When someone experiences a behavioral health crisis, people might be hesitant to call 911 when armed responders are sent by default. This is particularly true in communities of color and LGBTQ+ communities where people have been disproportionately arrested, incarcerated, and subjected to state violence.117

Such hesitancy extends beyond policing, with profound implications for crisis response. People of color are less likely than white people to trust medical institutions and physicians more generally.118 Among Black people, this distrust can be attributed, at least in part, to historical and contemporary discrimination by the U.S. medical establishment, disproportionate use of involuntary hospitalization, and ongoing disparities in health outcomes.119 Latinx people similarly confront legacies of harm committed by the medical establishment—such as eugenics-based sterilization in Puerto Rico in the aftermath of Law 116—and today face disparities in access to high-quality, culturally responsive care.120 Many other communities also experience discrimination and must overcome unique obstacles to receive the support they need. For example, trans people face persistent barriers to gender-affirming care, and in some places, experiencing a mental health crisis that results in involuntary commitment may foreclose future opportunities to access this life-saving treatment entirely.121

Amid this widespread distrust, grassroots efforts have taken shape to support people with unmet behavioral health needs. Grassroots organizations like the Black Emotional and Mental Health Collective, Anti Police-Terror Project, Call BlackLine, Trans Lifeline, Project LETS, and others have helped people overcome barriers to care, particularly among BIPOC communities, by providing them with crisis services and peer support in the absence of trusted institutional responses. Jurisdictions should look to these efforts and strive to develop programs that honor the concerns and expertise of grassroots crisis responders.

Key recommendations

  • Acknowledge and address distrust in system-based call centers
  • Acknowledge and address distrust in system-based responses

Acknowledge and address distrust in system-based call centers

In a crisis situation, the decision to call someone for help can be complicated not only by distrust in 911 but also by distrust in crisis lines because of the possibility that police might still show up.122 For example, although the National Suicide Prevention Lifeline directs crisis center staff to use “the least invasive intervention” possible, it also requires the initiation of an “active rescue” for people who staff determine are “unwilling and/or unable to take action to prevent [their] suicide” and who remain at imminent risk.123 Often, in the absence of civilian responders who are unarmed and specially trained in de-escalation, this means having police respond to people in crisis without their consent.124

Local crisis systems should consider how grassroots hotlines have tailored their approaches to address the concern among callers that they will receive a police response. For example, Trans Lifeline, which provides trans peer support to callers in the United States and Canada, says one of its “unwavering principles” is that it will “not call emergency services to assist a caller in danger without their request.”125 The organization cites, among other concerns, the risks associated with police involvement, the potential consequences for young trans callers who may not be out to their families, and the possibility that an involuntary commitment will preclude them from receiving gender-affirming medical treatment in the future.126

Similarly, Call BlackLine, which focuses on providing peer support and counseling by phone for BIPOC communities across the country, does not call the police as a matter of policy.127 Vanessa Green, the organization’s founder, said that in cases involving acute crises, Call BlackLine’s operators will try to connect callers with mobile crisis teams where they are available.128

As jurisdictions work to transform their crisis systems, they should continue to minimize the use of nonconsensual active rescues. Moreover, 911 and 988 staff should collaboratively determine how to maximize the use of local civilian responders rather than police when operators do initiate these interventions.

Acknowledge and address distrust in system-based responses

Some advocates have expressed concerns that government-based or government-adjacent civilian response programs might engage with people in crisis in ways that perpetuate distrust. For example, programs like CAHOOTS in Eugene, Oregon, still work with police and sometimes call them for backup.129 Some civilian responders, like police, also have the power to involuntarily hospitalize—”psychiatrically incarcerate”—people in crisis, and in some cases they may be required to do so because of reporting requirements associated with their profession.130 These responses can violate trust and exacerbate trauma.131 Grassroots, peer-led initiatives strive to develop crisis response approaches that minimize these harmful outcomes.132 For example, Project LETS trains crisis responders on how to “maximize [client] consent” and builds peer-led responses without the ability to involuntarily hospitalize people in crisis.133 However, system-based programs may also build trust by clearly communicating their policies and protocols concerning police involvement and involuntary hospitalization.

Local governments that are developing new crisis response systems should develop programs that complement the vision of existing grassroots responses. For example, in Sacramento and Oakland, California, the Anti Police-Terror Project (APTP) launched local, volunteer-run “Mental Health First” programs to provide a non-police response to community members in crisis.134 In 2021, the Oakland City Council passed a resolution—with the support of APTP advocates and their allies—that embedded a new crisis response program in the Fire Department and asserted that it would “center the input” from Oakland’s “most impacted communities.”135

In Sacramento, however, City Council plans to open a Department of Community Response were met with concern from APTP co-founder Asantewaa Boykin regarding the continued involvement of police.136 Advocates have also criticized the planning process for lacking sufficient community input.137