People experiencing behavioral health crises are in urgent need of compassion, care, and support—to ease their distress, to keep them safe, and to plan for their ongoing wellbeing.
In the vast majority of jurisdictions, police officers—as default first responders for 911 calls—are tasked with meeting these needs. They are often ill-equipped to do so.
Indeed, officer involvement can make these situations worse; this is particularly true in Black communities and other communities of color, which have disproportionately shouldered the harms of policing.1 Research conducted nationwide shows that most Black people, in contrast to most white people, live with the fear that police will hurt them or their family members.2 The tragic police killings of Daniel Prude, Deborah Danner, Walter Wallace Jr., Joseph DeWayne Robinson, and far too many others experiencing behavioral health crises have driven community demands for systemic change.3
In turn, an increasing number of jurisdictions are developing civilian–led crisis response programs. Staffed by unarmed teams of clinicians, peers, and other specially trained civilian responders, such programs are demonstrating that they can safely act as an alternative to police for people in crisis.4 However, to truly address the needs of people most harmed by the status quo, jurisdictions must work to eliminate racial disparities and improve outcomes for everyone as they plan, implement, and evaluate these programs. In other words, crisis response programs must prioritize antiracism and equity.
But what does an antiracist and equitable crisis response program look like?
To answer this question, researchers from the Vera Institute of Justice (Vera) interviewed national subject matter experts and local program stakeholders, including people with direct experience in establishing and managing crisis response operations. Vera used the findings of these interviews to produce this toolkit. Vera hopes that it will provide guidance to advocates and practitioners alike who aspire to design and deliver more equitable crisis response services in their communities.
Methodology
The strategies and promising practices highlighted in this report draw on interviews conducted with advocates, practitioners, and researchers, as well as a review of program materials.
Vera researchers completed 35 interviews with a total of 44 national subject matter experts and local program stakeholders with professional and lived experience in behavioral health and crisis intervention, policing, 911 communications, peer support, research, and advocacy. Vera aimed to learn from local programs at different stages of planning and implementation and to include programs with novel approaches and innovations. Vera researchers included communities with diversity in size, geographic location, and demographic composition. Vera also sought to include stakeholders with subject matter expertise in areas relating to equity, such as racial equity, immigration, disability justice and access, and peer advocacy and workforce development.
Interviews were conducted over Zoom and were audio recorded and transcribed for analysis. The researchers did not record two of the 35 interviews, based on the preference of interview participants. For these interviews, a Vera researcher took detailed notes during the interview. Advocates and other interviewees who were not speaking with Vera in their professional capacities were offered a $50 prepaid credit card for participating in the interview.
Vera researchers followed a semi-structured interview question guide tailored to each participant. The guide included questions on defining and measuring antiracism and equity for crisis response programs and identifying strategies and recommendations to advance antiracism and equity during program planning, implementation, and evaluation.
A team of three Vera researchers used Dedoose qualitative data analysis software to organize and analyze the qualitative interview data. Through an iterative process during regular team meetings, the researchers developed a set of codes to identify the key themes and findings of the interviews.
Vera researchers also requested and reviewed relevant materials from local programs. Examples of these included program evaluation reports, data dashboards, and program planning materials and documentation.
Decision-making and equity: From caller to crisis response
When someone in crisis needs immediate support, there are numerous decision points that may produce inequities. At each point, local practitioners, depending on the action they take, can help reduce disparities and ensure that all people in crisis receive the care and support they need.
Overview of recommendations
Through their interviews with subject matter experts and program stakeholders, Vera researchers identified seven key areas where communities can take action to develop antiracist, equitable crisis response programs. The table below summarizes Vera’s recommendations for each program area.
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