SUMMARY - Who Should Respond to a Mental Health Crisis?

A city announces that mental health crises will now receive response from crisis teams rather than police, and a person in psychiatric distress who would have faced armed officers instead meets clinicians who understand their experience, who do not treat them as threat, who connect them to care rather than courts - the different response producing a different outcome. A county implements co-response teams that pair police with mental health professionals, and police provide security while clinicians provide expertise, and the partnership addresses both safety and health concerns. A community creates a peer-led crisis response where people with lived experience respond to people in crisis, and something about being met by someone who has been there changes what the encounter means. A person calls 911 for mental health help and is told that the mental health team is not available, that police will respond instead, and they decline, choosing to manage their crisis alone rather than involve the system they fear. A fire department trains paramedics in crisis intervention and they become first responders to mental health calls, bringing medical rather than law enforcement perspective. Who responds to mental health crisis shapes what happens during the response and what happens after. The question of who should respond is the question of what kind of society we want to be.

The Case for Non-Police Response

Advocates for alternatives to police response argue that mental health crisis is health matter, that police are wrong responders for health emergencies, and that alternative models produce better outcomes.

Mental health crisis requires mental health response. Police are trained for enforcement; mental health crisis requires clinical expertise. The mismatch between training and need explains poor outcomes. Sending appropriate responders produces appropriate response.

Alternative models work. Programs like CAHOOTS in Eugene, Oregon have demonstrated that unarmed crisis teams can safely and effectively respond to mental health calls. The evidence shows that non-police response is possible. What works should be implemented.

Police response causes harm. Deaths, injuries, arrests, and trauma result from police response to mental health crisis. Removing police from mental health response removes the harms police response causes. The case for change is the harm that current response produces.

From this perspective, crisis response reform requires: building non-police crisis response capacity; diverting mental health calls from police dispatch; training alternative responders; and measuring outcomes to demonstrate improvement.

The Case for Police Involvement

Others argue that some mental health calls involve danger, that police must be available for situations that turn violent, and that removing police entirely creates unacceptable risk.

Situations are unpredictable. Calls that begin as mental health crises can involve weapons, violence, or danger to responders. Sending unarmed responders into potentially dangerous situations puts them at risk. Some police involvement remains necessary.

Alternative capacity does not exist. Police respond to mental health calls because alternatives do not exist at scale. Building non-police capacity takes years and resources. In the meantime, someone must respond. Removing police without alternative leaves no response.

Co-response addresses both concerns. Police paired with mental health professionals can provide both safety and clinical expertise. Officers trained in crisis intervention can handle mental health calls better than untrained officers. Improvement within existing systems may be more achievable than replacement.

From this perspective, response should: improve police training for mental health calls; develop co-response models; build alternative capacity gradually; and maintain police involvement for situations requiring it.

The Dispatch Question

How do dispatchers decide who responds?

From one view, dispatch protocols should route mental health calls to mental health responders. Questions that identify mental health nature of call should trigger alternative response. Protocols can be designed to match calls to appropriate resources.

From another view, dispatchers have limited information and limited time. Calls are often ambiguous. Expecting accurate sorting at dispatch may be unrealistic. Flexibility in response, not rigid protocols, may be necessary.

How dispatch works shapes who arrives.

The Capacity Question

Is there capacity for non-police response?

From one perspective, capacity must be built. Mental health workforce development, mobile crisis team creation, and peer responder training require investment. Claiming capacity does not exist justifies the status quo. Building capacity requires deciding to build it.

From another perspective, workforce constraints are real. Mental health professionals are in short supply. Building capacity takes time that crises do not allow. Realistic timelines must acknowledge constraints.

How capacity constraints are understood shapes pace of change.

The Twenty-Four Hour Question

Can alternative response be available around the clock?

From one view, mental health crisis does not follow business hours. Response must be available whenever crisis occurs. Twenty-four-hour alternative capacity is essential. Anything less leaves gaps that police will fill.

From another view, twenty-four-hour capacity is expensive. Building daytime capacity first, then expanding, may be realistic path. Perfect coverage should not prevent progress on improved coverage.

How around-the-clock availability is prioritized shapes service design.

The Question

When a person in mental health crisis is met by armed officers rather than mental health professionals, what does that meeting mean? If alternative response models work elsewhere, why do we resist implementing them? When police response produces deaths that alternative response would have prevented, who is responsible for those deaths? If we know that who responds shapes outcomes, why do we keep sending the wrong responders? What would it look like to actually build the crisis response system that evidence says works? And when we continue what does not work while refusing to build what would, what choice are we making?