Mental health response

The responsibility of responding to mental health crises has not always landed on the shoulders of police departments. In the first half of the twentieth century, institutionalization was the standard for mental health care, with over half a million Americans being treated in these facilities by the mid-1950s. However, media coverage of their poor living conditions, as well as the development of psychiatric medications, prompted the public to call for a transformation of the American mental health system. President Kennedy proposed the Community Mental Health Act in response to this public pressure, asserting that, “when carried out, reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability.” Congress passed the legislation in 1963, granting three billion dollars in federal funding to establish community mental health centers. Though the Act led to rapid deinstitutionalization, the community centers that policymakers had envisioned largely failed to materialize. By 1980, the inpatient population at public psychiatric hospitals had decreased by 75%. 


However, the “open warmth” of structured treatment and concrete resources did not meet those who emerged from these restrictive facilities. Former inpatients returned to their families or were left to navigate living on their own for the first time. Without community institutions in place to respond to mental health crises, family and community members called police officers to restore the peace or manage a stressful situation. Because it has fallen to law enforcement to respond to mental health crises on a local level, the severely mentally ill have historically faced a cycle of abandonment, homelessness, desperation, and reinstitutionalization—in prison. The criminalization of severe mental illness in the United States is a result of the lack of adequate response units, and the present-day statistics that highlight this issue are alarming. 


According to a 2015 report from the Treatment Advocacy Center, half of the 7.9 million Americans with severe mental illnesses are not receiving any kind of treatment to manage their symptoms on any given day. Given the absence of community support, the severely mentally ill overwhelm the criminal justice system. They account for one in ten of all law enforcement responses and one in five of all jail and prison inmates. Most concerning is that the severely mentally ill account for one in four of all fatal police encounters. These fatalities often occur during the first step of the criminal justice process, when a person is being approached or stopped by police in the community. Having a severe mental illness is a major risk factor for violence in an encounter with police, and receiving medical treatment greatly reduces the likelihood of a person even interacting with the police in the first place. The Treatment Advocacy Center asserts that “treating the untreated is a proven practice for reducing the role of mental illness in all criminal justice involvement, including in deadly law enforcement encounters.” 


One only has to watch the news to realize that the current system isn’t working. The Washington Post started logging every fatal shooting by an on-duty police officer in the United States in 2015. As of April 2021, searching the database with the filter “mental illness” returns 1,422 results. Oftentimes, these fatal shootings begin with a family member placing the 911 call because, given the lack of social services or knowledge of existing ones, the police are the people to call in a crisis. 


Many cities have worked to address this tragedy by providing their officers with Crisis Intervention Training (CIT). First developed in Memphis in 1988, CIT provides police officers with a basic understanding of how to approach an individual experiencing a mental health crisis and use discretion to divert them to non-carceral treatment facilities. Over 2,700 police departments nationwide are staffed by officers who have received CIT, with each department adjusting the basic guidelines of the training to fit local needs. However, it is rare for a department to send every one of its officers to CIT. Furthermore, CIT programs continue to place the responsibility of providing mental health care on police officers, who are trained to show authority and take control of a situation by whatever means necessary rather than calmly de-escalate it. 


Several cities across the U.S. are working to provide viable, cost-saving, and life-saving alternatives to sending police officers to those experiencing a mental health crisis. The most notable example is a program from Eugene, Oregon, known as CAHOOTS (Crisis Assistance Helping Out on the Street). The program began in 1989 as a partnership between the non-profit White Bird Clinic and the Eugene Police Department (EPD). Over the past 30 years, CAHOOTS trained 911 dispatch officers to “recognize non-violent situations with a behavioral health component and route those calls to CAHOOTS.” At that point, CAHOOTS sends a two person  team consisting of a medic and a crisis worker with substantial training and experience in mental health work. CAHOOTS works to ensure a non-violent resolution of crisis situations, but can always call for police backup if they believe the situation requires it. In 2017, the CAHOOTS team answered approximately 17% of EPD’s call volume, only called backup on 0.6% of calls, and the program saved the city approximately $12 million in public safety spending (“CAHOOTS”).


Officers in Eugene are highly appreciative of CAHOOTS services. Sgt. Rick Lewis, the CAHOOTS police coordinator in 2019, noted that "[CAHOOTS]s provide a different avenue than just handcuffs.... For patrol, we typically are only staffing six or seven officers out there for our city and so to have this different group, CAHOOTS, come in and have the additional time to spend with these folks to try to get resources and services to them, it’s beneficial most importantly to the person, but also to the department and the city as a whole. So we love them." These sentiments are not unique to officers in Oregon. Police people across the nation acknowledge that as they are more frequently called upon to answer calls about homelessness, drug addiction, and health crises that are beyond the scope of traditional police training. 


Baltimore, Denver, Hartford, Portland, and Olympia, Washington, are among multiple cities who have piloted or implemented mental health response systems similar to the one in Eugene. These municipalities, with support from taxpayers and police unions alike, are shifting resources towards people whose professional lives are dedicated to supporting those in a crisis and providing them with the healthcare they need. 


Regardless of the number of CIT training hours completed and CIT trained professionals integrated in police departments, these officers will not (and should not) understand a mental health crisis in the same way as a licensed social worker. Crisis Intervention Training programs are a step in the right direction, but cities and states should prioritize sending crisis response teams staffed by those whose life’s work is to manage these types of situations.

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