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Behavioral Health Crisis Alternatives

Shifting from Police to Community Responses

Police are ill-equipped to safely and effectively serve people experiencing behavioral health crises. With more than 240 million 911 calls made each year, police have become the default first responders for a wide range of social issues, from mental illness to substance use to homelessness. For 911 call volume, see National Emergency Number Association (NENA),”9-1-1 Statistics,” https://www.nena.org/page/911Statistics. The dire shortcomings of this approach are reflected in the disproportionate number of people with mental illnesses and substance use disorders killed by police every year and the disproportionate numbers held in jails and prisons. Amam Z. Saleh, Paul S. Appelbaum, Xiaoyu Liu et al. “Deaths of People with Mental Illness During Interactions with Law Enforcement,” International Journal of Law and Psychiatry 58 (2018), 110-116; Jennifer Bronson and Marcus Berzofsky, Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-12 (Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics (BJS), 2017), https://www.bjs.gov/content/pu...; and Jennifer Bronson, Jessica Stroop, Stephanie Zimmer, and Marcus Berzofsky, Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007-2009 (Washington, DC: BJS, 2017), https://www.bjs.gov/content/pu.... Although many officers may possess de-escalation skills, the mere presence of armed, uniformed officers with police vehicles can exacerbate feelings of distress and escalate mental health-related situations, particularly in Black communities and other communities of color, where relationships with police are historically characterized by tension and distrust. See for example Substance Abuse and Mental Health Services Administration (SAMHSA), National Guidelines for Behavioral Health Crisis Care—A Best Practice Toolkit (Washington, DC: U.S. Department of Health and Human Services, SAMHSA, 2020), 68-69, https://www.samhsa.gov/sites/d...; Drew DeSilver, Michael Lipka, and Dalia Fahmy, “10 Things We Know about Race and Policing in the U.S.,” Pew Research Center, June 3, 2020, https://www.pewresearch.org/fa.../. Too often, encounters between the police and people in crisis end in handcuffs with an enforcement action or emergency department transport. Too often, they do not end in voluntary assessment and referral to the long-term supports people with mental illnesses and substance use disorders need to thrive.

Police themselves have been saying for years that they are asked to do too much. Why do we continue to ask them to respond to crisis calls that health professionals could address more safely and effectively?

For communities to shift away from police-led responses to people experiencing behavioral health crises, they must engage and fund new partners who can plan and implement different approaches. But developing alternatives that reduce police involvement in crisis response and divert people from jail does not require reinventing the wheel. There are many existing examples of community-based, health-centered responses that can lead to better outcomes for people with behavioral health issues. This report provides an overview of crisis response programs, including a typology of approaches organized by the involvement of law enforcement, before examining the efforts of three communities—Eugene, Oregon; Olympia, Washington; and Phoenix, Arizona—to reduce the number of crisis calls directed to police. Although these efforts involve varying degrees of police participation and collaboration, and each reflects different stages of program implementation, they all promote the use of alternative first responders who can intercept calls concerning mental health and substance use that would have otherwise gone to police. Finally, the report offers key considerations to aid communities in planning and implementing programs that shift responses from police to community.

Crisis response programs in context

Recent decades have seen severe reductions in behavioral health services due to a series of events, including deinstitutionalization and the failure to fund promised community-based services and supports. William H. Fisher, Jeffrey L. Geller, and John A. Pandiani, “The Changing Role of the State Psychiatric Hospital,” Health Affairs 28, no. 3 (2009), 676-684, https://perma.cc/Z3SS-ZKA7. Because of this failure, increasing numbers of people with mental illness and substance use disorders have come into contact with the police, experiencing trauma during these encounters and even ending up in jail, where they stay longer than people without behavioral health conditions facing similar charges. Serious Mental Illness (SMI) Prevalence in Jails and Prisons (Arlington, VA: Treatment Advocacy Center, 2016), 2, https://www.treatmentadvocacyc.... Many communities have increased both funding for correctional facilities and mental health treatment in jails; Rikers Island in New York City, Cook County Jail, and Los Angeles County Jail hold more people with behavioral health conditions than the dedicated mental health treatment facilities across the country. Ibid., 1.

At the same time, some communities have introduced crisis response programs designed to address urgent concerns. These concerns include repeat encounters with police, poor connections to care, incarceration of people with mental illness for low-level offenses, and deaths of people with behavioral health conditions at the hands of police. The resulting programs, including Crisis Intervention Team (CIT) and co-responder models, often involve ongoing collaboration among police, advocates, and health and social service providers; extensive crisis scenario training for officers that includes de-escalation practice; and diversion from arrest to appropriate services and supports.

Literature Review

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Unfortunately, many existing programs are hindered by an overreliance on police, limited community collaboration, and underinvestment in community-based resources. Communities must pursue new approaches that minimize trauma and distress, promote dignity and autonomy, and reduce repeat encounters with police for people who experience behavioral health crises. Reducing law enforcement involvement in crisis calls is a critical step toward these goals.