Series: From the President

We Need to Think Beyond Police in Mental Health Crises

Nicholas Turner President & Director
Apr 06, 2022

In March of 2020, Joe Prude called 911 for assistance. His brother, Daniel Prude, was behaving erratically and had just bolted out the back door of Joe Prude’s home in Rochester, New York. Police officers arrived, found and restrained Daniel Prude, placed a mesh hood over his head, and pinned him to the pavement. Two minutes and 15 seconds later, Daniel Prude stopped breathing. He died a week later at a hospital.

Daniel Prude’s horrific death is the worst-case outcome. When police respond to calls related to mental health crises—situations they are often ill-equipped to handle safely and effectively—fatal outcomes are not uncommon. In 2021, at least 104 people were killed after police responded to someone “behaving erratically or having a mental health crisis.”

More commonly, interactions between police and people in mental crisis end without people getting the care they need. And too often, these exchanges end in handcuffs and jail time. It’s why some U.S. jails hold more people with serious mental health conditions than any treatment facility in the country.

People across the country are calling on local elected officials to implement alternatives that curb police involvement and violence in situations related to mental health or substance use. One promising solution has broad support. Operating in more than a dozen cities—including Rochester, New York—civilian crisis response programs dispatch teams of specially trained first responders—instead of police—to help people experiencing behavioral health crises.

Many cities have looked to Eugene, Oregon, where this kind of program has existed for more than 30 years. Crisis Assistance Helping Out on the Streets (CAHOOTS), operated by Eugene’s White Bird Clinic, pairs a medic with a crisis worker to respond to behavioral health crisis calls. Two-person teams provide crisis intervention, counseling, basic emergency medical care, transportation, and referrals to services. In 2019, CAHOOTS responded to an estimated 17,700 calls, or 17 percent of all calls for service.

Behavioral health issues make up a substantial percentage of 911 calls for which police have been the default first responders. One recent analysis of eight cities found that between 21 and 38 percent of 911 calls are related to mental health, substance use, homelessness, and other quality of life concerns—all matters that could be better addressed by people other than police.

Even in situations in which police officers have completed relevant training, the mere presence of armed, uniformed officers can exacerbate feelings of distress for people with behavioral health conditions. In 2020, recognizing the need for greater behavioral health supports for people in crisis, Congress passed legislation to create 988, a new three-digit number for the National Suicide Prevention Lifeline. Set to launch in July 2022, its goal is to make critical support services more accessible. And it has the potential to reduce interactions between police and people in crisis.

Programs like Eugene’s can also save cities millions. CAHOOTS has an annual budget of roughly $2 million. According to CAHOOTS, the long-running program saves the city $14 million annually in ambulance trips and emergency room costs, plus an estimated $8.5 million in public safety costs.

The Crisis Response Unit (CRU) in Olympia, Washington, which launched in April 2019, and Denver’s Support Team Assistance Response (STAR) program, which started in June 2020, both looked to CAHOOTS as a model. Working in two-person teams, CRU and STAR have responded to thousands of calls related to mental health, poverty, homelessness, and substance use. Without them, these calls would have been handled by police.

San Francisco’s Street Crisis Response Team (SCRT) started as a pilot program in November 2020. It sends out three-person teams, made up of a social worker, a paramedic, and, notably, a peer specialist with lived experience—someone who may be able to better relate to people in crisis. Advocates and stakeholders have emphasized the importance of staffing these teams with responders who reflect the communities they serve.

A growing number of cities—including New York; Portland, Oregon; and St. Petersburg, Florida—are demonstrating that these civilian responders can safely and effectively respond to people in crisis. Since the vast majority of 911 calls do not involve crimes or violence, these pilots and programs are an important start. But this should only be the beginning of broad and bold efforts to better align system responses with unmet needs and reduce reliance on police.

Cities and counties, as well as states, should fund civilian crisis response programs and other needed crisis services, and Congress should allocate federal dollars to jumpstart these initiatives in communities across the country. We need to invest in the people and the programs that can actually provide the support our communities need.