The growing movement to send counselors, not cops, to mental health crises

[By Jennifer Mascia, first published in The Trace, September 2020. Additional reporting: Lakeidra Chavis. The Growing Movement to Send Counselors — Not Cops — to Mental Health Crises]


On September 13, a police officer in Lancaster, Pennsylvania, fatally shot a man in the midst of a mental health crisis. The family of the 27-year-old victim, Ricardo Muñoz, said he had been diagnosed with schizophrenia and bipolar disorder, but hadn’t been taking his medication.

“He had an episode,” Muñoz’s sister told The Pittsburgh Post-Gazette. “He was just incoherent and acting out. I called to find out what the procedure was to get him some help.”

Munoz’s killing — along with Daniel Prude’s restraint death in custody in Rochester, New York, in March and the police shooting of a 13-year-old boy with autism in Utah on September 4 — highlight the dangers of sending armed officers to mental health calls. They have also renewed demands to reform the way that we, as a society, respond to people in the throes of a mental health crisis.

One promising alternative is sending mental health professionals instead of police officers to certain 911 calls. Across the nation, from Oregon to Connecticut, a handful of cities are experimenting with programs that they say provide a potentially life-saving alternative to traditional law enforcement responses — and save millions of dollars in the process. 

“Law enforcement officers are trained to show their authority and take control of the situation because they’re there to protect the safety of the public, so they enter into these situations automatically as escalators,” said Elizabeth Hancq, the research director of the Treatment Advocacy Center, a Virginia-based nonprofit that advocates for people with mental illness. “Someone in a psychiatric crisis needs a de-escalating presence.”

People with severe mental illness are 16 times more likely to be killed during a police encounter, the Treatment Advocacy Center has found. A quarter of people fatally shot by police in 2015 suffered from mental illness, according to a 2018 analysis of The Washington Post’s database of police shootings. The American mental health system often fails to provide treatment until someone becomes dangerous, and that means that cops are often functioning as frontline mental health workers, a role for which they are frequently ill-suited, said Hancq.

“Crisis workers are better responders, because they can connect people to treatments,” she said. 

Sending officers to mental health calls also eats up valuable time and police resources. According to a national survey of police and sheriff’s departments that Hancq and her organization conducted last year, law enforcement spend 21 percent of their time responding to mental health calls and transporting patients to hospitals, at an estimated cost of $918 million a year. Many times, officers deployed to calls that result in emergency room visits must wait until the patient is admitted, a process that can take anywhere from a few hours to a few days, Hancq said. Sometimes, it’s just easier for cops to take a mental health patient to jail:

“It’s five times farther for law enforcement officers to bring someone to an emergency room than transport them to a jail,” she said.

Since 1989, as part of the Crisis Assistance Helping Out On The Streets, or CAHOOTS, program, 911 dispatchers in Eugene, Oregon, and neighboring Springfield have sent an unarmed team comprised of a medic and a behavioral health expert to calls regarding the homeless or mentally ill that don’t involve violence or criminality. The crisis team, which operates out of the White Bird Clinic in Eugene, can also be reached through a nonemergency phone number. The program, thought to be the country’s oldest of its kind, saves about $8.5 million per year in public safety costs, and another $14 million in ambulance transport and emergency room costs, according to the program’s own stats. In 2019, CAHOOTS says it handled 20 percent of 911 calls in the two cities. The team called for backup for 150 of the 24,000 calls it fielded in 2019 — less than 1 percent.

Tim Black, the director of consulting for CAHOOTS, told The Trace that the model could go even further in reducing police violence in cities with higher concentrations of Black residents, because implicit bias often plays into police officers’ decision to use force. Clinicians aren’t steeped in the militarized culture that permeates American law enforcement and preaches that police work is inherently violent. 

“We hear a lot of talk about officers being told they’re warriors,” Black said. “There’s almost that battleground mindset that they’re approaching every interaction with.” 

The success of CAHOOTS has inspired the creation of mobile crisis units across the country. In Pennsylvania, teams are up and running in several counties, including Chester, Montgomery, and Philadelphia. Last year, Olympia, Washington, began sending “crisis responders” to nonviolent calls involving people grappling with mental illness, addiction, or homelessness. These workers arrive prepared to connect the person with services, which may include a place to stay. They also do street outreach, offering rides to medical appointments and handing out food and clothes. The program’s annual $550,000 budget is funded by a voter-approved public safety levy

Earlier this month, Chicago lawmakers proposed a program modeled on CAHOOTS that would deploy a social worker and emergency medical technician from one of the city’s five crisis centers. “What we’re really trying to do is divert a lot of the calls that police are being tasked with, and allow officers to respond to violent crime,” said Arturo Carrillo, the director of violence prevention and neighborhood health initiatives at Brighton Park Neighborhood Council, a community group, who helped develop the proposal with local lawmakers. 

More recently, other cities have adopted versions of this approach. In June, Denver launched a six-month pilot program through which paramedics and mental health clinicians respond to drug overdoses, mental health crises, and situations where someone is suicidal. In July, the Oakland City Council cut $14.3 million from the Police Department’s budget and used some of the funds to create a pilot program that will send counselors and EMTs to mental health calls. Portland Street Response, which is modeled after CAHOOTS and has been in the planning stages since last year, is set to debut in the Oregon city in February. And Hartford, Connecticut, plans to set aside $5 million over the next four years to create a team of civilian responders that would take calls related to mental illness.

Some cities have embraced a hybrid approach, dispatching both mobile crisis units and police officers to mental health-related 911 calls. Tucson’s Mental Health Support Team serves as a co-responder unit alongside officers, and clinicians provide follow-up care. A local crisis response center takes custody of patients within minutes, saving officers hours spent waiting around. 
Advocates say co-response models are a step in the right direction, but still have pitfalls: Even the presence of an armed officer can escalate a situation.“When an intervention is initiated from the standpoint that force is expected to be used, it’s inevitable,” Black said. “Even seeing the badge, the gun, the handcuffs is enough to trigger somebody. Mobile crisis teams are also able to handle low-priority calls in a timely manner, unlike police, who have to contend with all manner of crimes. And early intervention, Black said, is key. 

“If we can talk to you when you’re a 2 out of 10 as opposed to a 7 or 8 out of 10, there’s a lot more we can do to prevent a crisis,” he said. 

While programs like these remain rare, advocates hope the results they produce can be used to make the case for more sweeping reforms. The American public appears to support the idea: According to a survey conducted in June by the progressive think tank Data For Progress, 68 percent of voters support the creation of a nonpolice first responder agency to handle calls involving mental illness or addiction. The same percentage of voters support programs that train community leaders to de-escalate potentially violent situations. 

Already, a CAHOOTS-inspired bill introduced last month in Congress would set aside Medicaid funding and $25 million in grants to states that establish mobile crisis programs.

“By removing law enforcement from that situation and instead deploying mental health crisis workers, you’re allowing them to treat mental illness like the illness that it is, rather than a criminal justice matter,” Hancq said. Even police officers understand that they aren’t mental health experts and shouldn’t be sent to every call, she said, something she discovered while conducting her survey. “It’s not because they don’t want to or think it’s a burden. It’s because they understand that they’re not trained — and they’re criminalizing an illness by their involvement.”

Ultimately, Hancq said, there would be fewer crisis calls to 911 if mental health  care was more accessible in the community. After Ricardo Muñoz’s shooting in Lancaster, the mayor called for an expansion of state-funded mental healthcare, and the City Council president said, “I can’t help but wonder, if Mr. Muñoz got all the care he needed years ago, could we possibly be in a different place?” 


This story is part of the SoJo Exchange from the Solutions Journalism Network, a nonprofit organization dedicated to rigorous reporting about responses to social problems.
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