Innovative solutions to address the mental health crisis: Shifting away from police as first responders – Brookings Institution

Several recent incidents underscore the risks when we expect police to resolve incidents involving people experiencing crises associated with behavioral health or developmental disorders. Sometimes the results are tragic, such as the death of Daniel Prude in Rochester, New York, the shooting in Utah of a 13-year-old boy with autism, and the killing of Walter Wallace in Philadelphia. Such episodes raise questions about what role if any police should play in such cases.

A significant part of the problem is the long-standing, inadequate level of mental health services in the United States. A 2019-2020 report produced by The Blue Ridge Academic Health Group, which advises academic medical centers, draws attention to the sharp reduction in the number of inpatient psychiatric beds since the 1960s. It was intended that such deinstitutionalization would be accompanied by increased community-based care, but that has been insufficient. This inadequate access to care may explain an analysis of police calls in Washington D.C., showing calls from family and friends disproportionately involve mental illness. With racial minorities more often living in under-resourced communities and so less likely to be properly diagnosed with mental illness and receive adequate treatment, it becomes more probable that police may be called to deal with a minority individual experiencing a mental health crisis.

The Treatment Advocacy Center estimated in 2015 that people with untreated mental illness are 16 times more likely to be killed during a police encounter than other civilians approached or stopped by law enforcement. A study in the American Journal of Preventive Medicine, using data covering 2009-2012, found that one in five (21.7%) legal intervention deaths were directly related to issues with the victims mental health or substance-induced disruptive behaviors. Meanwhile, surveys by the National Alliance on Mental Illness have found that people in a mental health crisis are more likely to encounter police than to get medical attention, resulting in two million people jailed every year.

A few jurisdictions, such as San Francisco, are considering removing police from dealing with many situations involving psychiatric conditions or substance abuse, and instead using mental health or emergency medical technicians (EMTs). Many others now provide regular police with special training for dealing with encounters involving people experiencing a mental health crisis.

Both these approaches have limitations. For example, if a situation turns violent, an EMT may not be able to prevent an individual in crisis from injuring themselves or other people. And while police training helps, regular patrol officers rarely receive more than very basic training and still often resort to force rather than more appropriate approaches.

Some jurisdictions, however, are taking a very different route. They are addressing both the lack of community-focused mental health resources and the dangers inherent in police encounters by creating specialized Crisis Intervention Teams (CIT) or similar approaches for dealing with people experiencing mental health or substance abuse crises. These teams are comprised of specially trained police officers and mental health professionals. They collaborate to address and de-escalate high-stress mental health situations, while having the range of skills required to handle possibly dangerous developments. The teams can also help individuals obtain longer-term care.

The following examples indicate the approaches of a variety of innovative CIT models across the country.

Anne Arundel County Crisis Intervention Model Maryland

Anne Arundel Countys Crisis Intervention Unit utilizes a combination of techniques. In 2002, the county expanded its system of Mobile Crisis Teams (MCT) to help manage individuals with needs, and in 2014, with resources from the county police department and the Maryland Behavioral Health Administration, the county added CITs to deal with cases deemed too dangerous for regular mental health professionals. The system now includes:

In collaboration with the healthcare system, Anne Arundel Countys Mobile Crisis Response Team also coordinates follow-up care through one-on-one care coordination when an individual is released from the Emergency Department or a jail after a mental health crisis. When they are discharged, the crisis team picks up the individual from the hospital or jail and the clinician works with a nurse or community health worker to ensure that there is a safety plan in place. Police officers and clinicians also work together to ensure that the individual and their family is also given an overview of the criminal justice system and collaborate on health resources when a person is arrested due to a mental health crisis. The goal of this diversion program is to address any barrier that an individual may have so that they can adhere to their treatment plan and be successful. With this program, Anne Arundel County has experienced significantly lower recidivism rate for these individuals.

CAHOOTSEugene, Oregon

The Crisis Assistance Helping Out on the Streets (CAHOOTS) program is an initiative led by the White Bird Clinic, a Federally Qualified Health Center (FQHC) located in Eugene, Oregon. The program consists of two-person teams: one medic, nurse, paramedic, or EMT; and a crisis worker trained in social and behavioral health services. CAHOOTS calls come in through Eugenes 911 system through which local police dispatchers are trained to recognize non-violent, behavioral health focused situations and can route calls directly to the CAHOOTS team. The specialized team responds without police officers to first assess the situation. If necessary, the team can then call for immediate police backup; otherwise, the team stabilizes the individual within the community. When there is a case of urgent medical need or psychological crisis, the team can undertake an assessment, supply information and referrals, or provide transportation to the next step in treatment. In 2019, of the 24,000 CAHOOTS calls received, police backup was requested only 150 times. The budget for CAHOOTS is about $2.1 million annually.

LEAD Program Seattle, Washington

Seattles Law Enforcement Assisted Diversion (LEAD) program is an example of a series of programs across the country in which law enforcement and court officials seek to avoid prison sentences for apprehended individuals with drug-related problems. The Seattle program began in 2011 as a pilot, funded by private foundations. Police officers who knew the community and individuals with frequent arrests were enrolled in the program. Individuals enrolled in LEAD receive immediate access to substance use treatment and social services such as rental assistance, job training, and mental health programs. In exchange for their participation, no criminal charges are filed, even if they later relapse. With calls for police reform in Seattle, the LEAD program is currently being restructured as the LetEveryoneAdvance withDignity program, and a newoption for LEAD operationsis being re-developed to remove law enforcement from the center of the program and to have a more healthcare-driven perspective.

Albuquerque Community Safety Albuquerque, New Mexico

Since February 2018, the Albuquerque Polices Mobile Crisis Team approach consists of unarmed police officers and mental health professionals responding to mental health crises. Within Bernalillo County, six Mobile Crisis Teams (MCTs) now provide this specialized response to 911-calls related to behavioral health. The two-person teams consist of one MCT-trained law enforcement officer and an MCT-trained masters level behavioral health clinician. In June 2020, New Mexicos Institute for Social Justice reported that almost half of the more than five thousand calls received since the programs inception have been suicide or behavioral health incidents.

In the summer of 2020, in response to public pressures to reform the police, the mayor of Albuquerque announced an initiative to restructure the MCTs into a new cabinet-level department of first responders for mental health crises. Named Albuquerque Community Safety (ACS), it will serve alongside the Albuquerque Police Department and Albuquerque Fire Rescue to deliver what Albuquerque mayor Tim Keller described as a civilian-staffed, public health approach to public safety and mental health. ACS will be staffed by trained professionals such as social workers, housing and homelessness specialists, and violence prevention and diversion program experts. ACS will allow trained 911 dispatchers the option to send ACS personnel when a community safety response is more appropriate than an armed police officer, paramedic, or firefighter. The initiative is planned to begin by the end of 2020.

These examples are consistent with a pattern of actions across the country. Some jurisdictions are creating or expanding police/health professional teams. Others are seeking to remove police entirely from addressing mental health and some drug incidents. In Rochester, for example, following the death of Daniel Prude, the mayor has moved their family crisis intervention team and its funding out of the police department and into the department of youth and recreation services.

With the increasing attention given to the role and conduct of police officers in situations involving individuals undergoing a mental health crisis, it is likely that more jurisdictions will consider changes in the role of the police and such innovations as crisis intervention teams. But in doing so, they will need to ponder several issues, including:

The recent episodes of police injuring or killing individuals with mental illness in crisis have highlighted the argument that police officers are often not the right first responders in many such situationsespecially given the procedures that officers typically are expected to follow when there is an apparent risk to public safety. Fortunately, there are now a growing number of jurisdictions that have adopted a team approach to these incidents, in which mental health professionals can de-escalate the situation, with trained police protection in support. These promising programs need to be studied for their effectiveness and design; they suggest that the role of the police needs to be modified significantly when mental illness may be involved in an emergency call.

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Innovative solutions to address the mental health crisis: Shifting away from police as first responders - Brookings Institution