Visions for a Liberated Anti-Carceral Crisis Response

from a Mad Crip care worker and psychiatric survivor

Stefanie Lyn Kaufman-Mthimkhulu
22 min readSep 3, 2022
Dancing the Sacred Sefirot: From Liberation to Revelation by David Friedman. This artwork depicts the 10 sefirot, or 10 spiritual energies that drive life and flow through all of us and the universe (within Kabbalah).

Content notice: discussion of altered states, suicide, self-injury, and trauma surrounding the psychiatric system

Imagine you call for support during a mental health crisis, and the person or organization on the other end had the capacity and skill-set to show up creatively, uniquely, with a menu of options — and most importantly, met you where you’re at without imposing expectations or a standardized, liability-driven version of care?

This is how I have been navigating my care work for over a decade (and now, more “formally” in my work as the Director of Project LETS). Grounded in lineages and an intentional practice of Disability Justice and Mad liberation, I believe strongly in self-directed options for care and healing — especially in crisis situations.

Sometimes when someone reaches out in crisis they need $100 to fill their medication prescription before they go into withdrawal. Or they lost their insurance and need access to medication — now. Or they need alternative housing for the night or the week. Sometimes, they need to be on the phone with someone for 3 hours to share their story. Sometimes intervention is needed in the form of de-escalating a crisis or mediating a conversation or offering a group the ability to process something traumatic. Sometimes someone feels unsafe and wants a person to stay in their home with them until the feeling passes.

I have showed up in all of these ways during a crisis. I have driven across state lines to collect extra pills that community members I do not know were able and willing to part with (after a psychiatrist ghosted a peer). I have shown up at the psychiatric hospital and become someone’s medical proxy. I have put my body as a barrier between police, EMTs, and folks in crisis. I have stayed on the phone with family members, carers, and parents for hours and days after they called 911 for their own children out of fear and a desire for care — only to find it made the situation 100 times worse and they can’t find any help.

I have cooked food, delivered food, ordered groceries, made pot after pot of tea and coffee in my grandmother’s special mugs. I’ve shared weed, money, and mushrooms. I’ve let people stay on my couch or floor for 2, 3, 19 days.

I’ve let people be “in their crazy”(fully inhabit the expressions of their bodymind that may be deemed confusing, too much, out of control, inappropriate, or scary) while I work to make sure the other parts of their life that have to keep moving, keep moving. That means cleaning, taking care of pets or other kids, contacting jobs, advocating, saying the same thing over and over.

I’ve supported parents who are looking for guidance, confused, and stuck in cycles of blame/shame because their child continues to self-injure even after offering loving support. I’ve gone to homes, dorms, and co-ops and trained the people living there in real time on how to move through someone’s crisis. Once, when someone started coloring on the walls with sharpie, we all joined in and made it an activity — centering the fact that the wall can easily be repainted; rather than using it as a “sign” that a crisis is escalating because they engaged in a socially undesirable behavior or “damaged property”).

I’ve been available at 1 AM, 5 AM, 3 PM, and 10 PM. I have spoken to folks about demons and negative spirits and ancestral lineages of pain and harm. I have cleansed people, steamed people, made medicine with my hands and I’ve shared medicine that comes from a pharmacy.

There is no one answer.

There is no one answer to crisis response. There is no one program that will solve the problem of distress. We are forced to endure a society that is deeply out of balance with our needs as humans. This will manifest inside of our individual bodies, but it doesn’t mean the problem is individual.

Through an intentional spreading of the biomedical and pharmaceutical narrative, we have been discouraged from viewing our distress through a holistic and non-medicalized lens. Psychiatry convinced us that if we claimed these disorders and illnesses as our own, we would be able to be seen as Full Humans — because people would understand why we were suffering, that it wasn’t our fault, that we had an illness we can’t control just like diabetes.

But these white, Western cultural beliefs and frameworks do not serve us. They do not serve us when we are seeking empathy and solidarity from others and they do not serve us in the moments where our ability to stay alive depends on our capacity to be seen as full and complex humans worthy of dignity and care. Because Mad and Disabled people are not seen as full humans — especially when we cannot make our bodyminds conform to culturally accepted notions of normality, stability, acceptability, desirability.

With this in mind, here are some thoughts I have about how to offer humanizing, self-directed care to folks experiencing crises:

Learn to understand a crisis outside of capitalistic standards.

Many of us do not even have language to understand what a crisis is for us beyond “not able to keep up anymore.” We need to start building a relationship with our bodyminds and nervous systems especially, in order to understand what we’re like when we’re feeling safe, nourished and resourced; and what we’re like when our dignity, safety, and sense of belonging (Staci Hines, The Politics of Trauma) has been compromised. How does stress actually show up for us? Where does it hide in our bodies? What muscles have been clenched for years?

This is the important inventory to be taking, rather than only knowing things are wrong when we can no longer work well enough, produce enough, focus, or fulfill the many other responsibilities we have as humans.

For example, a crisis for me might be hallmarked by neglecting my “human body needs” like going to the bathroom, remembering to drink water or eat, for weeks on end. It might be that you notice yourself starting to post excessively on social media, or ruminate about your body size. You might notice voices that persist in aggression, a knot in your stomach that grows and doesn’t go away, neglecting things that you love, or a flat affect that won’t budge or shift. This will look different for everyone, and should be a never-ending process of curious and non-judgmental inquiry.

A crisis (and safety) is not defined by the discomfort of folks on the outside.

Are you scared or uncomfortable while supporting someone in a mental health crisis? That means you’re likely in a situation that you don’t necessarily have the tools for and your comfort zone is expanding — it doesn’t inherently mean you’re unsafe.

Many of us have learned to connect ideas of safety with how good or regulated our nervous system feels. Safety is not the same as a regulated nervous system — especially if you are white or move through this world with racial and class privilege/power. Your ability to feel good, to feel calm, is not what dictates standards of safety.

We also need to recognize that things that are disruptive are not always a crisis. And further, treating a disruption as a crisis can have severe consequences on a person’s life (including their ability to stay alive). For example, someone who is behaving out of alignment with accepted social norms or laws (like a person who is loudly singing on a subway car or walking around without a shirt on or counting all of the tiles in a department store and refusing to stop or get out of the store) has a higher chance of interacting with the police through 911 intervention (whether it is with the goal of “de-escalating” — an impossibility — and bring someone to a psychiatric facility or arrest them on the grounds of disorderly conduct, community disturbance, etc.).

Create space for big emotions and don’t force verbal speech.

Many of us have been conditioned to believe that people who typically communicate verbally but cannot or struggle to do so when distressed or activated are being manipulative, dramatic, difficult, or “attention seeking.” There are plenty of reasons why verbal speech capacities can go offline during times of heightened distress, activation, or crisis.

Rather than focusing on trying to get the person to speak and communicate, we want to offer multiple forms of communication. For example: asking yes or no questions that can be answered through nodding or pointing if that is accessible, offering pens and paper, the ability to type on a phone, or other forms of AAC (Augmentative and Alternative Communication).

We also don’t always need to be in “figuring it out” mode. Can we just be present? Can we let someone cry or scream without intervening? Are we willing to bear witness to things that might make us uncomfortable without rushing to understand?

Questions for reflection:

  • Am I able to sit with my own complex and uncomfortable emotions?
  • Can I sit and be present with the complex and uncomfortable emotions of others without fixing, without panicking, without rescuing?
  • How have I been forced to repress my own emotions?
  • How does that repression connect to seeing others having big, expressive experiences?

Recognize that crises happen in the context of relationships and environments being out of balance with our bodymind’s needs.

We need to build our capacity to be in deep relationship with each other. We need to understand what went out of balance to know where to start. Oftentimes, a state of crisis signals that our bodyminds are out of alignment with our environments, with our material needs, with our social relationships.

Open Dialogue is a peer-centered therapeutic model that believes crisis problems often involve “under-resourced relationships.” OD utilizes professional supports in the network of care, but they do not become the whole network. If the problem is in the web of relationships (and not inherently the person in crisis), a pathway to healing could be investing in the social relationships surrounding the person in crisis. Rather than asking, “how do we get this crisis to end?” we might consider asking, “how can we prepare the community to support this person?”

Offer concrete options.

When people are experiencing distress or a crisis, directly asking what they need is always important to consider. However, we must also remember that many folks will be overwhelmed with choice and making decisions; and the “let me know if you need anything!” can be difficult to act on, and can feel like an empty gesture — especially if we don’t follow through.

Rather, I encourage folks to come up with concrete offers that you can commit to. Here’s an example):

Hey friend. I know shit is overwhelming right now, so I made this list from 1–10 of things I can offer. Anytime, you can send me just a number and I’ll know which type of care or support you’re looking for! I might not be able to get back to you right away depending on the time of day or what’s moving for me, but I will communicate as quickly as I can:

  1. Bring you a home cooked meal
  2. Come over and spend the night
  3. Check in via text throughout the day
  4. Listen to you vent
  5. Take a walk in the park
  6. Loud (or silent with headphones) dance party
  7. Help you get connected to other care
  8. Figure out insurance/logistical shit
  9. Go scream in the woods
  10. Come and clean your house

Though I offer 10 different options here, it’s best to offer what you can actually realistically commit to.

Oppression is Disabling. We need to offer material resources to people in crisis.

People need housing, food, and money to have any chance at a balanced mental and emotional state. It’s become very clear in my work that the majority of people who enter a crisis also need a break– from their lives, from the stress of houseleness, debt, kids, job, and more generally, the oppressive and life-sucking nature of living under racialized capitalism. They need to get off the life merry go round. Even though we cannot fix every structural barrier, how can we work towards creating and offering more places of sanctuary in our homes or communities? How can we show up to ensure someone has their basic needs met? What are the practical things we can offer to make tangible changes in the circumstances of people’s lives that are causing distress? How do we create more opportunities for rest that exist outside of psychiatric hospitals?

Support folks in returning to a baseline or begin accessing a sense of safety.

We often cannot begin to address what is happening for people in an activated moment without working to create a sense of physical and emotional safety. In the beginning, this is probably not the time for complicated questions.

We can help support a person in restoring balance to the nervous system by: encouraging awareness of sensations inside the body, sensations we feel outside the body, and what is happening around us in the place that we are in (with consent — turning to the body can be grounding for some and activating for others); meeting their bodymind needs; creating space for big tears or screaming; offering sensory tools and opportunities for stimming; engaging in co-regulation; and letting them talk freely. We can also try and do something tangible to mitigate uncomfortable or triggering feelings and sensations.

An example of this could be adjusting their environment (altering set and setting): what can be changed to bring a small improvement or relief to their experience? What’s too bright? Too loud? Too messy? Too many people? As I read from my comrade Alison Wilens on Twitter, “we can have agency within environments we don’t control.”

It is important to remember that the goal of using these tools is not to “de-escalate someone enough” to comply with your demands, or one idea of healing. The goal is simply to support the person in calming their nervous system.

Reminder: our body secretes stress hormones in response to extreme experiences. We can support folks by giving them an opportunity to use their stress hormones, rather than them building up in the system. This could look like shaking, humming, or other somatic and body movement practices.

True care cannot happen under the guise of threat, force, and coercion.

This doesn’t just happen inside of systems. It happens in our communities and relationships as well. For example, I had a partner who would constantly pressure me to take psychiatric medications I didn’t want to be on; and when I was displaying emotions such as rage or anger at his abusive behaviors, would ask me if I took my pills today, or tell me I was so much nicer when I took my medicine. These are slow-burn assaults on the self, and serve to lead us to the “right” choice (in the eyes of others) — that we are better, easier, nicer, on medication.

So many of us lie and hide for our own survival, and then are blamed for not healing and opening up and digging into our deepest traumas. Recognize that trauma is inter-relational, and it can happen from the systems and people who claim to be most committed to our care.

There is value and meaning in someone’s altered states or things that “don’t make sense to you.”

I firmly believe that there is always meaning in someone’s experiences. We don’t get to automatically decide as onlookers that people who are saying things we don’t understand are manic or psychotic. Medicalization has limited our capacity to show up as curious humans, to find value or meaning in someone’s state or in their words — regardless of if they “make sense” to you or not.

I believe in treating every person like they are insightful. They may be making connections that you don’t even know about, traveling to another universe, or receiving messages. We don’t know what journey they’re on or how their souls, brains, or bodyminds are trying to speak and communicate with them.

As Jade Hui stated in their Psychiatric Survivor Oral History interview with Project LETS:

Please let me be free. Even if my mind is gone, it must have gone for a reason. And if it’s gone momentarily, then if you think of other people getting drunk or getting high… they eventually always do come back. Do not worry, because the physicality of the environment will force me, in some way or another, to acknowledge that we are in an intersubjective reality. But if i’m just not there, I’m not there. And it’s okay… it should be okay.

We can provide support for people who are experiencing an unshared reality in many ways that don’t involve 1) deciding they are hopeless and have no ability to “think rationally and logically”; and 2) getting them out of their altered state via force, isolation, medication. I know this because I have done it for others, and it has been done for me.

Imagine you were approaching the peak of a shrooms or acid trip (a self-induced altered state) and you begin crying loudly, experiencing intense emotions, and saying things that don’t make sense to others around you. Now imagine someone decides you’re in a really bad place, and injects you with an antipsychotic Haldol drip to bring you out of your trip.

What gets lost? What gets stuck? What memories, embodied knowledge, experiences, or feelings are not able to integrate because you were launched out of that state?

If someone tells me the wall is talking to them, I’m going to ask them what the wall is saying — rather than determine they are crazy, in danger, and there is no hope in communicating with them.

I asked my partner Thabiso Mthimkhulu (who is known as Gogo Ndlondlo), who is a profoundly gifted Afro-Indigenous inyanga (an ancestral healer, diviner, prophet, and medicine maker rooted in the Nguni lineages of Swaziland and South Africa) what his thoughts were on someone who deeply believed something that was objectively unreal. For example, a person who believes they have a child who is crying, when there is no baby that others can see or hear around them.

He talked about first connecting with the person and the family or closest circle around the person (if one exists) and speaking about what was happening in their world, if they lost a baby, and what was happening when they were a baby, etc. Most importantly would be understanding what the person believes is happening to themselves, and how they feel about the circumstances. He would then cleanse the person with medicine in a steam, a river, or other ritual healing practices that offer spiritual cleaning and energetic release.

Next, he talked about connecting with their ancestors:

I would ask their ancestors to come and speak to me directly and to come and guide their child. Does this person need to be born again, spiritually? Are they hearing the sounds of themselves crying as a child? What does this child need to communicate?

I would then talk to the baby and dive into this person’s world holding their hand, trying to see what they see, smell what they smell, hear what they hear. What does the baby need right now? What type of food do they like to eat? What kind of clothes does the baby like to wear? I would tell this person that I am here to support them and the baby, while providing care and letting the person stay in my home. I would fully engage. It would eventually become clear, over time and when they are ready and feel safe enough, what the significance of this child is, why it showed up now, and the different pathways available toward relief and healing.

For those of us who have been indoctrinated into a biomedical understanding of what we call mental illness, this orientation to altered states may feel radically different or inconceivable. However, Indigenous communities around the world have long sustained and continue to practice holistic and spiritually grounded frameworks for understanding and navigating Madness– many of which have been stolen, appropriated from, changed, chipped away at or lost entirely due to the violence of colonialism and white supremacy.

At no point in time did Gogo Ndlondlo discuss forced medication, isolation, restraint, or institutionalization. He saw many other pathways and opportunities for engagement, meaning making, and healing outside of carceral frameworks and resources. I share this example because there are healers who can offer radically different approaches to crisis — in holistic and spiritually grounded ways that affirm our humanity — and we need to support and uplift their work as much as possible.

I’ve also learned so much from Peter Bullimore and the Maastricht approach to hearing voices, and the Hearing Voices Network.

Reflect on why and how you’re showing up to help.

Ask yourself:

  • Is what I’m doing actually helpful? Or am I just making myself feel better/less worried/less responsible?
  • Am I causing more harm than I am helping? Am I reinforcing power imbalances? Am I coercing this person into receiving the type of care I want them to receive?
  • Have I asked what this person wants or needs? Or am I prioritizing what I want or need?
  • Has this person asked for my decision-making help or advice? Do I have consent to share what I think?
  • Am I trying to lead or support?
  • Am I considering the consequences of my actions?
  • Is this truly a life-threatening emergency? (i.e. someone is in the middle of overdosing, a suicide attempt has been made, person stops breathing, etc.)

Do not assume one method of healing is better than others. Recognize that the mental health system can make people sicker, and consider the importance of non-medicalized and non-clinical care options.

After I lived through a suicide attempt in 2020, I called many psychiatrist’s office because I thought it was the right thing to do for my kid. On the phone, they wanted a $250 deposit to hold my appointment three weeks away (while they checked to see if my insurance would reimburse any of the appointment). Of course, this was non-refundable. I chose instead to use the money to see two different spiritual and intuitive healers. These sessions got to some of the core roots of why I was experiencing such profound and intense distress, while centering the intergenerational dynamics of my family and lineages. These incredible folks incorporated massage, channeling messages from my ancestors and their guides, singing, dancing, cleansing, talking, imagining, drumming, and challenging.

That’s not for everyone, just like sitting in a therapist’s office isn’t for everyone. The point is that we can ask people about the type of healing or resources they may be interested in. Maybe it’s seeing a holistic healing or somatics practitioner. Maybe it’s getting a tarot reading or getting their bones thrown. Maybe it’s a change of environment or being by the ocean. Maybe it’s seeing a medium or psychic. Maybe it’s finding a peer respite house. Avoid the urge to assume that the mental health system knows best and is the authority on healing — and give choices.

Prioritize informed consent.

We do not live in the world I want or need to be able to engage in crisis response the way I would always like it to be done.

In her visionary book (and one of my most important guides) Medicine Stories: Essays for Radicals, Aurora Levins Morales writes about “la coyuntura” (the situation, the circumstances, the current historical moment — as it’s often used in an organizing context). It’s “the muddy ground we stand on while we stargaze” — looking towards our vision and bigger picture while reckoning with the “bloody difficult present.” To me, la coyuntura means that sometimes, a carceral response will happen. Someone will make the call. Someone will get scared or think it’s the right thing to do. Some of what we want to see cannot yet happen if the conditions don’t exist for it to be birthed or sustained. My goal is not to shame people who turn to or rely on carceral interventions. My goal is to continue imagining beyond the limits of the carceral ceiling, and to interrogate why people believe this is the only option (and further, why it so often is for many communities).

In the decade I’ve been doing this work, I have personally called for an emergency medical response once. Here’s what I did to prioritize informed consent:

  • I told the person I was making the call, I explained why I was making the call, and I did it right in front of them.
  • I stayed with them the entire time and helped them prepare.
  • When police arrived first, I used my body as a shield between myself and the person who was being taken to create a pause. They were immediately trying to restrain them to move the process along as quickly as possible, and offered no attempts at communicating directly with them. I was able to stall long enough and create enough interference for this person to go into the ambulance “of their own accord.” This is a tactic I only recommend for white people and those who feel able or comfortable interfacing with police/EMTs in this way.
  • I spent time talking to them directly and explaining what would happen next.
  • I stayed in accountability to the greatest extent possible. I went to the hospital, connected with family and community resources, and offered advocacy and peer support.
  • I kept the hospital aware that folks on the outside were keeping tabs by checking in multiple times a day and going for in-person visits every time I could.
  • I supported them after their release. I reflected on and took responsibility for what happened, my role in it, what could have gone better or differently, what we would have needed or wanted in an ideal situation, etc.
  • I allowed for experiences of anger or frustration, and prepared for this person to feel betrayed or not want to speak to me. However, I noticed that because of the way we had navigated the situation, they did not name that they were traumatized by this specific transport process.

But what about when people are acting “weird” or engaging in unsafe actions?

When someone is acting in a way that is out of alignment with their being (as you know it), or is a mismatch between the needs of the person and those in the community, we should first interrogate our conditioning around behavior, safety, harm, and risk. Are we worried this person is going to harm themselves, or are we feeling uncomfortable because they are acting in ways we don’t quite understand or agree with? Are their actions actually unsafe or just inconvenient or “disruptive”?

Then we want to look at our material reality and conditions — what is the risk? How do we reduce harm as much as possible while taking the lead of the person experiencing distress? How do we increase access to safety for folks experiencing harm? Who can we bring in to support our conversations? It’s also very important to recognize that what you consider to be a crisis as an outsider may not be interpreted that way by the actual person — and this will definitely guide the way we show up, respond, and the language/strategies we use.

Let’s say you have a friend who experiences altered states and is a parent. When they are in an altered state, they may not be as regular with their child’s schedule and its possible meal times have been missed. How could you navigate this?

  1. Honest and open conversation centered on specific and observable perceptions. As this person is your friend, you likely know their baseline. Talk about this baseline outside of times of crisis, and discuss signs that they’re moving away from their baseline.
  2. Name what makes you concerned directly to this person. We often fall into patterns of talking about people in distress or crisis (either in front of them or without them being present), which we want to avoid.
  3. Name your boundaries: if there are ways you cannot or are unwilling to show up, be clear about that. Also think about circumstances in which you would extend beyond your boundaries to show up as a support.
  4. Connect back to how the action(s) impact the collective or others we are in relationship with
  5. Utilize pre-made tools: such as crisis and safety plans, Psychiatric Advance Directives, and pre-made videos folks make themselves that they can be shown during periods of altered states
  6. Offer material and practical support: in the example given above, practical support could look like offering childcare, delivering meals, sending check in reminders about food, etc.
  7. Bring in folks that are known, trusted, and have established relationships (if possible)
  8. Understand the risks are ultimately theirs to take

This question and conversation is a much bigger one that I hope to continue having in future pieces.

We need to give people access to 1) choice and 2) community — not take it away.

If you get locked in a psych ward, you will experience: restricted visitation, no or limited access to a phone, no or limited access to a computer, restricted time outside. Imagine being in crisis, feeling out of control, feeling like you’re not able to determine what your life looks like or what’s happening to you — and then you’re brought to a space with even LESS control and choice. Someone tells you what to eat, when to sleep, what you can and cannot put in your body. Some people are looking for structure and for opportunities to rest. I understand that, and I also refuse to believe that a locked psychiatric facility is the only place we’re capable of offering those things to people.

Hold space for multiple truths at once.

I am under no illusion that Madness, Disability, altered states is an inherently magical experience. I have suffered deeply. I have tried to end my life. I have been in psychic pain for decades. I am not saying that every voice is a gift. I am saying that our lives have value and meaning, despite and because of who we are and what we endure and how we think and move through this world. I am saying that it is just as possible that a person who is labeled with psychosis is actually communicating with their ancestors and hearing the voices of spirits that want to guide them — as it’s possible that these voices are from trauma, a way for the brain to speak to itself; or a response to a post-viral infection; or, or, or…

I am saying that it is critical to offer people multiple ways to define and make sense of our experiences. That our frameworks and references for ourselves and our stories are important. They matter. And we can shift and change until we find the one that feels right. We don’t have to subscribe to the dominant models of what we’ve been told about ourselves. Though I understand why we often do.

As I write this piece, much of my wisdom has come from the depths of my consciousness when I’m experiencing altered states. If I was brought to a hospital and medicated against my will (as I have been in the past), you wouldn’t be learning from my knowledge in this written piece. It would be lost — deemed useless and meaningless and the empty material of a psychotic person.

I am glad that I can (hopefully) make this make sense to you. There is a level of safety in being understood by others. In turning your crazy into something digestible.

After 10 years of doing this work, I am left with more questions than answers. I still have the will to experiment, to be wrong, to move beyond my defenses when an approach that worked wonderfully for someone completely fails for someone else. I practice humility. I can be told to stop — and I still and often feel the same sense of helplessness that many of us feel. Yet, la lucha sigue. And as I learned from my comrade Carly Boyce, I try to reframe guilt to grief and remember that anytime we intervene counteractively against these systems, we are finding a piece of freedom.

I am a Mad person, a care worker, a Crip doula, an educator, facilitator, consultant, and the Executive Director of Project LETS — where we regularly train and support organizations, groups, and individuals to operate from an anti-carceral lens with regards to crisis response, peer support, and mental health care. Learn more about the radical and critical work Project LETS is doing. I am grateful to be in community with folks who have been willing to experiment, dream together, and show up when nobody else had the desire or courage. I have deep respect and appreciation for the comrades I’ve worked with, the peers whose lives and stories I’ve had the honor of bearing witness to, and the healers, elders, and mentors who have shaped and guided my learning, healing, and work on this planet.



Stefanie Lyn Kaufman-Mthimkhulu

Director of Project LETS. Organizer. Psychiatric Survivor. Multiply Disabled and neurodivergent. Parent. Non-clinical healer. Care strategist. Mad Crip doula.