, “oh, yeah, that's nice, go away, I'm not going to fix that.” That's why peers have to be involved in not just providing the support to people, but also informing some of the changes that need to happen. And when we look at our provider force, whether they're public health advocates, social workers, psychiatrists, psychologists, it’s important they just don't treat people but should also be looking, as a part of their education, at how you address the systematic structural issues.

Evan Figueroa-Vargas:  I would also include having lived experience with the criminal justice system. I think it's important for people with lived experience to gain a seat at the table, finding employment within the behavioral health system, where policies are being shaped. In the past I sought treatment for substance use disorder treatment. I was told that my condition was not bad enough, I guess, because I was only using prescription pain medication. After six failed attempts to enter into rehab, I ended up arrested on some misdemeanor charges. And when I stood in front of the judge, they allowed me to access inpatient treatment, outpatient treatment, and case management. They provided transportation. That’s why it is important for me with lived experience to work in the behavioral field. It’s the motivation behind me becoming a social worker, to fix a broken system. There is absolutely no reason why I should have stepped foot inside a jail cell or come into negative contact with the police for me to be able to access the treatment that I needed. 

Mark Salzer: What are some ways that people with lived experience, people of color, can actually influence and change the system?

Evan Figueroa-Vargas:  I think that when we're creating spaces, say a Wellness Center, or spaces to help people get better, we should include not only people with lived experience, but many members of the community who are aware of things such as the culture, history of trauma, systematic oppression, that can all be addressed when we’re developing programs. It’s important to educate and train people in the community to work at these sites and take an active role. That encourages others to walk into these resources. When you look at the Latinx community, there's a huge stigma, it’s very hush-hush for us to talk about mental health challenges. But if I see a buddy of mine who's accessing the services, a buddy of mine who's working there, the odds that I'm gonna walk into that place and access these resources go through the roof.