The majority of people of color in the behavioral health workforce fill non-licensed, lower-level positions that lack opportunities for career advancement.88 Moreover, low wages and a high demand for services contribute to burnout and turnover, which hinders patient access to high-quality care.89 These workforce challenges can undermine the sustainability and growth of civilian response programs. Even in Eugene, Oregon, where CAHOOTS has operated out of the White Bird Clinic for more than 30 years, staff have said the program must secure greater funds from the city to provide a “reasonable wage” that reduces turnover before expanding further.90

Jurisdictions must properly compensate frontline responders and adequately fund entities that are trusted by community members to lead these responses. This might mean housing programs in existing or newly created government agencies or contracting with community-based organizations to operate and staff these initiatives. In either case, local governments should be involved in program development efforts, focusing on strong stakeholder coordination and promoting equitable service delivery.

Key recommendations

  • Provide competitive pay
  • Structure program governance to promote adaptability, autonomy, and trust

Provide competitive pay

Civilian crisis responders typically do not receive compensation that is comparable with law enforcement. For example, CAHOOTS responders answered almost 17 percent of calls to Eugene’s emergency communications center in 2019, saving $2.2 million per year in officer wages.91 However, while “[CAHOOTS] team members start at $18/hour with no established path to an increase” according to a CAHOOTS press release, Eugene police officers earn no less than $30 an hour with greater opportunities for career advancement.92 Although there is community demand for continued expansion, CAHOOTS leaders have said the program must first renegotiate its contract with the City of Eugene to cover higher base wages that promote staff retention.93 Currently, “staff generally build skills within the program and then move on to other professions that pay a wage commensurate to their skillset.”94

One way to secure competitive compensation for crisis response staff is to make them employees of a government agency; as explored below, however, such decisions raise equity concerns of their own.

Anne Larsen, who previously oversaw the Crisis Response Unit (CRU) and Familiar Faces program in Olympia, Washington, has advocated for increased wages for civilian crisis responders.95 The Olympia Police Department (OPD) initially contracted with behavioral health organizations to staff both programs, but Larsen grew concerned that these specialists lacked pathways to wage increases.96 According to Larsen, when jurisdictions seek contractors to staff a community response program, “they always look at the budget” and “an agency is going to want to win by . . . lowballing.”97 With this concern in mind, Olympia made CRU members city employees and approved new funding for the previously grant-supported Familiar Faces to join city operations, enabling the city to increase staff wages.98 Larsen said the transition also provided greater job security for staff by insulating them from the city contracting process, through which positions may be more easily cut.99

Jurisdictions may house their civilian response program in a government agency from the outset to address pay equity and job security concerns proactively. For example, Portland, Oregon’s Portland Street Response (PSR) was embedded within Portland Fire & Rescue ahead of the program’s pilot launch. Commissioner Jo Ann Hardesty, who oversees the city agency, explained in the Portland Tribune that PSR was structured this way “to institutionalize Portland Street Response so it can’t disappear on a political whim; to create living-wage positions with solid benefits; and to ensure that the jobs would be stable so turnover would be minimal . . . leading to better outcomes for all involved.”100 When several city leaders raised the possibility of outsourcing the program to a nonprofit organization with lower staffing expenses, PSR staff responded with an open letter that described the meaning and value of an adequate wage.101 After a six-month evaluation highlighted PSR’s success, the City Council passed additional funds for the program’s citywide expansion and, ultimately, kept it embedded within Portland Fire & Rescue.102

Structure program governance to promote adaptability, autonomy, and trust

The choice to embed crisis response programs in a government agency or non-governmental contractor has implications for antiracism and equity, such as whether or not a program has access to resources and infrastructure and the degree to which a program is trusted and respected by community members. In every jurisdiction, local government has an essential role to play in working toward equity, and the preferred model for program governance and service delivery may vary based on the local context and capacity.

Situating a program in a government agency can bring various benefits beyond improvements to pay and retention. Local program leaders report that it can facilitate access to greater resources, supplies, and advancement opportunities, and reduce overhead expenses.103 Moreover, the ability of a government-operated program to use lights and sirens in rare cases may empower civilian responders to take on some particularly urgent calls that would otherwise receive status quo emergency responses.104 The potential benefits of situating crisis response programs within existing government agencies likely depend on the current capacity and infrastructure of those agencies.105

Yet the specific placement within government of a civilian response program can come with risks. Researchers Taleed El-Sabawi and Jennifer Carroll caution that programs housed under the “public safety arm” of local government may be “co-opted” and become “yet another law enforcement-led response.”106 Even non-law enforcement entities—such as county health and social service agencies—have historically treated the populations they serve “paternalistically” and left them “feeling marginalized,” partly due to their close collaboration with the criminal legal system.107

Local program stakeholders within government agencies acknowledged this tension. For example, Megan McGee, special projects manager with the St. Petersburg Police Department, said she was “not particularly in favor of developing an internal unit” within her agency because she “did not want something that was viewed as an extension of law enforcement.”108 Rather than operating a new initiative out of the police department, St. Petersburg contracted with a behavioral health organization to staff its Community Assistance and Life Liaison (CALL) program.109

Some advocates have likewise proposed funding community-based organizations to build trust in programs. For example, the New York City coalition Correct Crisis Intervention Today (CCIT-NYC) has said the city should contract with “community groups of color” for civilian crisis response, in contrast with B-HEARD’s current structure.110 After reviewing recommendations from the “Crisis Response Stakeholder Group” it convened, Allegheny County, Pennsylvania, announced that its solicitations for expanding and diversifying crisis services would “be explicit in seeking to attract organizations led by, operated by and serving people from groups experiencing the worst outcomes from our crisis systems, especially [B]lack and LGBTQ community members.”111 Additionally, Toronto is launching four distinct pilot programs in 2022 that the city will contract with different community organizations to operate.112 Asante Haughton, a Toronto-based mental health advocate and co-founder of the Reach Out Response Network (RORN), explains: “It made sense to connect with agencies already serving [Toronto’s diverse] communities because they had established rapport, were more culturally competent and appropriate.”113

In an effort to overcome distrust in existing responses, other local governments have established new agencies to spearhead civilian-led initiatives. For example, the city of Albuquerque, New Mexico, created Albuquerque Community Safety (ACS), a standalone department that began providing non-police responses to behavioral health crises in September 2021.114 Although ACS coordinates with police, as a result of community feedback, the agency’s responders collect personal information from clients using separate forms that police cannot access.115 Additional cities, from Sacramento, California, to Northampton and Cambridge, Massachusetts, have advanced similar plans to operate programs out of newly created government departments.116

As jurisdictions assess where to house a civilian response program, they should consider the equity and sustainability implications of operating initiatives out of newly created government departments or existing government agencies, and the role of contracted community-based organizations. Local stakeholders should consider the potential impact of local political cycles on a program’s sustainability, as well as the capacity of existing community-based organizations to deliver services aligned with the program’s goals. Regardless of where new response initiatives are ultimately housed, local governments have an essential role to play in facilitating the effective coordination and equitable implementation of crisis response services.