By Katie Sims
An elderly woman is suicidal after receiving a stage IV cancer diagnosis and feels like a burden to her family. A mother calls the police concerning her 13-year-old son with autism, who is having a mental health crisis. Someone calls 911 on their paranoid neighbor, who is too scared to speak to the police, because they believe the FBI is out to get them. These three individuals need help from trained professionals in the mental health field, where the average policeman might not be equipped.
There are more than 240 million 911 calls made each year in the United States. Of those calls, it is estimated that about 20% are for mental health or substance use crises. This means that nearly 48 million calls are serviced to individuals who need help from professionals who are properly trained in issues of mental health. This becomes a problem when the professionals responding to emergencies are not equipped to handle every situation they may encounter. Interim legal director for the ACLU of D.C. Michael Perloff states, “If you called the EMTs for your broken leg and they sent someone who didn’t know how to set a broken bone, that’s denying you effective care. People with mental health crises, that’s their experience with emergency response services.”
From 2015 to 2021, The Washington Post estimated that nearly a quarter of all people killed by police had a known mental illness. When police are not properly trained to handle individuals experiencing mental health crises, they rely on their own instincts, which can be clouded by constant experiences of trauma and stress. This lack of training and experience can create a hostile environment between police and the 911 caller, increasing the likelihood of injury and even fatality. This is why some police precincts have implemented mental health curriculum into their training.
Alternative emergency response programs have emerged all across the country in the aftermath of situations similar to George Floyd’s death, which fostered a lack of trust in the police. The reality is that a substantial number of people have become too afraid to contact the police because of past negative encounters and a lack of trust. However, with the implementation of alternative emergency response programs, there has been an increase in the trust of emergency responders to truly help their community. For example, the city of Durham, NC, performed a survey in 2023 on 600 of its residents and found that 57% were more likely to call 911 because of the city’s implementation of its alternative emergency response program.
Different types of alternative emergency response programs have proven beneficial for various areas of the country. One of the most common programs is the implementation of crisis intervention training (CIT) into the training of police officers. CIT teaches officers how to identify mental health crises in 911 calls, apply de-escalation techniques, and recognize situations that require psychological intervention. This helps prevent arrests and incarceration of individuals who instead need psychological help. In Miami-Dade County, Florida, officers are required to attend a 40-hour program in which they are trained by mental health professionals on how to interact with neurodivergent individuals and how to differentiate between mental illnesses. This training has led to a decline in unnecessary arrests and shootings, along with fewer physical altercations with police officers.
Another type of alternative emergency response program is called the co-response model, which embeds a mental health clinician into the 911 response team to assist police officers. In Mobile County, Alabama, mental health workers provide in-home or on-site outreach to people experiencing mental health crises and are trained in de-escalation techniques to resolve crises and prevent arrest. The mental health worker may transport the 911 caller to a behavioral health treatment center for immediate assistance, or they may provide access to outpatient mental health services and referrals to various agencies as needed. They are also equipped to provide medication management until stabilization of the 911 caller’s condition has been met.
Another type of alternative emergency response is called a community response program, which involves a mental health clinician or community worker responding to the scene and only includes police intervention if there is a perceived threat to safety. One of the oldest community response programs is the Crisis Assistance Helping Out On The Streets (CAHOOTS) program based out of Eugene, Oregon. The CAHOOTS program deploys to the scene a medical professional and a crisis worker who is trained in mental health intervention. According to the organization, since CAHOOTS was formed in 1989, only about 1% of their calls have ended up requiring police backup.
It can be costly to implement alternative emergency response programs into a city’s budget; however, there has already been data proving the cost-effectiveness of these programs compared to incarcerating individuals. Because of the work of CAHOOTS, the city of Eugene, OR, estimates that the program saves taxpayers an average of $8.5 million per year, allowing police to respond to calls pertaining to public safety. Unnecessary arrests can also be costly for cities. Miami-Dade County, FL, was at one point found to be spending $636,000 per day to incarcerate 2,400 people. It costs a substantial amount of funds to incarcerate an individual, so we must ensure each individual is an actual threat to public safety.
Not only is it cost-effective to promote alternatives to 911 services, but police resources are also utilized appropriately when we properly service individuals in mental health crises, meaning they are less likely to repeatedly call 911 for the same issue. In an interview with Arnold Ventures on what makes 911 alternatives work, Dr. Thomas Dee of Stanford University spoke to the reality of repeat callers. There’s “a deeper engagement with health care, which helps stop the ‘revolving door’ phenomenon, where people show up in the criminal justice system again and again.” He states, “there’s something deeply humane about providing health care to people in health distress, rather than a criminal justice response.”
In an effort to promote alternative emergency response programs throughout the country, Harvard’s Government Performance Lab (GPL) has introduced its Alternative 911 Emergency Response initiative to help various jurisdictions implement their own programs. The GPL has supported 35 jurisdictions so far in establishing or expanding alternative 911 emergency response programs, “which have the potential to connect individuals in crisis to teams of unarmed responders trained to de-escalate situations and connect individuals to community-based services.” The GPL services jurisdictions by helping them create programs that meet the unique needs of the surrounding community. This may include crisis lines, embedded behavioral health clinicians in police response, or unarmed community responder teams.
When crisis professionals are trained to specifically service individuals with mental illness, we decrease the likelihood of fatality and injury caused when untrained police officers are thrust into a situation without proper training. With the use of alternative emergency response programs, we can foster a community that equips its professionals to handle the unique situations that come about in the day-to-day.
