Local programs must be shaped by the perspectives and recommendations of community members. It is particularly important to hear from people who have direct, lived experience of current services and responses; people who have experienced behavioral health crises; and Black, Indigenous, and other people of color that have been disproportionately harmed by policing. Without these perspectives, programs risk perpetuating distrust and reproducing the inequities of status quo approaches.

Even with the best of intentions, community engagement and consultation efforts can be ineffective when they are one-off or infrequent, when they ask for input only and do not share opportunities for decision-making, or when stakeholders with institutional power are not open to critical feedback. People with lived experience should be in leadership and decision-making roles, contributing fully to programmatic and strategic decisions.5

Key recommendations

  • Partner and collaborate with people with lived experience
  • Allocate time and resources to integrate feedback

Partner and collaborate with people with lived experience

From the earliest stages of planning and development, crisis response programs should be designed in partnership and collaboration with stakeholders who have direct, lived experience of local services and behavioral health needs.

In Portland, Oregon, for example, a 2018 report revealed that the majority of arrests the prior year involved people identified as homeless, highlighting the particular impact of policing on this community.6 The campaign to establish a civilian crisis response service—Portland Street Response (PSR)—began in 2019 and was led by Street Roots, a local nonprofit organization that leads media, advocacy, and community outreach initiatives for people experiencing homelessness and poverty.7 Executive Director Kaia Sand recounted that when the Portland City Council began planning for the PSR pilot, “it became clear that we needed a large-scale way to bring unhoused voices into the plan development.”8 To guide the planning and implementation of the pilot, the Portland City Council allocated $500,000, hired a program manager, and formed several workgroups, including a group dedicated to community engagement.9 Street Roots helped lead listening sessions and a survey of 184 unhoused community members that informed recommendations for the launch and implementation of the pilot program.10

Similarly, in Toronto, a group of community stakeholders—the Reach Out Response Network (RORN)—engaged community members who were “most likely to be impacted by current and future crisis services” to inform their proposal for a new, civilian-led crisis response service.11 This included Black, Indigenous, and other communities of color; people experiencing houselessness; LGBTQ+ people; Deaf community members; people with developmental disabilities; neurodivergent people; youth; mental health service consumers and peer workers; family members; and advocates. Through a series of town halls, surveys, focus groups, and interviews, RORN ultimately engaged more than 800 community members; this work culminated in a report and proposal to the City of Toronto.12 The city was receptive and committed to continued community engagement and contracted with RORN and other Black-, Indigenous, and LGBTQ+-led organizations.13

Local program stakeholders shared many more examples of people with lived experience providing knowledge and guidance to the development of crisis response programs. In some places, people with lived experience were engaged in ongoing consultation with program leadership and, in others, they were embedded in core planning teams.14 Beyond the development of programs, people with lived experience are actively participating in state and local legislative advocacy. Through such efforts—writing op-eds and providing testimony to legislators, for example—they seek to improve the funding and infrastructure needed to support non-police responses.15

Allocate time and resources to integrate feedback

To be successful, programs must ensure that there are time, resources, and processes to meaningfully include the feedback provided by community stakeholders in program planning and development.

Local government stakeholders have reported that this can be a challenge amidst the many competing priorities that are required to launch and implement new programs. In New York City, a representative from the Mayor’s Office of Community Mental Health (OCMH) explained how the planning of the Behavioral Health Emergency Assistance Response Division (B-HEARD) pilot was on a short timeline to launch the program.16 OCMH representatives highlighted that advocates, experts, and community members were involved in the planning process for the B-HEARD pilot, but OCMH did not have the ability to meet with as many community advocates as they would have liked prior to the pilot program’s launch.17

Local challenges point to the need for collaboration processes that are clearly structured and well-resourced. Chacku Mathai, an ex-patient advocate and board member for the National Association for Rights Protection and Advocacy (NARPA), shared the insight that “the need to get money out the door oftentimes supersedes the quality of how to get that money out of the door” for government procurement processes; community involvement and racial equity concerns can become an afterthought as a result.18 Shannon Scully, the senior advisor for justice and crisis response policy at the National Alliance on Mental Illness (NAMI), added “what we always know about collaboration efforts is, if it's not funded, it's really kind of hard to keep people there continuing to do the work, because it tends to be the thing that falls to a lesser priority because people aren't paid to be there.”19

As these examples illustrate, community engagement and collaboration cannot be an afterthought in the planning process; this work requires resources and time to be successful.