Nationally, there’s been an amplified call for an ecosystem of services to help people manage conflict, address health issues, and promote socioeconomic stability and public safety without relying on the criminal legal system. This vision prioritizes prevention, accountability, and treatment rather than incarceration. Blueprints for public safety approaches that do not center incarceration—and a variety of strategies to fund them—already exist.
Governments can use their authority to dedicate resources to these strategies, including community-based behavioral health crisis services, permanent supportive housing programs, and violence prevention and de-escalation services. Genuine partnership with nonprofit organizations and advocacy groups must be at the center of efforts to create a network of supports that function effectively, equitably, and without funneling people into the criminal legal system.
Responding to Behavioral Health Crises without Incarceration
Because law enforcement is always available, and behavioral health services have fewer resources and limited capacity, police are often the first responders when people experience behavioral health crises—even if they are not the best prepared to render aid. Some jurisdictions have tried to address the disconnect between residents’ needs and the services available to them by investing in police-led diversion, additional law enforcement training, and programs that pair officers with behavioral health specialists in the field. But these approaches still center police intervention. Jurisdictions should move beyond these limited options to focus attention and resources on strengthening the broader mental health ecosystem. These investments are essential for successful solutions that operate outside of the criminal legal system because they build the capacity of behavioral health service providers and local health-focused organizations.
The investments detailed in this section can help jurisdictions reduce the use of jail incarceration by meeting people’s prevention and treatment needs without participation in any criminal legal process.
Crisis Call Centers
A crisis call center is a 24-hour clinically staffed, central location designed to provide immediate phone support to people who may be experiencing a behavioral health emergency—similar to the 911 system. These centers conduct behavioral health assessments and help callers problem-solve, develop coping strategies, and connect to other support services. Some crisis call services collaborate with local police departments to divert 911 calls that a behavioral health specialist can address. With the proper technological support, regional call hubs can also enhance coordination by using real-time information to track the availability of mobile responders, monitor the capacity of treatment providers, and verify when a person has been connected to services. These centers can help reduce the use of police response to behavioral health crises, which decreases the likelihood of arrest; physical harm to the person in crisis, other residents, or officers; and inadequate connection to care. In July 2022, the Federal Communications Commission plans to roll out 988 as a three-digit dialing code to reach the National Suicide Prevention Lifeline, which provides free emotional support 24/7 to callers experiencing suicidal crisis or emotional distress.
Warmlines are another telephone-based service offering behavioral health crisis assistance without traditional emergency responders. They provide people a confidential space to speak with a trained responder about their needs and symptoms. Warmlines differ from 24/7 crisis hotlines in that they are not typically used for emergencies and are generally staffed by “peers,” or people who have direct experience with behavioral health issues. Warmlines can help de-escalate situations that may have otherwise resulted in an emergency department visit or 911 call.
Mobile Crisis Response Teams
Mobile crisis response teams are staffed by nurses and behavioral health specialists trained in crisis response, including at least one clinician who can provide assessments, de-escalation, and connections to other services as needed (including transportation). These teams may also include trained peers. Mobile crisis response teams may request police backup when they deem it necessary but are designed to respond without law enforcement. These teams also coordinate with local emergency medical services (EMS) and can operate as either an alternative to, or an extension of, EMS.
CAHOOTS
One of the best-known mobile crisis response programs is Crisis Assistance Helping Out On The Streets (CAHOOTS) in Eugene, Oregon. The program uses two-person teams pairing a medic and a behavioral health crisis worker to provide immediate stabilization, referrals, and/or transportation to further treatment resources.
Learn more about the CAHOOTS mobile crisis response model.
STAR
In June 2020, Denver, Colorado, launched Support Team Assisted Response (STAR), a program that dispatches a mental health clinician and a paramedic instead of armed officers to respond to behavioral health crises or low-level incidents related to poverty or homelessness, such as trespassing. STAR responders can connect community members to resources like food assistance, shelter, and ongoing mental health care. Dispatchers send STAR through 911 when appropriate calls for service come in, or STAR teams can be requested through Denver Police Department’s non-emergency line. In the program’s first six months, STAR teams responded to 748 calls and none resulted in police involvement or arrest.
PSR
Portland, Oregon, has also instituted specialized mobile crisis response to reduce police interaction. Portland Street Response (PSR) started in 2021 as part of a $500,000 pilot program to reduce police contact with people who are experiencing homelessness and/or behavioral health issues. When a 911 call about street homelessness or public disorder comes in, PSR dispatches specially trained medics alongside peer support specialists who have direct experience with being unhoused. In addition to providing care for non-life-threatening medical issues and connecting people to services, the team may provide transportation to shelters, clinics, or another destination the person being helped selects.
Crisis Stabilization and Receiving Services
Jails have become some of the largest institutions providing psychiatric care in the United States.Corrections officials, behavioral health professionals, advocates, and others have called for more resources to enhance behavioral health treatment within jails—and for ways to displace jail as a behavioral health provider for people in crisis.
One approach is to provide residents, mobile crisis teams, and other first responders with a rapidly accessible location in the community to use when a person is experiencing a behavioral health crisis that cannot be handled onsite. These crisis response centers also provide treatment space for residents and their loved ones to proactively access without relying on first responders.
Crisis receiving and stabilization centers offer a therapeutic, non-hospital environment for temporary observation and rapid service delivery to handle acute behavioral health crises. They’re designed to accept everyone who accesses the center 24/7, whether they walk in, are referred by someone in the community, or are brought by a first responder. Once a person arrives at a receiving and stabilization facility—sometimes called a drop-off center—they are assessed, stabilized, and connected to the appropriate levels of care, all within 24 hours. When police respond to someone experiencing a behavioral health crisis, a drop-off center can serve as a quick and suitable destination that is neither jail nor the emergency department.
In addition to short-term stabilization and receiving, drop-off centers can facilitate connections to employment/vocational assistance, legal help, food and nutrition assistance, emergency housing, substance use treatment, and other services to foster people’s success in the community. Although these services alone are not sufficient for managing behavioral health needs long-term, they can help build an infrastructure capable of reducing jail use by providing immediate diversion from criminal legal system contact and connections to long-term support. Crisis stabilization centers and other similar facilities have increased the use of less restrictive treatment options, reduced unnecessary hospitalizations, and shortened inpatient stays when psychiatric hospitalizations did occur.
Non-Jail Crisis Responses in Chicago and Pima County
In Chicago, the Westside Community Triage and Wellness Center provides urgent behavioral health care and serves as a hub to connect the neighborhood’s largely Black and Latinx residents to ongoing behavioral health services.