How a Colorado town is untangling behavioral health care from the criminal justice system

In Alamosa County, law enforcement officers who believe drug abuse is at the root of a person's criminal behavior can refer that person to treatment and other services, rather than arresting and jailing them. The Law Enforcement Assisted Diversion (LEAD) program, used in multiple places around the country, has helped the county jail fewer people and send more into treatment. It also has caused a large drop in arrest warrants, because case workers help people make their appointments in court and elsewhere. Now, San Miguel County, N.M., is working to adopt LEAD, though it needs more treatment facilities.

Tucson Police Department's Substance Use Resource Team reaches out on the streets to people with substance-use disorder, offering them treatment instead of arrest and jail. The team is an extension of the department's mental health support team and was started in response to the opioid epidemic. Officers talk to people they find on the streets, or follow up on 911 calls for overdoses. Not everyone accepts the offered help, and some end up arrested on warrants. But, at a time of rising overdose deaths, the officers and the peer support specialists who accompany them often can get people into treatment.

Police officers paired with substance abuse counselors go onto Brattleboro's streets to offer no-strings-attached help to people using drugs. Without using arrests or other coercion, the Project CARE "recovery coaches" have connected dozens of people to rehab and other needed services since the program began in July 2018. Modeled on bigger, successful programs in Gloucester and Brockton, Massachusetts, CARE's effect on overdoses is unknown and the involvement of police is seen by some as a drawback. But the outreach has let the community know help is available for the asking – even from cops.

The LEAD program (Law Enforcement Assisted Diversion), which was launched in Seattle in 2011 and is used in such cities as Atlanta, Los Angeles, Portland, Philadelphia, and Baltimore, provides intensive case management and services to people who come in contact with police and qualify to have their low-level cases bypass the criminal justice system. LEAD has been shown to lower recidivism by half and to make it more likely that people with drug and mental health, and other problems can find housing and jobs more easily. But this critical analysis argues that the police should not serve as gatekeepers.

After San Joaquin County adopted a slew of criminal justice reforms, crime dropped by 20 percent, the lowest number in a decade. One of the things that was implemented were speciality courts aimed at decreasing arrest time and helping “former prisoners find jobs, housing and treatment for mental health and addiction problems.” Other measures include ending cash bail and racial bias training. “Crime has always been issue No. 1, but the narrative in this city is one about being a second chance city.”

The Frederick Police Department’s Crisis Response Team combines law enforcement with paramedics and mental health professionals to respond to calls. The team can showcase each person’s expertise as needed, providing more individualized care when responding to mental health emergency calls.

Dallas' Rapid Integrated Group Healthcare Team dispatches clinicians and social workers with police to 911 calls for mental health crises. Within two days, the team follows up to make sure people received the services they need. In its first three years, the area of the city using the program saw 60% fewer arrests and 20% fewer emergency-room visits among people in mental health crises. Critics argue that the presence of police can needlessly escalate such crises, but the city is sticking with the co-responder model and spending millions to expand the program.

Less than a year after Rochester experienced its own version of the George Floyd case, when a clash with police led to the death of Daniel Prude, a man in a mental health crisis, Rochester diverted money from the police to fund a Person In Crisis team to respond differently to such crises. Two mental health and social workers accompany police on relevant calls 24/7, about 100 calls per week. Their presence can de-escalate potentially violent encounters and get people the help they need without an arrest.

The Summit County, Colorado, sheriff's office runs SMART (Systemwide Mental Assessment Response), which pairs armed deputies with clinicians to respond to mental health crises. In 2020, the two teams took hundreds of calls but made only one arrest. Instead, most people are helped on the spot or referred to services that can help. The county plans to expand the service to 24/7 with two more teams, plus one mobile crisis until to handle suicide threats, staffed only by civilian mental health professionals. This report discusses the range of models used nationwide with and without police involvement.

A pilot project in three New York Police Department precincts of Harlem showed in its first month that it can divert some mental-health crises away from hospitalization and toward other forms of help. Teams of medics and social workers took about one-quarter of such calls, sometimes at NYPD invitation. They sent about half of the people in crisis to a hospital, significantly less often than the police do in such cases. The goal in replacing police is to avoid needless violence and arrests in non-violent, non-criminal emergencies.