SUMMARY - Mental Health Calls: Should Emergency Services Be the First Responders?

A man in psychotic crisis stands in a parking lot, confused and frightened, and someone calls 911, and police arrive with weapons drawn, shouting commands he cannot process, surrounding him in ways that escalate his terror, and within minutes he is dead, the emergency response to his mental health crisis becoming the emergency that killed him. A mother calls 911 because her adult son is suicidal and she cannot keep him safe alone, and police arrive and arrest him, and he spends seventy-two hours in jail before being transferred to a psychiatric facility, the criminalization of his illness adding trauma to crisis. A woman experiencing a panic attack in a shopping mall is surrounded by security and then police, the attention and uniformed presence intensifying her symptoms, the help that arrived making things worse. A city creates a mental health crisis team - unarmed responders with clinical training who respond to mental health calls - and the team diverts thousands of calls from police response, with better outcomes and lower costs. A family member of someone with serious mental illness keeps a crisis plan by the phone, knowing exactly what to say and not say to 911, having learned through experience that the wrong words bring the wrong response. When mental health emergencies are treated as law enforcement emergencies, the response itself becomes dangerous. The question of who should respond to mental health crises is literally life and death.

The Case for Non-Police Mental Health Response

Advocates for alternative mental health response argue that police are trained for enforcement, not mental health, that armed response escalates crises, and that specialized teams produce better outcomes.

Police training focuses on enforcement. Officers receive limited mental health training compared to extensive training in use of force. When people in crisis encounter police, they encounter responders whose instincts and training may not match the situation. Mental health crises require mental health response.

Armed response escalates crises. Weapons, commands, and enforcement posture can escalate psychiatric emergencies. Someone experiencing psychosis may perceive police as threat and respond in ways that lead to violence. Removing weapons and enforcement framing from mental health response reduces escalation.

Alternative models show better outcomes. Cities with mental health crisis teams report better outcomes - more connections to services, fewer injuries, fewer deaths, lower costs. The evidence supports specialized response. What works should replace what does not.

From this perspective, mental health response requires: dedicated crisis teams with clinical training; unarmed responders for mental health calls; dispatch protocols that route mental health calls away from police; and evaluation of outcomes to guide improvement.

The Case for Police Involvement

Others argue that mental health crises can involve danger, that police provide safety for responders and public, and that separating mental health from police response creates risk.

Crises can become dangerous. Mental health emergencies sometimes involve weapons, violence, or unpredictable behaviour. Sending unarmed responders into potentially dangerous situations puts them at risk. Police presence provides safety that enables other work.

Situations are hard to assess remotely. Dispatch decisions are made with limited information. What seems like mental health crisis may involve other dangers. Police ability to handle multiple scenario types provides flexibility that specialized teams lack.

Co-response combines strengths. Police paired with mental health professionals can provide both safety and clinical expertise. Officers trained in crisis intervention can handle mental health calls more effectively than untrained officers. Improvement within existing systems may be more practical than alternative systems.

From this perspective, mental health response should: improve police training in mental health; pair officers with mental health professionals; maintain police involvement for safety; and enhance rather than replace existing response.

The Criminalization Question

When police respond to mental health crises, outcomes often involve criminal justice.

From one view, jails have become de facto mental health facilities. People arrested during mental health crises fill jails where treatment is inadequate. This criminalizes illness, creates records that affect future employment and housing, and fails to address underlying conditions. Diverting mental health calls from police prevents criminalization.

From another view, some behaviour during mental health crises is criminal regardless of mental state. Assault, property destruction, and other harms may warrant criminal response even when mental illness is present. Mental illness does not excuse all behaviour. Response must protect community as well as person in crisis.

How mental illness intersects with criminal responsibility shapes what response is appropriate.

The Family Dilemma

Families often must decide whether to call for help.

From one perspective, families face impossible choices. They need help managing crises they cannot handle alone, but calling 911 may bring response that harms their family member. Some families do not call until situations are desperate, and delayed response produces worse outcomes. Families need options they can trust.

From another perspective, families should not have to manage mental health crises alone. Reluctance to call reflects system failure that should be fixed, not accommodated. The goal is making 911 response safe enough that families feel confident calling early.

Whether families can trust emergency response determines whether they access it.

The Capacity Question

Alternative response requires capacity that does not currently exist.

From one view, mental health crisis teams require trained personnel who are in short supply. Building capacity takes years. In the meantime, police will continue responding because alternatives do not exist at scale. Transition must be gradual as capacity is built.

From another view, resources currently spent on police response could fund alternatives. The workforce exists; the investment does not. Claims about capacity may mask unwillingness to redirect resources. Building alternatives requires committing resources to them.

How capacity constraints are understood shapes pace and direction of change.

The Question

When a man in psychiatric crisis is killed by the responders who came to help him, what does that reveal about our emergency system? When families fear calling for help, what kind of help are we providing? If specialized response produces better outcomes at lower cost, why do we resist it? When jails become mental health facilities, what have we chosen? What would it mean to treat mental health emergencies as health emergencies? And when the response to someone's worst moment makes that moment worse, or makes it their last moment, what responsibility do we bear?