Counseling and Mental Health Services

It is vital that barriers to local mental health services or resources are minimized and equitably distributed. Early detection and referral require accessible and affordable mental health services. This includes appropriate follow-up. It is also important to reduce social stigmas associated with mental illness and distress, and with seeking treatment. Researchers have found that those who receive sufficient treatment for mental health or substance use issues are less likely to engage in violence, especially for adolescents who are at higher risk of impulsive behaviors.(1,2) Recommendations that place a focus on culturally safe care will increase the chances than an individual can receive timely and appropriate care.

In the previous sections, we highlighted many community-based mental health resources appropriate for someone approaching a crisis, however, someone actively in crisis or with severe mental distress may require more emergent and crisis-specific care from trained mental health providers (e.g., psychiatrists, psychologists, social workers) and/or in-patient services (i.e., hospital care). Yet, de-escalation interventions such as multidisciplinary crisis intervention teams to refer individuals to appropriate services, substance use treatment programs to help individuals address addiction and self-medication issues, and domestic violence programs designed to reduce familial conflict are vital resources for reducing a crisis from boiling over into violence. It is also critical that safety net programs such as these both provide temporary help (e.g., safe housing) and longer-term resources designed to break the pattern of an acute crisis into violence. This may include helping people develop individual coping or employment skills (e.g., training programs), increasing mental health services and their accessibility, and educating people about early signs and what to do when they suspect a crisis is imminent.

Settings for Mental Health Services: Schools, Workplace, Healthcare Facilities

Recommendations for Crisis-Specific Mental Health Services

• MI Behavior Health Crisis Services. Michigan Department of Health and Human Services (MDHSS), in partnership with stakeholders across the state, is in the process of developing a crisis services system for all Michiganders. Based on the Substance Abuse and Mental Health Services Administration (SAMHSA) model, the system will have three primary components: central crisis line (MiCAL/988), mobile crisis, and crisis stabilization units. Resources are comprehensive and can help the individual identify the appropriate care based on the needs identified.
• Substance Use Prevention and Treatment Services. Researchers have reported a strong correlation between alcohol or drug abuse and gun violence.(3,4) It has been shown that individuals who meet the criteria for alcohol or drug abuse/dependence are 2.4 times more likely to report impulsive angry behavior and to carry guns in public compared to those who did not misuse substances.(5) Researchers have also found that suicides by firearm are more likely to have been preceded by alcohol use than suicides by other methods.(6) Directing individuals in crisis to tailored interventions, including substance use treatment, can play a critical role in gun prevention.
• Domestic Violence Intervention Programs. There is also a well-established correlation between domestic violence and gun violence. Incidents of domestic violence are often linked to firearm use, and the presence of firearms in such situations significantly increases the risk of fatal outcomes. The Educational Fund to Stop Gun Violence reports that around 4.5 million women in the U.S. have been threatened with a gun, and nearly 1 million women have been shot or shot at by an intimate partner.(7) Furthermore, a recent study found that nearly two-thirds of mass shooters have a history of domestic violence.(8) Interventions for domestic violence is crucial to protect victims and potential targets from harm. Removing firearms or restricting access to them in cases of domestic violence can help prevent these outcomes and safeguard the wellbeing of those at risk. Data also shows that young women, particularly racial/ethnic minority women, are disproportionately affected by domestic violence.(9).

Mentorship Programs

Researchers have consistently found that social connectedness and supportive relationships are fundamental for mental health.(10–13) Successful mentoring programs that include one-to-one contact to help individuals with emotional support, navigating difficult situations, or decision making can provide vital social connections for people. This may require matching people with appropriate peers, having young adults be supports for adolescents, or connecting employees with a supervisor or peer to help them negotiate issues in their work environment. Researchers have also noted, however, that adequate training and support for the mentors is a key component of any mentoring program.(14–16) Additionally, mentorship programs that include a reporting and subsequent support structure for mentors and mentees to report problems and concerns is important for success. Mentoring programs for youth may also need to consider issues unique to minors such as location and transportation, how individuals are matched, and how youth are identified and motivated to participate in such programs. The matching process in youth mentoring programs is also a critical issue to consider as random assignments may not be the most effective way to connect a youth to an appropriate mentor. One useful strategy for youth mentoring programs is to include processes for current participants to nominate peers and to invite their peers into the program. Program leaders also need to develop processes and screening criteria for identifying mentors that consider interests, availability for consistent contact, effective coping skills themselves, obtaining references, and background checks. In the workplace, mentorship programs can include specific policies requiring newer employees to be connected to an experienced employee for their first few years on the job, but again matching and training for the mentors is vital for success.

Settings for Mentorship Programs: School, Community and Faith-Based Organizations

Recommendations for Mentorship Programs:

• Big Brothers Big Sisters of America (BBBSA) is a nationwide nonprofit organization committed to providing mentoring relationships for youth and adolescents. The organization offers a variety of programs that include community-based, school-based, and workplace-based mentoring. Big Brothers Big Sisters focuses on creating positive, one-to-one relationships between adult volunteers (Bigs) and youth (Littles). These relationships aim to support the holistic development of young individuals by engaging in educational, recreational, and character-building activities. The organization operates through local chapters across the United States, each adapting its programs to meet the unique needs of its community. Research has consistently shown the effectiveness of BBBSA on academic achievement, social connectedness, and other positive behavioral and health outcomes.(17–20)
• Boys and Girls Club is a nationwide nonprofit organization dedicated to providing after-school programs and services aimed to bolster the positive development of youth and adolescents. Unlike some mentoring-focused organizations, Boys & Girls Clubs operate on a broader scale, delivering comprehensive programs within a club setting. These programs cover areas such as education, career development, character and leadership development, health, arts, and sports, encouraging social interactions and a sense of community among participants. The organization’s commitment to affordability and inclusivity ensures that children, regardless of their background, can benefit from the multitude of opportunities provided.
• The National Mentoring Partnership is a leading nonprofit organization committed to enhancing the quality and quantity of mentoring relationships for young people across the U.S. Unlike specific mentoring programs, MENTOR serves as a catalyst for a diverse range of mentoring initiatives, collaborating with organizations, businesses, and communities to drive the mentoring movement forward. By providing information, tools, and best practices, MENTOR supports and strengthens existing mentoring programs, fostering a culture that recognizes the transformative impact of positive adult-youth relationships. The organization’s advocacy efforts extend to the national level, promoting policies that prioritize youth mentoring as a key component of positive youth development. Mentor Michigan is the state affiliate of the MENTOR Program.

Community Violence Interrupter Programs

Interpersonal gun violence disproportionately affects communities of color that have endured historical policies such as redlining and disinvestment that have resulted in concentrated poverty, limited educational resources, and underserved areas for public services (e.g., transportation).(21) This kind of environment then results in limited opportunities for advancement while also increasing crime and violence, and victimization. This creates a context whereby residents often find themselves trapped in cycles of violence, victimization, trauma, and retaliatory violence. For generations, addressing gun violence in underserved communities has primarily relied on policing and incarceration which further exacerbated racial inequalities. While criminal justice approaches are a part of the solution, they are not the only solution, as evidenced by the fact that the cycle of crime and violence persist in disadvantaged communities. Rather, a more multidisciplinary and holistic approach that involves other community institutions and alternative strategies may be required to make the kind of changes needed to break the cycle of crime and violence. Many communities, for example, are implementing strategies that engage with individuals at highest risk of violence.

Community Violence Interrupter (CVI) programs are community-based initiatives designed to prevent and intervene in potential violent conflicts within neighborhoods. These programs typically employ individuals known as “violence interrupters,” who have deep ties to the community and often have personal experiences related to violence. Violence interrupters work to mediate disputes, de-escalate tensions, and prevent the outbreak of violence. Many of the existing CVI programs focus on reducing homicides and shootings by establishing relationships with people at the center of gun violence within a community. These programs support people at the highest risk of being victims or perpetrators—or both—of violence. In many instances, the programs employ former perpetrators and gang members to be part of the interruption process. CVI programs have demonstrated major success in reducing violence by addressing its root causes and fostering a sense of community responsibility.(22–27)

Furthermore, empowering survivors to share their experiences and actively participate in advocacy not only lends to a critical human perspective that drives policy discussions but also fosters a sense of agency and control over their narrative. Engaging in advocacy allows survivors to transform their trauma into a catalyst for change, promoting healing through action and contributing to a sense of purpose. Many community leaders have advocated for major investment in CVI infrastructure and frontline workers. The city of Oakland, California serves as a strong example of how investing in CVI, in partnership with law enforcement, can promote policy reform and reduce gun violence by placing a more concentrated effort on a very small number of individuals at greatest risk of gun violence.(28)

Another community setting for effective early intervention for individuals in crisis is the hospital setting because this is where victims of a gunshot are most often treated before they return to their neighborhood. Individuals who survive a gunshot wound are not admitted into the hospital and are released within hours from the emergency department. The emergency room provides a unique and highly trusted setting that can be an important component of a CVI approach. This teachable moment has been the focus of some evidenced-based programs that help build individuals’ skills, alter behavior, and reduce retaliatory violence. Some of these programs are mentioned below.

Settings for CVI Programs: Neighborhoods, Schools, Workplace, Faith-Based Organizations, Healthcare settings

Recommendations for CVI Programs:

• FORCE (Faithfully Organizing Resources for Community Empowerment) Detroit is a community organization that constitutes interfaith, grassroots, and public sector leaders committed to addressing complex community issues, pushing boundaries, and generating creative justice-oriented solutions. FORCE Detroit leverages media and culturally relevant strategies to connect people least likely to be engaged in civic infrastructures.
• Group Violence Intervention (GVI) is a comprehensive strategy that utilizes a data-driven process to identify the individuals and groups at the highest risk of committing or being involved in gun violence and deploying effective interventions among these individuals. It was first used in the landmark initiative called Operation Ceasefire in Boston in the mid-1990s, which showed a 61% reduction in youth homicide.(29) It has now been implemented across a wide range of U.S. cities and has proven to be consistently and highly effective – with reductions in homicide between 30 to 60%.
• Cure Violence (formerly CeaseFire) is another community-based model that uses “violence interrupters” to treat gun violence as a disease and works to stop its transmission among community members. “Violence Interrupters” are individuals who understand the dynamics of the community and can connect with those most at-risk to commit or become the victims of gun violence. For example, within the first week of implementation in Chicago the program saw a 48% reduction in shootings.(24,30)
• Hospital-Based Violence Intervention Programs (HVIP) are multidisciplinary programs that combine the efforts of medical staff with trusted community-based partners to provide safety planning, services, and trauma-informed care to violently injured people. The HVIP model offers timely, intensive, and individualized support in the immediate post-injury period and may also seek to address the social environment and needs of patients. While data is still emerging, we know there is a decrease in repeat injury which results in a large monetary savings, studies project an estimated savings in excess of $3.9 million annually per average HVIP.
  • A prominent example is SafERteens, which is an evidence-based brief intervention for youth presenting in the emergency room to break the cycle of retaliatory violence and prevent subsequent violent behavior. Researchers have found that patients who receive the SafERteens program are less likely to report involvement in violence and violence-related consequences at follow-up compared to youth who do not receive the program.(31–33)
  • Another example is Caught in Crossfire (Oakland, CA), which launched at the Oakland Highland Hospital in 1994, and has since been replicated in other cities. The program focuses on youth admitted to the hospital with a violence-related injury who then speak with an Intervention Specialist to help the patient cope with injury and consider alternatives to retaliation. Youth who were treated were 70% less likely to be arrested for any offense 6 months post-injury, and 60% less likely to have any criminal involvement than the control group.(34)

Key Components of CVI programs:

• A focus on those individuals at highest risk of experiencing or perpetrating community violence in the near term.
• Data from multiple sources that are vetted for racial, ethnic, economic, or other biases to inform the approach.
• Practices that are informed by, and respond to, the effects of trauma on individuals and the broader population in historically underinvested communities.
• Involving stakeholders that include:
  • Trusted, credible messengers and practitioners to deliver key intervention elements.
  • Representatives of the affected communities as full partners to ensure intervention approach is locally relevant and culturally appropriate.
  • Public, private, and community collaboration to ensure multi-sector involvement and support
• Strengthening community resources and assets to build social capital.
• Attention to racial, ethnic, and socioeconomic equity including understanding the many social, demographic, economic, and institutional factors that perpetuate community violence, and avoiding victim blaming.

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2. Sanchez C, Jaguan D, Shaikh S, McKenney M, Elkbuli A. A systematic review of the causes and prevention strategies in reducing gun violence in the United States. Am J Emerg Med. 2020;38(10):2169–78.
3. Banks G, Hadenfeldt K, Janoch M, Manning C, Ramos K, Wolf DAPS. Gun violence and substance abuse. Aggress Violent Behav. 2017;34:113–6.
4. Kaufman E, Morrison CN, Branas CC. Reducing gun violence using alcohol-related convictions:“never Use Alcohol, Over-the-Counter Drugs, or Prescription Drugs before or while Shooting.” JAMA Intern Med. 2020;180(1):43–4.
5. Swanson JW, Sampson NA, Petukhova MV, Zaslavsky AM, Appelbaum PS, Swartz MS, et al. Guns, impulsive angry behavior, and mental disorders: Results from the National Comorbidity Survey Replication (NCS‐R). Behav Sci Law. 2015;33(2–3):199–212.
6. Lange S, Jiang H, Kaplan MS, Kim KV, Rehm J. Association between acute alcohol use and firearm-involved suicide in the United States. JAMA Netw Open. 2023;6(3):e235248–e235248.
7. Tjaden PG. Full report of the prevalence, incidence, and consequences of violence against women: Findings from the National Violence Against Women Survey. US Department of Justice, Office of Justice Programs, National Institute of …; 2000.
8. Geller LB, Booty M, Crifasi CK. The role of domestic violence in fatal mass shootings in the United States, 2014–2019. Inj Epidemiol. 2021;8:1–8.
9. Petrosky E, Blair JM, Betz CJ, Fowler KA, Jack SP, Lyons BH. Racial and ethnic differences in homicides of adult women and the role of intimate partner violence—United States, 2003–2014. Morb Mortal Wkly Rep. 2017;66(28):741.
10. Newman MG, Zainal NH. The value of maintaining social connections for mental health in older people. Lancet Public Health. 2020;5(1):e12–3.
11. Holt-Lunstad J, Robles TF, Sbarra DA. Advancing social connection as a public health priority in the United States. Am Psychol. 2017;72(6):517.
12. Turner RJ, Brown RL. Social support and mental health. Handb Study Ment Health Soc Contexts Theor Syst. 2010;2:200–12.
13. Roach A. Supportive peer relationships and mental health in adolescence: An integrative review. Issues Ment Health Nurs. 2018;39(9):723–37.
14. DuBois DL, Holloway BE, Valentine JC, Cooper H. Effectiveness of mentoring programs for youth: A meta‐analytic review. Am J Community Psychol. 2002;30(2):157–97.
15. Rhodes JE, DuBois DL. Mentoring relationships and programs for youth. Curr Dir Psychol Sci. 2008;17(4):254–8.
16. Rhodes J, Reddy R, Roffman J, Grossman JB. Promoting successful youth mentoring relationships: A preliminary screening questionnaire. J Prim Prev. 2005;26:147–67.
17. Grossman JB, Tierney JP. Does mentoring work? An impact study of the Big Brothers Big Sisters program. Eval Rev. 1998;22(3):403–26.
18. Herrera C, DuBois DL, Heubach J, Grossman JB. Effects of the Big Brothers Big Sisters of America Community-Based Mentoring Program on social-emotional, behavioral, and academic outcomes of participating youth: A randomized controlled trial. Child Youth Serv Rev. 2023;144:106742.
19. Herrera C, Grossman JB, Kauh TJ, McMaken J. Mentoring in schools: An impact study of Big Brothers Big Sisters school‐based mentoring. Child Dev. 2011;82(1):346–61.
20. Rhodes JE, Haight WL, Briggs EC. The influence of mentoring on the peer relationships of foster youth in relative and nonrelative care. J Res Adolesc. 1999;9(2):185–201.
21. Jacoby SF, Dong B, Beard JH, Wiebe DJ, Morrison CN. The enduring impact of historical and structural racism on urban violence in Philadelphia. Soc Sci Med. 2018;199:87–95.
22. Henry DB, Knoblauch S, Sigurvinsdottir R. The effect of intensive ceasefire intervention on crime in four Chicago police beats: quantitative assessment. Chic IL Robert R McCormick Found. 2014.
23. Delgado SA, Alsabahi L, Wolff KT, Alexander NM, Cobar PA, Butts JA. The effects of cure violence in the South Bronx and East New York, Brooklyn. 2017.
24. Butts JA, Wolff KT, Misshula E, Delgado SA. Effectiveness of the cure violence model in New York City. 2015.
25. Picard-Fritsche S, Cerniglia L. Testing a public health approach to gun violence: An evaluation of Crown Heights Save Our Streets, a replication of the Cure Violence Model. Center for Court Innovation New York, NY; 2013.
26. Skogan WG, Hartnett SM, Bump N, Dubois J. Evaluation of ceasefire-Chicago. Chic Northwest Univ. 2008;42(5).
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• MI Behavior Health Crisis Services: https://www.michigan.gov/mdhhs/keep-mi-healthy/mentalhealth/mi-behavioral-health-crisis-services
• The November 2023 Quarterly Report details: https://mpcip.org/wp-content/uploads/BH-Crisis-System-Update-November-2023.pdf
• Substance Use Prevention and Treatment Services: https://www.michigan.gov/mdhhs/keep-mi-healthy/mentalhealth/drugcontrol/treatment
• Domestic Violence Intervention Programs: https://www.michigan.gov/-/media/Project/Websites/mdhhs/Folder2/Folder20/Folder1/Folder120/2017_DV_FAQ_survivor.pdf?rev=ce2df4a89e9d455797653f2f3162c1cc
• Alcohol misuse and gun violence report conducted by the Consortium for Risk-Based Firearm Policy: https://publichealth.jhu.edu/sites/default/files/2023-05/2023-may-cgvs-alcohol-misuse-and-gun-violence.pdf
• The Educational Fund to Stop Gun Violence: https://efsgv.org/learn/type-of-gun-violence/domestic-violence-and-firearms/
• Resources from National Sexual Resource Center: https://www.nsvrc.org/saam
• Substance Abuse and Mental Health Services Administration: https://www.samhsa.gov/
• Big Brothers Big Sisters Michigan Capital Region: https://www.bbbsmcr.org/
• Boys and Girls Club: https://www.bgca.org/
• Mentor Michigan, the state affiliate of the MENTOR Program: https://www.michigan.gov/leo/boards-comms-councils/mcsc/mentor/program-resources
• MENTOR Website: https://www.mentoring.org/who-we-are/mission-vision/
• 42 Strong: https://42strongtate.org/
• Boys2Men: https://www.boys2menyouthmentoring.com/
• Youth Assistance - Mentors Plus: https://www.oakgov.com/government/courts/youth-assistance/mentors-plus
• Ascend Foundation: https://www.theascendfoundation.org/
• The Boomerang Project: https://www.boomerangproject.com/link/what-is
• FORCE (Faithfully Organizing Resources for Community Empowerment) Detroit: http://forcedetroit.org/
• Cure Violence Program: https://cvg.org/impact/
• SafERteens: https://firearminjury.umich.edu/saferteens/
• Vera on Community Violence Interruption Programs: https://www.vera.org/community-violence-intervention-programs-explained
• Healing Communities in Crisis PDF: https://giffords.org/wp-content/uploads/2019/01/Healing-Communities-in-Crisis.pdf
• CD-CP Toolkit: Enhancing Police Responses to Children Exposed to Violence: https://medicine.yale.edu/childstudy/services/community-and-schools-programs/yctsr/cev%20toolkit%20-%20online%20version_444971_284_54953_v1.pdf
• Article on HVIP Programs: https://www.americanprogress.org/article/hospital-based-intervention-programs-reduce-violence-and-save-money/
• SafERteens Program at University of Michigan: https://saferteens.org/home/
• Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors by the CDC (Includes SafERteens): https://www.cdc.gov/violenceprevention/pdf/yv-technicalpackage.pdf