Mental Health Interventions: How to Respond to a Behavioral Crisis

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 community programs to formal training on behavioral and mental health issues, steps can be taken to reduce harm of people with mental health disorders and other disabilities while connecting 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 or other conditions.  

For example, a person in crisis may express to someone they know that they are having thoughts of suicide. 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 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, police officers are put in a challenging position when responding to a scene where someone is experiencing a mental health crisis. As a result, these individuals are often unnecessarily arrested—approximately 383,000 people with severe mental health disorders are incarcerated.

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.

The intersection of race and disability is critical to understand from a public health perspective. One study showed that unarmed Black men with perceived mental illness were more likely to be involved in officer-related shootings than white men of the same age who showed signs of mental illness. TIME Magazine explained that as a result of health inequities, not only are Black communities more prone to mental health issues, they are also less likely to get a proper diagnosis and treatment. 

Research shows that individuals with mental health conditions are disproportionately affected by police-related fatalities.

People with other disabilities, including autism spectrum disorder, are more likely to experience interactions with law enforcement. A 2017 study indicates that about 20% of youth with autism spectrum disorder had been stopped and questioned by police by the age of 21; nearly 5% had been arrested. 

Additionally, the nature of police departments’ “compliance culture” fails to recognize certain disabilities, such as Deaf or hard of hearing individuals. In the aforementioned article for TIME Magazine, lawyer and activist Haben Girma explained that a person with a disability may be perceived as noncompliant because they do not respond in a way that is expected, which may result in use of force against them.  

Girma, who is Deaf-blind, explained, “Someone might be yelling for me to do something and I don’t hear. And then they assume that I’m a threat.” 

Making behavioral emergencies the sole responsibility of law enforcement can also be considered an ineffective use of funding. 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 shows that 21% of total law enforcement staff time was used to respond to and transport individuals with mental illness.

How to Respond to Behavioral Emergencies

Because of 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 1.K MB). Furthermore, 55% of U.S. counties do not have a single practicing psychiatrist, according to the National Alliance on Mental Illness.

Consult 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.

Alternatives to Calling the Police

In some cases, individuals may not feel safe calling law enforcement when their friend or family member is experiencing a behavioral emergency. Additionally, it’s important to be aware of how police involvement may affect an individual you do not know who appears to be experiencing mental health issues. There are many steps one can take to learn about community-based alternatives to law enforcement. 

  • Assess the situation. Sometimes as a bystander you may perceive a stranger’s actions as something more serious than it is. When the situation allows, take time to think through the steps to ask yourself before calling the police (PDF, 1.6 MB)
  • Research local resources. Directories such as Don’t Call the Police allow individuals to search by location and type of service to find services and organizations that may be helpful. 
  • Utilize crisis hotlines. Having a direct line of communication to someone who can talk about your current situation may help in finding a solution that does not require police intervention. For example, SAMHSA’s National Helpline provides information on mental health and substance use. 
  • Seek more information. Learning more about issues related to public safety, mental health and racial justice can help you participate in broader efforts to improve your community’s response to behavioral emergencies. Doing so can empower you to help improve public safety before there is a crisis.

Note: Please use your discretion for the safety of yourself and others when evaluating whether it is necessary to involve law enforcement and emergency services. This content is for informational purposes only.

Engage Your Community

There are also 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 being pursued.  
    • 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 the cause.

Resources for Further Reading