This report is a follow up to research published in November 2020.
Last November, we co-authored a Brookings report on alternatives to police as first responders when dealing with people experiencing a mental health crisis. In the report, we drew attention to pathbreaking examples and innovative strategies from around the country that are using specially trained crisis intervention teams rather than armed police. We also highlighted a range of steps needed for such teams to become the standard approach to defusing dangerous mental health incidents.
In just the last six months, there have been several promising steps towards a change in the traditional approach. For example, after the Federal Communications Commission decided to create a national 988 number for mental health crises (which would normally activate non-police response), Congress passed legislation providing grants to jurisdictions to boost their capacity to handle the 988 call system. Thanks to that funding, together with companion actions at the state level, the national system should be up and running in the summer of 2022. Several states have already introduced bills to implement the system, including Washington state, California, and Nevada. In addition, many cities and counties reviewing the role of their police departments are adopting the crisis intervention team model and revising police training – while weighing different views of the best approach. These include the nation’s capital area, where the District of Columbia and the bordering Maryland counties recently announced policy and funding changes.
These developments have received an enormous boost by the passage of the American Rescue Plan Act of 2021 (ARPA), the $1.9 trillion legislation to stimulate the U.S. economy. Several mental health initiatives are included in the ARPA that will help jurisdictions improve mental health services and introduce reforms based on the success of cities that have used alternatives to regular police involvement and tactics during incidents involving mental health crises.
Included in the legislation:
- An 85 percent enhanced federal matching rate under Medicaid for three years to states that opt to cover mobile crisis intervention services. The ARPA also includes $15 million in planning grants to states to help them apply for the option.
- Increased federal funding for home and community-based services, which can include mental health services.
- $1.5 billion in community mental health services block grant funding. Untreated mental health conditions are a major factor in police confrontations, and people with mental health problems face significantly higher death rates during interactions with police.
- $122 billion for schools (K-12) to implement programs and strategies to address school-aged children’s mental health, social, emotional, and academic needs.
The ARPA legislation will help expand mental health services. It will also encourage the use of mobile crisis intervention teams and related approaches to addressing the growing mental health crisis in the United States. These teams have the ability to de-escalate behavioral health emergencies and connect individuals to services and needed healthcare – and in turn avoid expensive emergency department visits, unnecessary arrests, or shooting of people with mental health challenges.
One model that was the impetus for including crisis intervention funds in the ARPA is Eugene, Oregon’s Crisis Assistance Helping Out On The Streets (CAHOOTS) program. CAHOOTS dispatches teams of mental health experts and medics to respond to mental health crises and have reported a large drop in the need for law enforcement to respond to such emergencies. In March 2021, Senator Ron Wyden (D-OR) and Representative Peter DeFazio (D-OR) introduced the CAHOOTS Act in Congress, to allow states to use Medicaid funds to set up programs similar to that in Eugene. The legislation is reflected in ARPA.
There is an increasing number of examples states and communities can learn from as they consider using ARPA funds and other funding to establish mental health crisis intervention strategies. In addition to the examples we identified in our earlier report, they could examine:
Street Crisis Response Team – San Francisco
San Francisco’s Street Crisis Response Team (SCRT) began its pilot program in November 2020 as a collaboration between the San Francisco Department of Public Health, the San Francisco Fire Department, and the Department of Emergency Management. Before 2020, the crisis response team was affiliated with the San Francisco Police Department. The goal of this cross-sector program is to provide an appropriate non-law enforcement response to behavioral health crises, including responding to 911 calls with behavioral health or medical response; delivering de-escalation services, and diverting individuals in crisis away from emergency departments and criminal settings into behavioral health treatment; providing appropriate linkages and follow up care for people in crisis. Currently, the SCRT program is comprised of six different teams which are staggered in shifts to provide 24-hour coverage throughout the city. Based on Mental Health San Francisco’s most recent implementation working group issue brief, additional funding through the ARPA could expand the annual budget to build out more than six teams of core response team field staff.
Health One – Seattle, WA
The Seattle fire department (SFD) has a Mobile Integrated Health response unit that is equipped to respond to determine an individuals’ mental health, clinical, housing, or other needs. Comprised of firefighters and case managers who are linked to local social service providers, the goal of Health One is to reduce the number of non-emergent calls to the fire department and subsequently connect individuals in need with the appropriate level of care and service. The Health One unit is either directly dispatched by the SFD Alarm Center or requested by SFD units that may already be onsite. In May, Seattle’s City Council introduced legislation to authorize spending $116 million in Coronavirus Local Fiscal Recovery funds in direct aid provided by the ARPA, via the Seattle Rescue Plan. This relief plan invests $41.5 million into community wellbeing and encompasses such mental health services as Health One.
STAR Program – Denver, CO
The Denver STAR Program, which was launched after a 2018 ballot initiative, pairs a mental health clinician or social worker with a paramedic. This team is a third alternative (in addition to the police or ambulance/fire services) as a response to 911 calls so that nonviolent individuals can be placed into the care of a mobile health care team rather than police officers being sent to the scene. In the first six months of the program, launched in 2020, the STAR Program resolved 748 mental health incidents (averaging six calls a day) that involved no force, arrests, or jail. With many of these calls related to unmet social needs, the team vehicle is equipped with food, blankets, and other resources to ensure that immediate non-healthcare needs can also be addressed on site. Before the passage of the ARPA, the program was funded primarily from the city budget and a grant from Denver’s sales tax-funded mental health fund. ARPA funding could provide the approximately $3 million needed to hire more social workers and more vans to reach a broader scope of the city and surrounding regions, according to the Denver Police Department’s chief.
Portland Street Response – Portland, OR
Portland Street Response (PSR) is a pilot program that responds to lower-risk behavioral health requests through both 911 and a non-emergency number. The team is comprised of four professionals, including a Licensed Mental Health Crisis Therapist, a firefighter EMT, and two Community Health Workers. PSR is dispatched when a report comes in that a person may be experiencing a mental health crisis (including intoxication and/or drug-related cases) and is outdoors or in a publicly accessible space. The PSR team is not sent if there are indications of a weapon, violence, or other situations where police might be more appropriate. In some cases, however, it is the police who request PSR support. The program has a call/data dashboard where the public can view the program’s performance. ARPA funding could expand programs like PSR by funding PSR personnel, supporting the citywide expansion of a PSR-style approach through a 911 dispatch center, or expanding the hours such services are available.
Familiar Faces Program – Olympia, WA
Olympia’s version of the mobile crisis unit approach has multiple layers of collaboration between police, behavioral health specialists, and other service providers. The Familiar Faces Program has a key feature – using peer navigators with lived experience to build the necessary trust and relationship to help individuals with complex health and behavioral problems navigate the health system. Individuals are identified for the program based on recurrent contact with the Olympia Police Department’s Walking Patrol. The peer navigator helps individuals obtain mental health and substance use disorder treatment, links them with primary health care providers, and helps with arranging stabilizing services such as permanent supportive housing and trauma-informed care. With the flexibility associated with ARPA funding, it may be possible for Olympia and other jurisdictions to hire a less conventional workforce to support individuals experiencing mental health crises.
Rapid Integrated Group Healthcare Team (RIGHT Care) – Dallas, TX
The Rapid Integrated Group Healthcare Team (RIGHT Care) program was founded as a collaboration between The Meadows Mental Health Policy Institute (MMHPI), Dallas Fire-Rescue Department (DFR), Dallas Police Department (DPD), and Parkland Health & Hospital System. It was launched with a multi-million dollar grant from the W.W. Caruth, Jr. Fund at the Communities Foundation of Texas. The original proof of concept, initiated in 2018, consisted of three team members: a community paramedic from DFR, a licensed behavioral health clinician from Parkland, and a specially trained police officer from DPD. The teams provide prevention and intervention outreach services and also respond to behavioral health-related 911 emergency calls in South Central Dallas. The team responds to all 911 generated calls in its service area related to mental health, and across 6,679 calls in nearly 2.5 years of operation, nearly seven in 10 were diverted to other services (2,660) or resolved on the scene (1,963), about one in five (1,479) were hospitalized, and only 130 (2%) were arrested for new offenses (with another 139 arrested on outstanding warrants). In February 2021, the program was expanded through inclusion in the city of Dallas’s annual budget. ARPA funding will make it possible to expand the number of RIGHT Care teams throughout the city and may also enable other cities to create similar teams.
Many jurisdictions are now reassessing both the training and use of their police forces. One of the impulses for that reassessment has been the growing recognition that armed police are not the right first responders to a situation where someone is having a mental health crisis. At best, the police are rarely able to connect a person with appropriate professional help. At worst, the result is unnecessary injury or death. Fortunately, more and more jurisdictions have been introducing crisis intervention teams, special hotlines, and similar models that lead to very different, more effective results. The funding now available through ARPA will allow more cities and counties to adopt these alternatives to armed police arriving after a mental health crisis leads to an emergency call.