More communities shifting mental health crisis response away from police ======================================================================== * Kim Krisberg ![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/53/9/1.2/F1.medium.gif) [Figure1](http://www.thenationshealth.org/content/53/9/1.2/F1) Medics and workers from Crisis Assistance Helping Out on the Streets answer a call in 2019. The all-civilian, unarmed team responds to 911 mental health calls without police. Photo courtesy White Bird Clinic/CAHOOTS > “I’ve spoken to countless families who agonized over that decision to call police, especially minority families. There’s such relief when there’s an alternative to law enforcement.” > > — Elizabeth Sinclair Hancq For many people experiencing a mental health crisis, calling for help ends in jail instead of treatment. That was frequently the case in Orland Park, Illinois, located just south of Chicago. Residents experiencing a mental health emergency who called 911 — or whose families did — were often arrested or taken to emergency departments, which are already overburdened and typically ill-equipped to provide mental health treatment. The decision to call 911 can also be a fatal one. A 2015 report from the Treatment Advocacy Center found that people with untreated mental illness are 16 times more likely to be killed during a police encounter. Federal data show about a quarter of people in jail meet the standard for serious psychological distress. “A lot of people can’t access regular mental health services, so things build and build and build until it hits a crisis point,” said Bonnie Hassan, MA, director of outpatient services at Trinity Services, a mental health provider in Orland Park. “They don’t know what to do, so they call 911.” In 2020, with the support of a Department of Justice grant, Trinity Services joined with Orland Park Police to scale up a new Mobile Crisis Response Unit that helps divert such calls away from the criminal justice system. The partnership lets police request a Trinity Services mental health provider— available around the clock — meet them at the scene and intervene in real time. At the scene, the health worker takes the lead, assessing a person’s risk of self-harm and whether a hospital visit is necessary, and offers to connect them to mental health and social services. If a provider is not available to meet in person, police can request one join via video. Over a two-month period in late 2020, Orland Park police responded to 61 mental health calls, and the Mobile Crisis Response Unit was on the scene for almost half, according to a DOJ brief from its Justice and Mental Health Collaboration Program, which gave Orland Park its start-up grant. More than half of the encounters were resolved at the scene, 3% resulted in an arrest and 13% ended in an ED visit — the latter two representing significant declines. Hassan said the partnership has since expanded to nine police departments. “If we want to reach people and help them access resources, one way we can do that is being right there in the moment with police, guiding them through the process,” she told *The Nation’s Health*. Similar efforts to reform mental health crisis response have been gaining momentum across the U.S. for a few decades, with communities adopting a variety of models. The need is great, with research estimating that at least 20% of police calls for service involve a mental health or substance abuse crisis. But progress is slow: An analysis from *The Washington Post* showed that since 2015, 20% of fatal police shootings involved someone in mental health crisis. “The absence of comprehensive crisis systems has been the major front-line cause of the criminalization of mental illness and a root cause of shootings and other incidents that have left people with mental illness and officers dead,” according to the 2020 National Guidelines for Behavioral Health Crisis Care from the U.S. Substance Abuse and Mental Health Services Administration. “Collaboration is the key to reversing these inacceptable trends.” ![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/53/9/1.2/F2.medium.gif) [Figure2](http://www.thenationshealth.org/content/53/9/1.2/F2) From left, team leads Emily White and Amy White from Mobile Crisis Response Teams, an organization that responds to behavioral health, drug or alcohol-related situations, speak to a resident during a call in San Diego in March. More communities are eschewing police for mental health calls. Photo by Melina Mara, courtesy The Washington Post/Getty Images The response models that communities have adopted range from training police, to co-response teams like the one in Orland Park, to replacing police entirely with civilian teams. For example, many communities — more than 2,700 — are using a police-based crisis intervention team, or CIT model, which started in the late 1980s and in which police receive special training and take people to a certain mental health facility. Fewer have co-response teams, in which police are paired with a mental health professional on the scene. Research shows people — especially Black residents — served by such teams are less likely to be arrested than those met only by police. And far fewer communities have what SAMHSA considers the preferred option for mental health emergencies — an all-civilian response team. “The care and treatment of people with mental illness, especially those in crisis, has fallen to systems that can’t say no — law enforcement and ERs,” said APHA member Elizabeth Sinclair Hancq, MPH, director of research in the Office of Research and Public Affairs at the Treatment Advocacy Center. “But you can only train police so much. We need another option.” Hancq said interest in more effective crisis response has surged since 2020, following large-scale nationwide protests against police violence. Exactly how many communities have adopted approaches that go beyond training police is not fully known, she said. But in general, she said most major cities have formed some type of co-response or mobile mental health crisis team. Such models are typically more common in urban and suburban areas than rural ones, which face challenges such as fewer mental health providers and long distances to treatment facilities. Hancq said it is “incredibly urgent” to scale up such work, noting the swell of calls coming into 988, the nation’s new suicide and crisis hotline. Since 988 launched in July 2022, it has received more than 6 million calls, texts and chat messages. “I’ve spoken to countless families who agonized over that decision to call police, especially minority families,” she said. “There’s such relief when there’s an alternative to law enforcement.” Since 2006, DOJ’s Justice and Mental Health Collaboration Program has funded hundreds of organizations to improve mental health crisis response, including 140 police agencies that used the money to create intervention teams. Carleigh Sailon, MSW, a project manager at the Council of State Governments’ Justice Center, which works with the federal collaboration, said law enforcement tends to be supportive of mental health response reforms, especially after realizing how effective they are at freeing up police time. A 2022 report from the Vera Institute of Justice that analyzed 911 calls from nine cities found an average of 19% could be answered by unarmed crisis responders instead. “(These interventions) are very effective at diverting people away from catch-all solutions,” Sailon said. One of the most well known and oldest all-civilian crisis response programs is Crisis Assistance Helping Out on the Streets, based in Eugene, Oregon. Keaton Sunchild, communications specialist for CAHOOTS, said continually building trust with community stakeholders has been key to its success. “It doesn’t work if the public doesn’t buy it,” he told *The Nation’s Health*. CAHOOTS, which started over 30 years ago, is an all-civilian, unarmed team that responds to 911 mental health calls without police. In 2021, it res-ponded to almost 16,500 calls and only had to call for police help in less than 2% of responses. Researchers estimate the program saves the city of Eugene about $8.5 million in public safety spending each year. To date, Sunchild said CAHOOTS has helped about 10 communities establish similar programs. “For people really struggling, it can be a matter of life or death for them to have an option like CAHOOTS in their city,” Sunchild told *The Nation’s Health.* In Washington, D.C., some advocates have stopped waiting for city officials to fix their crisis response system. In July, Bread for the City, a local nonprofit that helps underserved residents, sued the city, arguing that its practice of sending police rather than mental health professionals to respond to mental health emergencies is a violation of the Americans with Disabilities Act and the Rehabilitation Act. According to the ACLU, which represents the nonprofit, less than 1% of D.C. 911 calls for mental health emergencies during fiscal year 2022 received a response from providers working with the city’s crisis response team. In contrast, health responders were sent to 90% of 911 calls for physical health emergencies. “Parity for people experiencing mental health emergencies is what we’re looking for,” Michael Perloff, JD, a staff attorney with ACLU of D.C., which is also part of the lawsuit, told *The Nation’s Health.* “We know people do better with a medic than an armed responder.” A number of presentations at APHA’s 2023 Annual Meeting and Expo will discuss responses to mental health emergencies, including a Tuesday, Nov. 14, session on mental health interventions that features a review of alternatives by staff at Health Resources in Action. For more information, visit [www.treatmentadvocacycenter.org](https://www.treatmentadvocacycenter.org/) or [www.vera.org](https://www.vera.org/). For the Annual Meeting program, visit [www.apha.org/annualmeeting](https://www.apha.org/Events-and-Meetings/Annual). * Copyright The Nation’s Health, American Public Health Association