Q&A with Elena Kravitz, CPRP

As one of New Jersey’s leading trainers on psychiatric advance directives, you have taken a leadership role on initiatives to bring law enforcement and mental health services together. Psychiatric advance directives allow people with mental illness to make a legal record of their preferences regarding treatment before a mental health crisis occurs. How can these documents help individuals with mental illnesses avoid bad outcomes resulting from contact with the criminal justice system?

In all of my responses, I’m speaking for myself and not in my official capacity with Disability Rights New Jersey.

Years ago, I heard a presentation on psychiatric advance directives, and I was completely floored because I had never heard of anything that gave people who get diagnosed with mental illness this sense of control. This is a legal document, and I believe that everybody needs one.

The outcome of a crisis situation can be so detrimental to a person’s future—setting the ball rolling for involvement in the mental health or the criminal justice system—and many people can never extricate themselves from this. I believe that a psychiatric advance directive can put up a barricade for that. It gives a person an opportunity to explain behaviors that may not be what other people think they are. There’s a lot of error that happens when something goes wrong and the police are involved, and once that begins, you can’t turn that back.

I have met people in forensic facilities and jails and other institutions who really could have used this as a way to navigate or circumnavigate the criminal justice system. So, a psychiatric advance directive is a way to present these things even once somebody may be involved in the criminal justice system.

You promote and provide Crisis Intervention Team (CIT) training to law enforcement. What is your primary message to law enforcement and first responders encountering individuals with mental or substance use disorders who may be experiencing a crisis?

The first message is that things aren’t always what they first appear to be. For me, this has been a phenomenal opportunity to be able to work with law enforcement and first responders, and in doing so, I’ve had the opportunity to learn a tremendous amount from them about what they go through, as well.

So, in my advocacy, I have taken that back to the people that I serve in the mental health community to let them know that this is two-sided. For law enforcement and first responders, we must educate them on how to speak and approach people in a mental health crisis, creating an environment of safety for what may occur next.

Over the years, I have seen some of these programs in the mental health system that are successful, but there is still so much more to do. Police get limited training in what to do in a mental health crisis. CIT is important, but these teams are not everywhere, and not everybody is completely invested in them. I believe if you lack understanding about what may help in a mental health crisis, speak to a peer.

You are a Certified Psychiatric Rehabilitation Practitioner who formerly managed a peer support wellness center that serves individuals with serious and persistent mental illness. What does having a wellness-focused lens regarding recovery look like?

You need to see a person as who they are first and be willing to meet them where they are. The person is not their diagnosis. I’m all about helping people follow the eight dimensions of wellness (emotional, spiritual, intellectual, physical, environmental, financial, occupational, and social) to have a good life. Being wellness-focused is about knowing that what someone may consider a barrier is not necessarily that—it’s just an opportunity of learning a new way to do something.  

Somebody once said to me, “It’s not about walking in front of somebody, not pushing them from behind, but really walking beside them.” People have strengths that we’re not aware of, and we have to allow them to share that with us. We must reach out to other people and respect that they have a story and I have a story and it’s an exchange. When you work in mutuality, you really accomplish far more with people.

You were a former member of the federal Interagency Serious Mental Illness Coordinating Committee (ISMICC). How did being a member of ISMICC heighten your perspective on the role of federal, state, and local collaboration on behalf of people with mental illnesses?

When I first took on the role, some in the advocacy community thought that it was disgraceful for me to be doing so, but I thought somebody should be at the table. And then, there were others who insisted that they should have been at the table instead. So, it was a rough place to be. But at the same time, it was an invaluable place to learn about how things work, so I’m truly grateful for that.

We had to do our original report on the state of care for people with serious mental illnesses and serious emotional disturbances in somewhat of a hurry, so the nonfederal members decided to have monthly phone calls, because we determined that every 6 months wasn’t enough time for us to generate ideas and conversation about our beliefs. My contributions came from the peer perspective, which sometimes is not valued as much. But I think people are seeing more and more, in this time of COVID, that peer input and peer support is vital to people.

I started to see the role of the federal government as providing suggestions, guidelines, programs, and money. The states pick that up as they see fit and promote local collaboration on behalf of people with mental illnesses. That’s where our roles really fall, in community, and trying to shape how we use what comes down through the federal government. Clearly, I want states and communities to promote the peer perspective.

Given your new role at Disability Rights New Jersey, where you serve as a senior staff advocate, what would you like law enforcement and first responders to know when interacting with individuals with disabilities?

The outcomes of their interactions could be devastating for a person. Take the case of a young man who took a cigarette he saw through a car window. He was arrested, and it became a runaway train. He was scared so he resisted, and charges were piled on top of charges. He wound up in the general population in jail, and he was not getting his medication.

Eventually, they pleaded him out as not guilty by reason of insanity. Once that happens to a person, they end up in a forensic facility, and everybody sees it as part of the mental health system, but it’s part of the criminal justice system. They are treated the same way as people in jails and prisons, and sometimes worse, because they don’t have a set sentence and often fewer rights and “creature comforts.” Somebody who may have gotten out of jail in 6 months with good behavior could sit in a forensic facility for up to 10 years.

So, going into it, law enforcement; first responders; public defenders and other attorneys; judges; and, of course, peers, families, and providers—people throughout the entire criminal justice system—need to be made aware of the outcomes of all of their interventions at every door, beginning with the first responder on the scene. SAMHSA’s GAINS Center teaches the Sequential Intercept Model (SIM) and ways it can divert people with mental health/substance use issues from involvement in the justice system. With more widespread implementation of this model, we can avoid having people locked up for years for stealing a cigarette.