The last year has seen increased publicity regarding how to improve community responses, especially to mental health crises, by law enforcement. Historically, law enforcement officers have been the primary responders to mental health crises (Kisley et al., 2010), and research within the United States suggests that one in ten individuals with mental illness encounter police prior to receiving mental health care (Livingston, 2016). Furthermore, as many as 20% of police calls involve individuals with mental illness (Livingston, 2016). The Treatment Advocacy Center (2015) reported that 25% of deaths from police shootings involve individuals with mental illness, and 20% of police officers’ time is spent responding to mental health crises. Since 2015, over 1,400 individuals with mental illness have been fatally shot by police, according to the Washington Post (Washington Post, n.d.). Over the last 30 years, several approaches have been developed and used worldwide to improve community response to psychiatric crises.
One approach is to train law enforcement officers on relevant topics, such as signs and symptoms of mental illness and de-escalation techniques. This approach, considered a best practice within law enforcement in the U.S. (i.e., Crisis Intervention Team), has shown promise in reducing arrests of people with mental illness as well as increasing access to mental health care for individuals served (Watson & Fulambarker, 2012). A second and alternative approach focuses on modifying crisis response models by creating co-responder teams. In this approach, a police officer and a mental health clinician are paired and respond to calls involving psychiatric crises. Such programs have been utilized in Canada (Kirst et al., 2015) and Australia (Huppert & Griffiths, 2015). Each of the aforementioned approaches has generally been found to reduce burden on law enforcement and to be cost effective (Dempsey et al., 2020; El-Mallakhet al., 2014; Kisley et al., 2010).
Other approaches to crisis response, however, involve police minimally, if at all. These programs utilize mental health care workers (e.g., psychiatric nurses, social workers, psychiatrists and/or psychologists) as the primary response teams for psychiatric crises. In February 2021, the city of Denver, Colorado, released a six-month progress report of their brand-new Support Team Assistance Response (STAR) pilot program (Denver Justice Project, 2020). STAR teams are comprised of a mental health clinician and a paramedic who provide free medical care, first aid or mental health support to non-criminal emergencies. When dispatchers receive a call for situations involving mental health emergencies, drug overdoses or requests for a welfare check, STAR teams are notified and sent instead of police officers. In six months, STAR teams responded to 748 calls, none of which required police assistance or resulted in arrests (Hauck, 2021). Similarly, an organization based in Oregon called CAHOOTS (Crisis Assistance Helping Out On The Streets) pairs a medic and crisis worker to respond to nonviolent urgent medical and/or psychological crises (Parafiniuk-Talesnick, 2019). In 2017, CAHOOTS teams responded to 17% of the Eugene Police Department’s call volume, saving an estimated $6 million in medical service costs (Parafiniuk-Talesnick, 2019). A similar program in Sweden resulted in fewer individuals needing to be taken to psychiatric emergency departments; in fact, a third of the cases attended to by Swedish teams required no further action (Bouveng et al., 2017).
Preliminary data from these approaches highlight the benefits of utilizing mental health clinicians as crisis responders, possibly instead of—or at least in addition to—law enforcement. A small but growing body of research has evaluated the implementation, effectiveness and impact of mental health crisis response models, and it will be vital to continue collecting and reviewing data on these programs to further inform best practice interventions and larger public policies. Specifically, more research is needed to compare the effectiveness of each approach in terms of patient experience, resources saved and economic benefit (Bouveng et al., 2017; Shapiro et al. 2015). Extant research, however, does indicate that response teams with mental health clinicians have more favorable outcomes (e.g., lower rates of injury and arrest, less time spent on scene) compared to police-only teams (Dempsey et al., 2020). More data is also needed on the impact of these approaches on marginalized communities who may experience higher rates of policing and/or less access to mental health care. For instance, the STAR program in Denver has not collected race/ethnicity data for a third of those served, limiting a full understanding of how their program may specifically impact communities of color (Hauck, 2021). Furthermore, additional work is needed to address challenges for implementation (e.g., coordination across law enforcement and mental health; Kirst et al., 2015; Koziarski et al., 2021). Despite the need for additional research and implementation improvements, available data appear promising and provide hope in the goal of reducing the criminalization of mental illness—as well as preventable death and trauma—within our communities.
About the Author
Alyssa Jones, MA, is a clinical psychology doctoral candidate at the University of Kentucky and a predoctoral intern at the Charleston Consortium Internship Program. She currently provides evidence-based treatment for trauma-related disorders at the Ralph H. Johnson VA Medical Center and at the Medical University of South Carolina (MUSC). Her research is focused on affective mechanisms associated with the development and treatment of posttraumatic stress disorder.
References
Bouveng, O., Bengtsson, F. A., & Carlborg, A. (2017). First-year follow-up of the psychiatric emergency response team (PAM) in Stockholm County, Sweden: A descriptive study. International Journal of Mental Health, 46(2), 65-73.
Dempsey, C., Quanbeck, C., Bush, C., & Kruger, K. (2020). Decriminalizing mental illness: Specialized policing responses. CNS Spectrums, 25(2), 181-195.
Denver Justice Project. (2020, June 8). DJP helps launch alternative public health emergency response pilot in Denver [Press release]. http://www.denverjusticeproject.org/2020/06/08/press-release-alternative-public-health-emergency-response-pilot-launches-in-denver/
El-Mallakh, P. L., Kiran, K., & El-Mallakh, R. S. (2014). Costs and savings associated with implementation of a police crisis intervention team. Southern Medical Journal, 107(6), 391-395.
Hauck, G. (2021, February 6). Denver successfully sent mental health professionals, not police, to hundreds of calls. USAtoday.com. Retrieved March 8, 2021, from https://www.usatoday.com/story/ news/nation/2021/02/06/denver-sent-mental-health-help-not-police-hundreds-calls/4421364001/
Huppert, D., & Griffiths, M. (2015). Police mental health partnership project: police ambulance crisis emergency response (PACER) model development. Australasian Psychiatry, 23(5), 520-523.
Kirst, M., Francombe Pridham, K., Narrandes, R., Matheson, F., Young, L., Niedra, K., & Stergiopoulos, V. (2015). Examining implementation of mobile, police-mental health crisis intervention teams in a large urban center. Journal of Mental Health, 24(6), 369-374.
Kisely, S., Campbell, L. A., Peddle, S., Hare, S., Pyche, M., Spicer, D., & Moore, B. (2010). A controlled before-and-after evaluation of a mobile crisis partnership between mental health and police services in Nova Scotia. The Canadian Journal of Psychiatry, 55(10), 662-668.
Koziarski, J., O’Connor, C., & Frederick, T. (2021). Policing mental health: The composition and perceived challenges of Co-response Teams and Crisis Intervention Teams in the Canadian context. Police Practice and Research, 22(1), 977-995.
Livingston, J. D. (2016). Contact between police and people with mental disorders: A review of rates. Psychiatric Services, 67(8), 850-857.
Parafiniuk-Talesnick, T. (2019, October 19). In Cahoots: How the unlikely pairing of cops and hippies became a national model. TheRegisterGuard.com. Retrieved March 8, 2021, from https://www.registerguard.com/news/20191020/ in-cahoots-how-unlikely-pairing-of-cops-and-hippies-became-national-model
Shapiro, G. K., Cusi, A., Kirst, M., O’Campo, P., Nakhost, A., & Stergiopoulos, V. (2015). Co-responding police-mental health programs: A review. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 606-620.
Treatment Advocacy Center (2015). Overlooked in the Undercounted: The Role of Mental Illness in Fatal Law Enforcement Encounters. https://www.treatmentadvocacycenter.org/storage/documents/overlooked-in-the-undercounted.pdf
Washington Post. (n.d.). [Police shootings database]. The Washington Post. Retrieved March 8, 2021, from https://www.washingtonpost.com/graphics/investigations/police-shootings-database/
Watson, A. C., & Fulambarker, A. J. (2012). The crisis intervention team model of police response to mental health crises: a primer for mental health practitioners. Best Practices in Mental Health, 8(2), 71.