Mental health first-responder programs are being launched in cities like New York, San Francisco, and elsewhere as an attempt to diminish police violence.
Graphic by COURIER.

From San Francisco to NYC, American cities are implementing first-responder programs that send behavioral health professionals—not police—to non-violent and mental health-related crises.

A disoriented, shirtless white male walks through downtown Olympia, Washington, throws his shoes into the street, and starts unintelligibly shouting at a customer in front of a coffee shop. 

It doesn’t exactly sound like a police emergency, but in most American cities, a minor disturbance like this often triggers a 911 call. This most often results in an armed police unit showing up on the scene, and from there, a series of possible escalations may ensue, including arrests and violent shows of force. 

But because this particular scenario recently played out in Olympia—one of several US cities with burgeoning behavioral health first responder programs—the 911 dispatch team had the option of sending two unarmed behavioral health specialists from their mobile Crisis Response Unit (CRU) to address the man’s needs and deescalate the situation, an outcome that saves police resources and can prevent unnecessary violence. 

Anne Larsen, CRU’s outreach services coordinator, told COURIER that in this particular example, the unit was already familiar with the man in question. They were able to pull up unarmed, calmly speak to him, offer basic comforts like water, a snack, clean socks, and a ride to a public place or his methadone clinic. 

That kind of de-escalation is precisely the goal of mental health responder programs. As Larsen told Olympia City Council, CRU’s “goal is to divert people from jail and the hospital.” In a traditional model, she said, ”if you call 911 and you have a first responder [come] and you go away in a vehicle, you’re going to go to jail or the hospital. So our goal is to divert folks.” 

Who Is Called—and Who Should Be Called—in a Mental Health Crisis?

A large percentage of emergency calls in the US are made for non-criminal or non-violent mental health, behavioral health, substance abuse, or houselessness issues. Yet the first responders dispatched to these calls are most often police officers. That’s because the community’s needs and the existing resources in much of the country don’t align. 

The problem becomes even more clear when you consider that, on average, American police recruits receive around eight hours of “Crisis Intervention Training” and closer to 60 hours of education on using firearms. Police simply aren’t trained to respond to mental health crises.

That imbalanced training is especially concerning, as the involvement of firearms in mental health episodes can lead to an increased danger of unnecessary violence. A recent study by the Treatment Advocacy Center found that 25%-50% of “all fatal police shootings” involve a victim with serious mental illness.

Along with Olympia, cities like Denver, Oakland, and Los Angeles have all implemented programs where trained mental health providers work in collaboration with traditional first responder teams to respond to mental health-related calls. And in the wake of nationwide anti-police brutality protests, even more cities are hurrying to find better ways to meet their residents’ emergency needs. 

But these programs aren’t completely new. Eugene, Oregon, a city of 170,000, is perhaps the unlikely trendsetter in the movement to create alternatives to policing for mental health issues.

Back in 1989, Eugene’s White Bird Clinic launched what they’ve referred to as, “an innovative community-based public safety system to provide mental health first response for crises involving mental illness, homelessness, and addiction.” Thirty-one years later, the program—called CAHOOTS (Crisis Assistance Helping Out On The Streets)—is thriving. In 2019 alone, CAHOOTS handled 24,000 crisis calls in the Eugene-Springfield area, saving the local government “roughly $14 million” in emergency systems costs. 

For Someone Experiencing a Mental-Health Crisis, Who Shows Up to Help Matters

Some of these new programs were designed as part of existing police departments. Some collaborate with the police, but have different leadership. New York City recently announced a cooperative pilot program that will send EMS and mental health crisis workers to behavioral health related 911 calls within two pilot precincts. These teams will work with police when violence is involved. The public can access Olympia and Denver’s programs by calling 911. Eugene and Springfield, Oregon, residents can use 911 as well as the police non-emergency number.

Some mental health first responder programs, however, operate outside of the 911 umbrella as a rule. MH First, a hotline of trained mental health volunteers operating through the Anti Police-Terror Project in Oakland and Sacramento, California, pride themselves on being completely separate from the local police forces. 

Cat Brooks, MH First’s co-founder, told COURIER that “law enforcement are taught to force compliance—that’s their training—and to escalate very quickly … as opposed to taking time and space and de-escalating,” which could prevent unnecessary violence. Brooks believes it’s crucial for people to be able to get help without dialing 911, since too many Black and brown people have learned to avoid police intervention for their own safety.

Because of America’s troubling track record with police violence, many communities simply don’t trust the police. And for that reason, behavioral health providers and EMTs that show up in plain clothes or their program’s polo shirts instead of police uniforms can place the situation on calmer footing. 

Zeyah Rogé, a somatic psychotherapist in Portland, Oregon, told COURIER that the people present to help during a mental health crisis can have a significant impact on whether that episode can be processed normally or escalate. 

According to Rogé, police can cause a greater fear response than other first responders because “our association with police is that we’ve done something wrong. 

“We’re about to get in trouble, so we don’t always see police as help,” she continued. For someone experiencing a mental health crisis—who is already overwhelmed and maybe panicking—the experience can be one of “fear on top of fear.” 

Can Small-City Success Translate to Bigger Cities Across the Country?

Today, spurred on by the public outcry against police brutality, the rest of the country is hurrying to catch up to these trailblazing programs. And although leaders at CAHOOTS admit their program “cannot be replicated with a cookie-cutter approach,” they do offer consulting and development services to a variety of cities. That includes Olympia and Denver, who have rolled out successful programs in the last few years, as well as more recent programs that are still in their early planning stages, like in San Francisco.

However, smaller communities like Eugene and Olympia—where these programs are experiencing widespread success—may not be the best models for large cities that are far more diverse in the people they serve. Both cities, though, jumping-off points for similar programs throughout Oregon and Washington, respectively. 

Larsen told COURIER that she would recommend larger, more diverse cities address that challenge by starting small and to “pick a precinct, or pick a ward, or pick a district,” as a pilot program, and build from there—as seems to be happening right now in New York City.

The Demand for Better Mental Health Responses in Policing Has Taken the National Stage

This year, progressive leaders like Rep. Alexandra Ocasio-Cortez, the Black Lives Matter movement, and millions of protestors across the United States have called to “defund the police.” The plea points out that police departments respond to a wide range of complaints that fall far outside the scope of crime, and that those funds could be diverted to better-suited groups to respond. 

That can include bigger investments in social and community programs, like those that would decriminalize and treat drug addiction and mental illness. President-elect Joe Biden has made clear that he does not support “defunding the police” as such. Instead, his plan includes invigorating “community policing” with a $300 million budget increase—an idea criticized by the left for ignoring the problem of police corruption.

However, Biden has promised to “fund initiatives to partner mental health and substance use disorder experts, social workers, and disability advocates with police departments … [to] train police officers to better de-escalate interactions with people in severe emotional distress before they become violent.” While Biden has yet to take office, the idea of “de-escalation” is a key component of all of the successful mental health responder programs that have been launched so far.

As Larsen told COURIER, a major component of de-escalation is time, which mental health responders have and police do not. Police officers generally have lists of incidents that they need to “resolve and move on to the next one.” But as Larsen said, that’s not the case with her program. “The great thing about CRU is: We have the benefit of time. So sitting there and not rushing someone and just be[ing] with them—that and listening is what de-escalates people.”