When someone is experiencing a heart attack, most people are confident that calling 911 is the right thing to do. When an individual is experiencing mental health issues, it can be more difficult for a bystander to make the same decision. Doing so could result in an unnecessary arrest or hospitalization, and alternatives to involving law enforcement rarely exist.
To better serve individuals with mental health disorders and handle behavioral emergencies more safely, cities across the United States are implementing initiatives to bridge the gap between law enforcement and mental health care.
In Colorado, co-responder programs have been established in several counties across the state to address this gray area. These programs allow two-person teams comprising one law enforcement officer and one behavioral health specialist to respond to calls regarding behavioral emergencies and provide specialized attention.
“[The specialist] is able to utilize their clinical skills and their backgrounds to engage with the individual who’s in crisis or otherwise in need of de-escalation,” said Emily Richardson, manager of co-responder services for the Colorado Office of Behavioral Health. “It’s a little bit less intimidating when you have a clinician speaking with you versus a law enforcement officer.”
From co-responder programs to formal training on behavioral and mental health issues for law enforcement, many things can be done to reduce incarceration of people with mental health disorders and connect them with the right services.
Addressing Behavioral Emergencies as a Public Health Issue
According to American Addiction Centers, a behavioral emergency, also called a behavioral crisis or psychiatric emergency, occurs when someone’s behavior poses a potential threat to the safety of the individual or others. Behavioral emergencies can be the result of a mental illness, substance use, and other conditions.
For example, a person in crisis may express to someone they know that they are suicidal. Another scenario might involve that person showing signs of agitation and other mental health symptoms in a public place, alarming bystanders.
Because few options for action exist, typically the first response to witnessing a behavioral emergency is to call 911. In many cases this is not the best solution, according to Richardson.
Law enforcement officers are often not given the tools to handle behavioral and mental health issues. Often, people experiencing behavioral emergencies have not committed an actual crime and need support, not police intervention.
Without the necessary training or guidance from behavioral health experts, officers are put in a challenging position when responding to a scene where someone is experiencing a mental health crisis. As a result, many of these individuals end up being unnecessarily arrested—approximately 383,000 people with severe mental health disorders are incarcerated.
Additionally, when law enforcement is unable to de-escalate a situation despite their best efforts, the safety of everyone involved can be compromised. Research shows that individuals with mental health conditions are disproportionately affected by police-related fatalities. The risk of being killed while being approached or stopped by law enforcement in the community is 16 times higher for individuals with untreated serious mental illness than for other civilians, according to the Treatment Advocacy Center.
Making behavioral emergencies the sole responsibility of law enforcement can also affect the department’s capacity to protect their community. When police officers respond to incidents that do not involve crimes or violence, it takes away time and resources that could be applied to other safety issues. A 2017 study found that 21% of total law enforcement staff time was used to respond to and transport individuals with mental illness.
How Communities Can Improve Their Response to Behavioral Emergencies
Due to disparities in mental health care access, behavioral emergencies often involve individuals who do not have access to consistent, long-term treatment. Data from the Substance Abuse and Mental Health Services Administration shows that 60% of adults and 50% of children diagnosed with a mental illness do not receive treatment for it. [PDF 1K MB] Further, 60% of U.S. counties do not have a single practicing psychiatrist, according to the National Alliance on Mental Illness.
Many communities are recognizing that people experiencing mental illness and behavioral health issues have specific needs and that meeting those needs with assistance from medical and mental health professionals can help minimize harm and improve outcomes. A variety of models currently exist in states across the country.
Examples of Mental Health Crisis Intervention Programs
- Crisis Intervention Team (CIT): This program model provides training to law enforcement officers on how to de-escalate situations involving individuals with mental illness or substance misuse issues. CIT programs are sometimes utilized in addition to other measures to improve behavioral emergency intervention strategies.
- Co-Responder Programs: The co-responder model pairs law enforcement and mental health or behavioral health specialists to respond to behavioral emergencies for the police service. These teams utilize the knowledge of crisis experts and the safety protocol of officers to de-escalate situations and help link individuals to appropriate services. Variations of this model exist in several cities across the United States, including Denver, Minneapolis, Houston, and Kansas City.
- Crisis Assistance Helping Out On The Streets (CAHOOTS). CAHOOTS is a first-of-its-kind program started in Eugene, Oregon, that dispatches two-person teams that include one medical professional—a nurse or emergency medical technician—and one crisis worker to respond to calls received by the police service. In these cases, a law enforcement officer is not present.
How Individuals Can Help Promote Behavioral Emergency Response Initiatives in Their Community
There are several steps individuals can take to encourage their city or state to enact change in how behavioral emergencies are handled to reduce harm.
- Do your research. Find out what programs currently
exist at the city and state levels, as well as what solutions are currently
- For example, this directory of CIT programs allows users to identify where CIT programs are currently being utilized at the state and county levels.
- Contact local legislators. Speak up to
encourage the use of safer interventions by interacting with the community
leaders who are responsible for systemic change.
- For example, Colorado’s Co-Responder Programs were launched after Senate Bill 17-207 [PDF 524 KB] was passed. The bill broadly addressed the need for improving behavioral health crisis services, and stakeholders from local organizations recommended providing funding for co-responder programs.
- Connect with advocacy groups. Many
organizations have local chapters, allowing you to work with others to support
- For example, NAMI is active in promoting programs that help law enforcement more safely interact with people with mental health disorders. The organization offers a directory of NAMI state chapters and affiliate programs.
Resources for Further Reading
- Behavioral Emergencies: American Addiction Centers
- Colorado Co-Responder Programs
- Crisis Assistance Helping Out On The Streets (CAHOOTS)
- Crisis Intervention Team (CIT) Programs: National Alliance on Mental Illness
- Treatment Advocacy Center