Many communities have made progress in reducing police involvement in crisis response, but there remains no clear consensus around exactly who, if not police, should be answering 911 calls involving behavioral health needs.57

Experts caution against the notion that replacing police alone will eliminate inequities arising from interactions between first responders and people in crisis. “We know that there’s a huge amount of bias within the mental health system as well, so the danger is still there,” explained Amy Watson, professor of social work at the University of Wisconsin-Milwaukee. She pointed to the potential for bias in how responders interpret a situation, interact with a person in crisis, assess that person’s needs, and rely on involuntary hospitalization to connect them to care.58 In fact, Black people are disproportionately subject to such coercive mechanisms, which can exacerbate trauma and sow distrust in the very services and supports meant to facilitate recovery.59 Vinnie Cervantes, organizing director with the Denver Alliance for Street Health Response, stressed the importance of crisis responders who have lived experience with behavioral health concerns and reflect the communities they serve.60 The behavioral health workforce is still disproportionately white, and a preference for professional designations such as licensed clinicians may present barriers to employing more people with lived experience in both frontline and leadership roles.61


Civilian crisis response programs are taking shape against a backdrop of workforce shortages and the underrepresentation of people of color and people with lived experience (known as “peers”) across the behavioral health field. As local stakeholders navigate these challenges, strategic hiring will play an important role in meeting community needs.

Key recommendations

  • Recruit responders who reflect the communities they serve
  • Focus on skills and experience
  • Integrate peers into crisis response

Recruit responders who reflect the communities they serve

Jurisdictions have pursued a variety of strategies to assemble teams that reflect the communities they serve. The Person in Crisis (PIC) Team in Rochester, New York, launched in January 2021 out of the Department of Recreation and Human Services (DRHS). It was developed amid community demands for “culturally competent health professionals” as an alternative to police.62 As such, the program made residency in the city, which is about 40 percent Black, a prerequisite for employment.63 Daniele Lyman-Torres, former commissioner of DRHS, explained that they needed staff who have “cultural understanding and relevance . . . as opposed to being afraid to drive down the street, or any street in the city, which our suburban counterparts are [afraid to do].”64 She noted that Rochester successfully realized its goal of creating a PIC Team that is largely made up of clinicians of color. To illustrate the importance of this, Lyman-Torres recounted a 911 call in which a white clinician suggested that his Black male client was violent and needed to be involuntarily hospitalized. Although multiple police cars were directed to the scene, a PIC Team clinician—who is a Black man and was simultaneously dispatched—was able to engage and connect the community member to treatment “without any issue.”65 The Community Assistance and Life Liaison (CALL) program in St. Petersburg, Florida, initially struggled to attract a diverse pool of candidates and ultimately expanded its hiring process to surrounding cities to recruit more responders of color.66 CALL’s other strategies included placing employment ads in more than 70 local newspapers, hosting community meetings, and connecting with smaller neighborhood associations.

Focus on skills and experience

Recruitment for civilian response teams requires careful consideration of the specific skills and experience that the program work demands and recognition that these might not be reflected in formal qualifications. For example, the CALL program does not require that most staff have a master’s-level education. The program’s 12 frontline “navigators” have bachelor’s degrees, and they are supported and supervised by five licensed clinicians. As Special Projects Manager Megan McGee explained, “I wanted to make sure we had a balance of the doers, the clinical, and . . . have them working together so we could really be effective.”67

The Crisis Response Unit (CRU) in Olympia, Washington, pursued a similar approach to its new hires when expanding in 2021. According to former Outreach Services Coordinator Anne Larsen, rather than prioritizing candidates with professional degrees, the program asked candidates questions that were focused on “getting to the root of . . . who’s the population we serve, what’s the work that this person is going to be doing.”68 Larsen noted that CRU experienced success building a more racially and ethnically diverse staff this way.

Integrate peers into crisis response

According to the Substance Abuse and Mental Health Services Administration, incorporating peers—people with lived experience of behavioral health conditions and crises—is a best practice for crisis services and systems.69 Peers can use their skills and experience to establish rapport and strengthen engagement with people in crisis and support follow-up beyond the immediate crisis.70 Although peers are increasingly being integrated across behavioral health systems, experts have noted the need to increase peer workforce salaries, improve supervision and career trajectories, and ensure that peers are integrated in ways that fully use their skill sets.71

San Francisco’s Street Crisis Response Team (SCRT) sends three-person teams to respond to people in crisis: a paramedic, a behavioral health clinician, and a behavioral health peer specialist.72 The peer specialist is employed by Richmond Area Multi-Services (RAMS), Inc., a contracted service provider that is a local leader in peer-based services.73 SCRT leadership and staff report that the inclusion of peers contributes to the team’s ability to respond with a wide range of skills, experience, and approaches to people in crisis.74 Simon Pang, section chief of community paramedicine for the San Francisco Fire Department, has stated that including a peer specialist in SCRT is “the gold standard for trauma-informed care.”75 And according to Michael Marchiselli: “As a [SCRT] peer specialist, I can relate to people that are in a crisis and also I can understand people’s distrust with institutions and in turn, offer a different approach.”76

Role definition is an ongoing challenge for the peer workforce. Toronto’s Reach Out Response Network suggests that “effective integration of peer workers . . . requires a balance between role flexibility and role clarity,” and programs must ensure that peers are not relegated to limited or inappropriate roles.77 For example, assigning peers the responsibility of sitting with a person while they wait for clinical intervention is an example of underutilizing peers’ skills if it denies them other, more dynamic opportunities for interpersonal connection.78

Professional development

Crisis response programs may require collaboration across different organizations and team members with different skills, experiences, and professional backgrounds. Joint training can be an important way for teams to strengthen their shared knowledge and skills. Training can also strengthen competencies for working with BIPOC and other equity-deserving communities, to support more effective service delivery for people in crisis.79

Key recommendations

  • Conduct joint trainings for multidisciplinary teams
  • Improve cultural competence and responsive practice

Conduct joint trainings for multidisciplinary teams

Crisis response teams often include people from multiple disciplines because of the range of interventions that may be needed—including de-escalation, peer support, non-emergency medical care, and clinical assessment. This can be challenging when team members bring different tactics to a scene.

Program leaders recommend designing training programs with this challenge in mind. For example, San Francisco’s Street Crisis Response Team (SCRT), with its three-person team of a paramedic, clinician, and peer specialist, has emphasized the importance of joint training to support cohesion and collaboration when they are in the field.80 SCRT leadership have noted that some team members have been used to being the primary decision-makers on scene and have had to enhance their skills in “sharing the remote” in SCRT’s more collaborative, interdisciplinary approach.81 Meanwhile, New York City’s B-HEARD program dispatches teams of emergency medical technicians/paramedics and social workers to 911 mental health calls. B-HEARD’s five-week training during the pilot phase included joint, experiential, scenario-based learning and sharing of skills across the team’s different disciplines.82

Improve cultural competence and responsive practice

Everyone has implicit biases.83 For crisis responders, these biases have the potential to adversely alter the substance and quality of the services they deliver.84 Research suggests that the impact of implicit bias trainings as conventionally implemented is limited.85 However, civilian-led teams that aim to reduce police involvement in crisis situations must account for their biases and find ways to provide culturally responsive interventions.

Local experts report that providing training on implicit bias, cultural competence, and related topics is a meaningful step toward providing equitable responses. B-HEARD team members, during the pilot phase, participated in a two-day training on racial equity and implicit bias—though a program leader cautioned that this kind of professional development should not be a one-off event.86 St. Petersburg made the provision of implicit bias training a prerequisite for behavioral health organizations interested in staffing the CALL program, and Portland Street Response has planned additional trainings for team members on working with BIPOC communities, immigrant communities, as well as LGBTQ+ people, veterans, and more.87 As more and more places navigate the early stages of program planning and implementation, they have a rare opportunity to establish a professional development paradigm that promotes equity by design.