By: Lisa Rode

Ian Adams, the executive director of the Utah State Fraternal Order of Police, recently observed that “years of defunding community resources to treat mental illness has made society over-reliant on police.” Both the dearth of services and the over-reliance on law enforcement disproportionately burden people with mental illness. The evidence is disturbing. More than two million people with mental illness are sent to jail each year and remain there twice as long as others, despite the fact that their crimes are typically nuisance or “quality of life” offenses. The number of people with mental illness or substance use disorders in jails and prisons is three to four times higher than in the general population. While only 10% to 20% of law enforcement encounters involve people with mental illness, between 25% and 50% of fatal law enforcement encounters involve people experiencing a mental health crisis. The Treatment Advocacy Center, an organization that promotes laws and practices that foster effective and innovative mental health services, estimates that people with untreated mental illness are, on average, sixteen times more likely to be killed by police. Based on these numbers, the Center contends that “reducing encounters between on-duty law enforcement and individuals with the most severe psychiatric diseases may represent the single most immediate, practical strategy for reducing fatal police shootings in the United States.”

Data like these strengthen mental health advocates’ longstanding claims that “mental health crises require mental health expertise” and that police generally “should not be responding to people in mental health crisis.” To that end, many cities have implemented special programs for responding to mental health emergencies. These programs are specifically designed to reduce the over-reliance on police as the default first-responders for mental health crises. They are based on the principle that mental health and substance abuse are public health issues, not public safety issues.

The Los Angeles Police Department (LAPD) claims to have pioneered the first such program over forty years ago. The Department’s current iteration—Systemwide Mental Assessment Response Team (SMART)—was introduced in 2004. SMART pairs police officers with mental health providers who co-respond to calls involving people experiencing a mental health crisis. In 2005, LAPD augmented SMART with a Case Assessment and Management Program (CAMP) to “identify, monitor, and engage” the people who generate a high number of mental health emergency calls and link them to appropriate community services. More recently, LAPD augmented SMART and CAMP with additional officer crisis management training and a Mental Evaluation Unit Triage Desk. The Triage Desk also pairs police officers with mental health providers who jointly determine for each mental health emergency whether to dispatch a SMART unit or instruct the officers at the scene to transport the person to a mental health facility. LAPD reports that its program defuses “potentially explosive encounters with people in the midst of a mental health crisis” and diverts “hundreds of people each year to treatment instead of jail.” Cities such as Boston, Chicago, Denver, Indianapolis, Seattle, St. Louis, and St. Petersburg as well as Dekalb County in Georgia have recently launched similar co-responder programs.

Other cities have launched civilian-only programs that further reduce over-reliance on police as default first-responders. These programs dispatch mental health and health care providers to calls involving behavioral issues; they send people armed with physical and mental health expertise rather than guns. For example, in Eugene, Oregon, the Crisis Assistance Helping Out on the Streets (CAHOOTS) program has for thirty years been pairing social workers with health care professionals, typically nurses, paramedics, or EMTs, who co-respond to calls involving people with mental health, substance abuse, or homelessness-related issues. White Bird, a longstanding community health clinic, staffs the CAHOOTS teams and the city funds the program through the police department. Two newly-minted examples of civilian-only programs are New York City’s Behavioral Health Emergency Assistance Response Division (B-HEARD) and Phoenix’s Community Assistance Program (CAP). B-HEARD—first piloted in 2021 as part of New York City’s police reform efforts—dispatches three-person teams of social workers and paramedics to 911 mental health calls that do not involve a weapon or risk of violence. Phoenix’s CAP— operating under the fire department—dispatches social workers to 911 calls involving mental health issues. The primary objectives of B-HEARD and CAP are to avoid crisis escalation, prevent unnecessary incarcerations and hospitalizations, link residents in crisis to appropriate community services, and free up police for core public safety activities.

Although sparse, data from the programs in Dekalb County, Eugene, and New York suggest that both the co-responder and civilian-only models reduce interactions between police and people experiencing mental health crises, achieve better outcomes, and save money. During the 2021 pilot, B-HEARD teams responded to about seventeen calls each day. Forty-six percent of people assisted by these teams were transported to a hospital, compared to 87% of people assisted by traditional teams. Forty-seven percent of people assisted by B-HEARD teams were treated at the scene or transported to a community-based care location, compared to 0% for people assisted by traditional teams. In 2020, Dekalb County found no significant difference in arrest rates between its co-responder and traditional police teams, but 55% of the calls handled by co-responder teams were resolved without hospitalization, compared to 28% of the calls handled by traditional teams. The cost of calls handled by co-responder teams was 23% lower than those handled by police alone. In 2019, CAHOOTS reported that its teams responded to 24,000 calls, about 20% of all 911 dispatches. Based on these numbers, the organization estimated that the program saved the city $8.5 million in public safety costs and $14 million in ambulance and E.R. expenses. Eugene Police Chief Skinner added that CAHOOTS lifts “a weight off the shoulders of police” and “get[s] law enforcement professionals back to doing the core mission of protecting communities and enforcing the law . . . .”

While these types of programs are gaining traction across the country and achieving positive results, both models face a number of challenges. First, as noted above, chronic de-funding has significantly reduced availability of mental health services around the country. Data compiled by the Health Resources and Services Administration indicate that 141 million people in the U.S. live in areas experiencing a mental health professional shortage, nearly twice the number who live in areas experiencing a primary care provider shortage. Especially in non-metropolitan areas where the shortages are particularly pronounced—and where people with mental illness are 39% more likely to be killed by police—recruiting mental health providers to participate in co-responder or civilian-only programs is “nearly impossible.” Second, both rural and urban areas lack sufficient mental health treatment centers to support the significant increase in referrals these programs will generate. At the same time, all areas lack sufficient community interest or funding to deploy these programs broadly enough to minimize to the greatest extent possible law enforcement encounters with people experiencing mental health crises for maximum effectiveness. Even LAPD’s well-established and well-funded program is limited in terms of hours of operation and geographical service area and has trouble keeping up with demand. In 2021, the Department reported that it had to dispatch traditional police teams to approximately 12,000 emergency calls that qualified for a SMART unit response due to lack of resources.

Still, programs like these are providing real-world experiences and information that communities across the country can use to tailor non-law enforcement solutions to their particular needs and resources. In the meantime, they are achieving positive outcomes for individuals, their families and communities. They are helping to reduce the disproportionate burden over-reliance on police has placed on people with mental illness for decades. Most importantly, they are helping to reduce the likelihood that a mental health crisis turns into “a death sentence.

Lisa is currently a 2L at ASU’s Sandra Day O’Connor College of Law. After completing graduate work in the sociology of sustainable development, she unexpectedly fell into a career building e-commerce, digital payment, and biometric authentication software. Those two worlds informed her initial legal interests in sustainable water policy and data privacy protection. After the first year of law school, those interests have expanded to include immigration policy, election integrity, and post-conviction relief.