More than a dozen cities push to minimize or even eliminate police presence at mental health calls

By Peter Nickeas, CNN

More than a dozen cities are developing “alternative” or “co-response” programs to minimize or eliminate the role of police officers responding to 911 calls involving mental health, homelessness, or substance abuse.

Thirteen cities just finished an eight-week “policy sprint,” coordinated by advocacy groups Everytown For Gun Safety and What Works Cities. The goal was for cities to develop pilot programs or to nudge cities along that have already explored this model of 911 response. A handful of others are testing out programs on their own.

Interest in these programs has grown over the last few years and intensifies each time a video surfaces showing an officer using force during calls that begin with a person in some state of mental health or drug-induced crisis. There are only a few full-fledged programs in the country aimed at sending mental health workers on calls with, or instead of, police officers.

The goal of the sprint was to connect workers in mental health, law enforcement, social work and government from those 13 cities with experts from Eugene, Oregon, where a program developed 30 years ago is serving as a model for cities across the country.

The 13 cities are Albany, New York; Albuquerque, New Mexico; Austin, Texas; Birmingham, Alabama; Saint Paul, Minnesota; Providence, Rhode Island; Louisville, Kentucky; Boston; Chicago; Phoenix; San Antonio; and Seattle, according to the advocacy groups, which did not identify one of the cities.

Experts from other cities, along with the two groups, also attended the eight-week program.

“Not everyone has the perfect answer but having conversations, finding possible ways to work through this, is the start. That’s the first step. We’re encouraging cities to start with a pilot (program), limited geography, (specific) type of calls. Working through things with support service providers before doing this at scale is important,” said Naureen Kabir, a senior policy adviser at Everytown, a gun violence prevention group. “That’s when a lot of these conversations need to take place. There’s no great perfect answer to this. But they’re conversations cities need to have.”

For social services, ‘this is street work’

The hope is this cohort of cities will stay in contact with each other, share what works and what hasn’t, and tailor their programs based on what they’ve learned from each other. Months or years from now, as the success or failure of each city’s experiment can be measured, the data can inform alternative response or co-response models elsewhere.

“Some things you know it’s the right way. In this space at this time, we don’t have a best practice of emergency response, and we’re trying to help cities use emerging evidence there and trying to innovate based on their communities,” said Simone Brody, executive director of What Works Cities, which advocates for data-driven best practices at the local level.

“Frankly we don’t have information on what works in any context. We need better differentiated evidence to say what works and in what context and what kind of community. But it’s hard work, I applaud our cities for doing this.”

There are as many policy choices cities will have to make as there are cities, and each new program will look a little different. Cities must choose which calls to respond to, how to equip workers, level of qualifications needed, whether to build new city agencies or contract the service out, and that’s all before getting to the question of finding money to pay for it.

Regardless of whether this new class of worker is a city employee or works for a non-profit, there’s going to be an expectation that they assume the hours and risk that comes with street-level crisis intervention, neither of which are normal in the social services field.

Michel Moore, chief of the Los Angeles Police Department, compared this new field to gang outreach work that goes on in big cities with decades-long gang violence problems. Former gang members use their standing to attempt to mitigate conflicts, but in doing so are putting themselves at some risk.

“Social services in America have to change the mindset that they have a shingle out front, work Monday through Friday 9 to 5, let everyone else deal with everything else, and I’ll deal with the behavior once it’s safe from my comfortable office chair,” Moore said. “This is street work.”

In Los Angeles, the mayor signed a budget Wednesday setting aside $3 million for a pilot program run by a group that helped connect homeless people with services over the summer.

“There are professionals saying you can’t pay me enough to do that,” Moore said. “The challenge is going to be, as a society, we gotta stop being cheap when it comes to mental health and safety and realize we’ve relied on police and fire for too long because other professions need to step up and aren’t there.”

There’s no one-size-fits-all approach

Though these efforts are sometimes framed as “replacing police with mental health workers,” the reality isn’t so simple. The number of guns in America — 400 million according to one estimate — complicates every aspect of crisis response.

The program in Eugene, and the pilot programs elsewhere, haven’t divorced police entirely from crisis response, according to interviews with city officials. The programs are largely integrated into police and emergency medicine dispatch networks.

In working with the cities during the policy sprint, experts from What Works Cities emphasized they weren’t prescribing a specific program to each city, but rather each city had to look at its 911 call data, existing social service network, and other factors to determine what works for them. One challenge to expanding these programs is the lack of data surrounding what works.

Professionals from different disciplines in each of the cities participating in the What Works Cities/Everytown program have met, as a group, for eight weeks. Phoenix approved a tentative spending plan that expands a pilot program to a full-on part of city government, which includes $15 million for their Community Assistance Program. Albuquerque just passed a budget with $7 million set aside for the Albuquerque Community Safety department.

“We have to figure out how to do things in a different light,” said Mariela Ruiz-Angel, director of that department. “How do we support our current public safety infrastructure in a different way that’s integrated, how do we really start to systemically change how we look at public safety.”

The CAHOOTS program in Eugene was developed to provide “mental health first response for crises involving mental illness, homelessness and addiction.” The acronym stands for Crisis Assistance Helping Out On The Streets. It’s widely regarded as a success and has served as a fount of expertise for any city looking into a similar program.

Eugene is a largely white city in rural Oregon, about two hours south of Portland, nestled between three national forests.

The types of things that will complicate a crisis response in bigger cities like Chicago — widespread community violence, open-air drug markets, decades long gang conflicts, systems adjacent to violence that are often in conflict with each other instead of working together — don’t exist on a large-scale in Eugene.

It is why, in some ways, Eugene was the ideal incubator for a program like this.

“We have a relatively well-established network of services around 24-hour access to crisis stabilization, being able to lodge people in sobering houses and detox, having options to address basic needs around hygiene, food and shelter,” said Tim Black, director of consulting at CAHOOTS. “Having that constellation of services … if you don’t have that 24-hour center, an accessible sobering center, (if) it’s difficult to meet basic human needs, you’re just going to be cycling people through the hospital or delaying the inevitable criminal-legal involvement.”

The service is run by White Bird Clinic and contracted by the cities of Eugene and Springfield, though it’s dispatched by the Eugene Police Department. Every CAHOOTS response includes at least an EMT and a crisis response worker, and they can ask for police or paramedics as they see fit.

There’s a ‘need to invest in mental health care’

According to the agency, CAHOOTS responders handled 17 percent of the city’s 911 calls in 2017. Part of what has made this program successful is the 24-hour availability of services that CAHOOTS workers can refer people to. Black said a common misconception is that the CAHOOTS program can exist as a “cookie cutter” model for different cities hoping to achieve the same results.

“Our work is recognizing there are these exact differences between a small college community surrounded by a forest in the middle of Oregon, compared to Illinois or New Jersey or wherever,” Black said. “This sprint is all about allowing folks to ask questions they need to ask to build something that’s going to work for that community specifically.”

Aside from the 13 cities, CAHOOTS has worked with over the last eight weeks, there are pilot programs or full-fledged programs in Denver, Houston, Los Angeles, Portland, Oregon, and Rochester, New York.

Some efforts, like Denver’s, started with mental health workers working alongside police officers. That city later built a program to send mental health workers without police, depending on the type of 911 call. Denver was also offered as a model during the policy sprint.

In Rochester, the city is trying out two separate programs: a Person-in-Crisis team, and a Family and Crisis Intervention Team. In Los Angeles, a city that receives about 140,000 non-emergency calls related to homelessness each year, Moore sees reason for hope in a pilot program targeting the Hollywood and Venice areas that will begin on July 1.

The city of Phoenix is expanding a pilot program after officials there approved a tentative budget Wednesday that included $15 million to expand a program that’s largely supported by volunteers and grant funding. Building it into the city’s infrastructure was important to ensure the program’s longevity, said Kate Gallego, the mayor of Phoenix.

“I expect this program to save lives. We’re excited about the potential to meet the community’s needs and better serve residents,” said Gallego said. “The whole world has changed in the last year. The awareness of the need to invest in mental health care is at an all-time high. Covid and the pandemic laid bare what we already knew: the existing mental health system had holes. But we have good policy ideas and we ought to move forward and try to plug them.”