Leaving Behind Uniforms And Sirens, Summit County Sheriff Expands Crisis Response

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.

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.

The police chief in Eugene, Ore., home of the CAHOOTS program, which other communities see as the model for finding alternatives to policing, supports the program because it saves lives and saves the city money. Sending unarmed medics and social workers on calls involving behavioral health problems, mental health crises, and substance-use psychotic episodes automatically de-escalates many situations because of the lack of a police presence.

In its first month as a pilot project in a part of Harlem, New York's Behavioral Health Emergency Assistance Response Division (B-HEARD) handled one-quarter of 911 calls for mental health crises. Despite fears of danger to the teams of social workers and paramedics, police backup was needed only seven times out of 110 cases. More people accepted help from the non-police teams than in the past from teams of police and paramedics. And that help depended half as often on hospital visits. People got helped on the scene or went to community centers for services. The city plans to expand the program.

CAHOOTS has become a national model because of its uncommon partnership with the Eugene Police Department. The police chief says CAHOOTS' unarmed first responders to mental health crises can de-escalate crises before crimes occur or someone gets hurt. That's the idea behind the decades-old agency that takes calls where police can sometimes cause worse outcomes. The crisis intervention workers and medics treat people on the scene or transport them to places where they can get the help they need. Police are available but rarely needed for safety on those calls.

As the nation’s largest city to embrace an alternative approach to responding to 911 calls in non-violent personal crises, Denver finished the first year of its pilot program having never needed police backup when its medics and social workers handled problems on the streets. About a third of calls to STAR (Support Team Assisted Response) came from police who saw STAR as a better responder to certain calls. In about 40% of calls, people in mental health or substance use crises received the services they needed without involving arrests or conflicts with police.

Montgomery County's longtime crisis response center illustrates the pitfalls of embracing a policing alternative without proper resources or thinking through the implications. The racial-justice protests of 2020 inspired many more cities and counties to explore mobile crisis response teams instead of police, to minimize violence and get people needed help instead of incarceration. While Montgomery County's team often deescalates crises and can either provide care or refer people to needed services, it lacks the staff to respond effectively. And the system of mental health care is too thin for the need.

The nationwide 988 call system for suicide prevention and mental health crises will go live in July 2022, with federal funding available for certain local crisis response programs. Santa Cruz and Alameda counties already offer a variety of police and non-police teams that will either benefit from the new system or must adapt to the changes coming. Most of the non-police responses in the area operate only during daytime hours, and in the case of Santa Cruz's Mobile Emergency Response Team are not well known by the public. When police are the default responders, people may not get the care they need.

The long-running CAHOOTS program, which replaces police with medics and social workers to respond to non-violent, non-criminal mental health crises, suicide threats, and problems stemming from homelessness, serves as a model for similar programs in the nationwide push to reimagine policing. CAHOOTS teams de-escalate crises at first simply because they are not armed police. They also take the time and have the training to calm situations and get people the help they need. Programs in Phoenix and Denver demonstrate how the idea plays out in larger cities.