Over the past three years, tens of thousands of people in crisis have been met with behavioral health specialists and social workers instead of police officers. Interactions like these are taking place across the country more often today compared to previous years. While unarmed crisis responders have existed for decades, public outrage over the 2020 police killings of George Floyd, Breonna Taylor, Daniel Prude, and many others prompted cities to create new ways to respond to people in crisis.
Police are often called to respond to situations involving people experiencing mental health crises—with disastrous results. According to The Washington Post’s database of fatal police shootings, at least 1 in 5 people fatally shot by police since 2015 were experiencing a mental health crisis at the time. More than 40 percent of the people incarcerated in state prisons nationwide had a history of mental health problems, according to data from the federal Bureau of Justice Statistics. In the absence of better healthcare, municipalities often turn to police and jails to house and “care” for people in crisis—big-city jails like New York’s Rikers Island and Los Angeles County’s Twin Towers Correctional Facility are often referred to as some of the largest mental health institutions in the country, for example. Experts say criminalizing people for their health problems only makes things worse.
“We’re just catching and releasing,” said Mariela Ruiz-Angel, director of Albuquerque, New Mexico’s Community Safety department, which sends health professionals to certain 911 calls. “If anything, people come out of the jails more drugged up than they came in.”
To break that cycle, dozens of cities nationwide have launched alternative crisis response programs. While these programs can take many different forms—and typically work best when they are tailored to the needs of the local community—they generally involve sending mental or behavioral health professionals to respond to certain kinds of emergency calls, such as welfare checks or calls involving suicidal ideation.
How They Work
Albuquerque created its Community Safety department in 2020. Community Safety is its own city department, like the fire department or the police department, and is considered the city’s third branch of public safety, Ruiz-Angel said. It is one of the largest crisis response programs in the country, with 130 employees. When a call comes into 911 that the Community Safety department is eligible to respond to, dispatchers will send one of three types of Community Safety teams.
In Dayton, Ohio, the city established a Mediation Response Unit (MRU) in 2022 to respond to low emergency 911 calls, such as calls involving disputes between neighbors, child custody exchanges, or barking dogs, Raven Cruz Loaiza, a coordinator for the program, said in an interview. The MRU is small—just seven members—and is a program under the umbrella of the Dayton Mediation Center, a city agency. MRU members are unarmed and wear black pants and maroon polos with “Mediator” written on the back. The goal is to resolve conflicts between community members without police involvement.
“We might show up for the barking dog, but then we get there and there’s like seven years of issues between the neighbors,” Cruz Loaiza said. “We try to get people to come together and have conversations[…]Once, I ended up sitting on someone’s front lawn while I held this man, rocking him as he sobbed. Everything in his life had just caught up to him.”
In other cities, community members have created non-police crisis response teams without city involvement. In the San Francisco Bay Area, the Anti Police-Terror Project, an organization dedicated to ending police violence, founded M.H. First Oakland, a community-led crisis response program. MH First Oakland has seven volunteers and is available on Fridays and Saturdays, Cat Brooks, one of the organization’s co-founders, said. Between 2 p.m. and 2 a.m., community members can call a hotline to receive help with issues like intoxicated people, mental health crises, or domestic violence safety planning.
While many crisis response programs are new, they’re already delivering results. Since it began operating two years ago, the Albuquerque Community Safety (ACS) department has diverted more than 33,000 calls from the city’s police department, according to data shared with The Appeal. In a significant portion of ACS calls, the department connected the person in crisis to service providers—such as shelters or substance use programs—instead of jail cells. A 2022 Stanford University study of Denver’s crisis response program found that reports of low-level crimes fell by 34 percent in neighborhoods where the city’s Support Team Assistance Response (STAR) program operated. The study also suggested that the crisis-response team saves taxpayers money, as incarceration is more expensive than treatment and support services.
Interviews with seven experts leading crisis response programs and a review of such programs nationwide identified common factors that help crisis response programs flourish. Effective crisis response programs are tailored to their communities’ needs, created with input from residents, have buy-in from both community members and the police department, often start slow with small pilot programs, and rigorously collect data to build confidence among stakeholders and the public.
Experts from several crisis response programs interviewed by The Appeal said that their programs began with a small set of eligible calls but have been so well received that they have already been able to—or are looking to—take on more.
“We started out with nine call types, now we’re up to 21 call types,” Dayton’s Cruz Loaiza said.
In North Carolina, the city of Durham established its crisis response department about two and a half years ago, said Ryan Smith, director of the city’s Community Safety Department. The 50-person department runs the city’s Holistic Empathetic Assistance Response Teams (HEART) program, which it launched in June 2022. HEART has several components, Smith said: there’s crisis call diversion, which puts mental health professionals in the 911 call center and allows mental health responders to de-escalate crises over the phone. Smith said HEART employees also follow up on these calls and check in on people later.
The city also has community response teams, which are three-person units consisting of a licensed clinical social worker, an emergency medical technician, and a peer support specialist. These teams are dispatched through 911 and handle calls for issues including trespassing, intoxicated people, welfare checks, and suicides without a weapon. Smith said these teams often transport people and carry supplies like snacks, clothing, tents, and sleeping bags.
HEART also has a co-response component that sends clinicians and police officers to calls that are deemed violent or carry a risk of violence.
Smith told The Appeal that HEART has “been very well received in our city. Our department has grown by 150 percent this year.”
Currently, Smith said, HEART’s community response teams have the capacity to respond to around half of the calls they are eligible for. With the teams expanding in the coming months, Smith said he believes HEART can respond to 80 percent of those calls. Smith said the team’s goal is to get to a place where they can respond to all calls that come their way—and continue to assess whether “we’ve drawn the right boundaries for this work” or if “there are calls that we can add in.”
Diverting 911 Calls
Thinking of crisis response programs as the third branch of public safety—and giving the programs commensurate independence and financial support—has also helped alternative crisis response flourish, said Durham’s Smith, Albuquerque’s Ruiz-Angel, and Amy Smith, acting chief of Seattle’s Community Assisted Response and Engagement (CARE) department.
“If we’re gonna be aligned with first responders, they need to get paid and have the same kind of seniority,” Ruiz-Angel said.
Amy Smith and Ruiz-Angel said they find it helpful for their departments to have direct access to 911 calls because it allows them to study which calls could be handled by their departments.
“I think it’s a significant advantage because I have a direct line of sight into the dataset,” Smith from Seattle said. “Half of the calls we get—if you just thought about who best to solve this problem, it’s not going to be police or fire or EMS—it has nothing to do with any of the three. We’ve just been defaulting to police for so long[…]We’re trying to figure out where we can divert away from the criminal justice system.”
Seattle’s CARE department launched late last year. It’s starting small. Three teams of two health professionals work seven days a week from 11 a.m. to 11 p.m. Seattle is using a dual dispatch model—meaning police go in their own vehicle to respond to calls at the same time as the CARE team—to minimize the public concern about violence, Smith said. For now, Smith said the teams mainly respond to “person down” calls and welfare checks.
Cat Brooks, who co-founded Oakland’s community-led crisis response program, cautioned against making 911 the only way people can reach a crisis response program. When you do that, Brooks said, “You are losing huge swathes of the population because they’re never gonna call that number no matter what.”
While most calls come into Albuquerque’s Community Safety department through 911, people can also call 311 or contact the agency directly for help. In Dayton, Cruz Loaiza said the MRU also does outreach to food pantries, shelters, soup kitchens, and mental health programs to ensure community members know calling the program is an option.
As cities nationwide expand non-police crisis response, some common roadblocks occur. Finding qualified clinicians willing to work in the field—sometimes during unfavorable hours—can be difficult. The rise of remote healthcare work and a shortage of mental healthcare workers have made recruiting even harder.
However, experts say the biggest problem is the overall lack of investment in systems of care for people with severe mental health issues, substance use issues, and people experiencing chronic homelessness. Those involved with Denver’s STAR program say the teams are unsure how to expand their hours without more places to bring people in the first place.
STAR began as a pilot program in the second half of 2020. It has expanded since then and is now budgeted for 16 clinicians, 16 EMTs or paramedics, and some administrative staff members, said Marion Rorke from Denver’s Department of Public Health and Environment, which administers the program. Denver 911 dispatchers can send STAR teams to respond to specific calls, like welfare checks, suicidal ideation, and trespassing, every day of the week from 6 a.m. to 10 p.m., Rorke said.
“One of the things that we hear from our clinicians doing the work is, ‘We can go 24/7, but we won’t have anywhere to bring people at night,’” Andrew Dameron, the director of Denver’s Emergency Communications, said. “There’s a dearth of resources there.”
Experts said that preventing people from coming into contact with the criminal legal system because of a health issue or personal crisis is good, but it’s not enough. Without substantial investment in social services, affordable health care, and housing, people in crisis may be picked up by a social worker instead of a police officer, but they still won’t always be able to get the care they actually need.
“We hope in the future we get more people into long-term services and long-term help, but the system of care needs to be invested in,” Ruiz-Angel said. “Yesterday, I personally took somebody into detox, and it took four hours just to get through the intake process. I am watching people fall through the gaps.”