A Smarter Public Safety Model
Addressing Crises Related to Mental Health, Substance Abuse, and Chronic Homelessness
By Dr. Ronal Serpas | IACP Police Chief Magazine | January 2021
On October 31, 1963, U.S. President John F. Kennedy signed a bill meant to free many thousands of people with mental illnesses from life in institutions. It envisioned building 1,500 outpatient mental health centers to offer individuals with mental illnesses community-based care instead. The bill was the last piece of legislation Kennedy signed; three weeks later, he was assassinated. (1)
However, despite the aspirations for the bill, one needs only to look at the police and the criminal justice system’s role in responding to mental health issues, drug and alcohol addiction, and chronic homelessness to see how far the United States is from achieving Kennedy’s vision.
The police—and, by extension, the broader criminal justice system—have become the government’s de facto first responder to persons suffering from mental health issues, drug and alcohol addiction, and chronic homelessness. Should it be this way?
It is well known that “the three largest mental health providers in the nation today are jails: Cook County in Illinois, Los Angeles County, and Rikers Island, New York.” (2) According to the National Alliance on Mental Health,
The vast majority of the individuals [with mental illness in jails] are not violent criminals—most people in jails have not yet gone to trial, so they are not yet convicted of a crime. The rest are serving short sentences for minor crimes. (3)
Moreover, as research has shown, and as police personnel all know from experience, “jailing people with mental illness creates huge burdens on law enforcement, corrections, and state and local budgets” without advancing public safety. (4)
“Central to the philosophy of community policing is that the community prioritizes what and how the police will respond—such that the police response itself is in cooperation with the community.”
Why have jails and prisons become the default for those in need of mental health and drug and alcohol treatment and those experiencing chronic homelessness in the United States? For the most part, federal, state, and local governments have continued to choose or resort to the police as the “designated first responder” when individuals call about events or observations relating to these matters or when police see a public disturbance or crime in progress. When the police respond, they are often left with few options other than making an arrest to resolve the problem. So, often, the police respond to complaints of trespassing, public intoxication, aggressive panhandling, blocking traffic, and more without adequate tools to address the underlying issues that led to the call to 911—whether those issues are mental illness, addiction, homelessness, or a combination of these factors.
According to recent research by the U.S. Department of Justice,
About 1 in 7 state and federal prisoners (14 percent) and 1 in 4 jail inmates (26 percent) reported experiences that met the threshold for serious psychological distress (SPD) … Similarly, 37 percent of prisoners and 44 percent of jail inmates had been told in the past by a mental health professional that they had a mental disorder. (5)
The time has come for the government to create a new and fully resourced system of first responders to address these complex challenges—to proactively provide services for populations in crisis—without resorting to arrest or incarceration. Undoubtedly, if there are signs of violence or serious crime, the police should still provide a secondary response, as is currently done for many other first responders (such as fire and EMS).
The Impact of Community Policing Considered
Over the last 40 years, there have been dramatic changes in police service delivery. In the early 1980s, before the emergence of the community policing era, most police officers responded reactively to calls for service, primarily concerning vehicle crashes, alarms, crime reports, disputes, and the like. (6) Community policing brought a fundamental change in police service delivery—encouraging the profession to become proactive. Community policing can be understood as “a philosophy that promotes organizational strategies that support the systematic use of partnerships and problem-solving techniques to proactively address the immediate conditions that give rise to public safety issues such as crime, social disorder, and fear of crime.” (7)
Central to the philosophy of community policing is that the community prioritizes what and how the police will respond — such that the police response itself is in cooperation with the community. Often, communities call upon the police for noncriminal, nonviolent events or disputes. Over time, community policing has been successful in realigning police response away from the reactive days of the profession to today’s community-oriented proactive and responsive posture. This realignment necessarily meant that the police dramatically expanded the type of issues to which they respond to include issues that are far removed from violent crime or even serious crime. Concurrently, police departments’ staffing levels have increased over the last few decades in response to these new demands. This may explain the paradoxical situation that many communities have seen: over the past decades, crime rates have fallen significantly in the United States, while police staffing has increased in many jurisdictions. (8) Local governments’ sworn police officers have increased from approximately 375,000 in 1992 to nearly 470,000 in 2016. (9) As the police have expanded into nontraditional police duties—for the purpose of building support and confidence in their communities—while also working to improve the essential police function of preventing and solving crime, communities’ demands for services have dramatically increased. (10)
It is critical to note some additional findings on the role of police in communities. The Vera Institute of Justice analyzed 911 calls for service between 2016 and 2017 in the Camden, New Jersey; Tucson, Arizona; New Orleans, Louisiana; Detroit, Michigan; and Seattle, Washington, police departments. (11)
Key findings from this study include the following:
As many as half of computer-aided dispatch (CAD) records may be of limited reliability due to lack of call type specificity and other call information omitted from the narrative.
Officers spend a substantial proportion of their time responding to calls for service, few of which are related to crimes in progress, let alone serious crimes in progress.
Most calls do not relate to serious or violent crime; instead, the most frequent calls involve nuisance complaints and low-level crimes.
The most frequent incident type was noncriminal in nature. In four of the five sites, the most frequent incident type was some variation of a complaint or request for an officer to perform a welfare check. Across all sites, the most common priority types were non-emergency.
The findings across all sites suggest the need for future research and local conversations about whether certain types of 911 calls for service require responses by police. (12)
These findings likely ring true for police leadership as more agencies have expanded their responses beyond traditional law enforcement to meet the needs of the community policing era.
Moreover, when considering response strategies for 911 calls associated with mental illness, which often co-occurs with homelessness and substance abuse, Governing Magazine recently reported that one in ten calls for police service concern mental health issues. (13) Research also suggests that most encounters between police and persons with mental illnesses do not involve major crimes or violence, nor do they rise to the level of requiring emergency apprehension. (14) Accordingly, as noted by John Snook, the executive director of the Treatment Advocacy Center: “This isn’t a law enforcement problem… Police are forced to be the first responders for mental health calls, something that they aren’t suited to do.” (15)
Recognizing this reality does not in any way diminish the role of the police or question the public’s requests for assistance in response to violence, serious and non-serious crimes, and the scourge of illegal narcotics trafficking and use. Nor does it suggest that crises involving mental illness, drug and alcohol addiction, and chronic homelessness cannot become violent—for they can and sometimes do.
But these data do underscore the need for a robust public safety model that relies on health professionals as a first response and the police as backup when needed. In determining how to most effectively respond, an analysis of calls for service will help inform each specific community’s needs.
The Public Safety Model Needed
Continuing to rely on or add to the first responder duties of police in calls for service pertaining to mental health, substance abuse, and homelessness misses the point. As people across communities have demanded, it is time to imagine a new public safety response. The government should properly staff, support, and officially designate an agency of first and proactive responders of health professionals in the fields of mental health, drug and alcohol addiction, and homelessness. (16) In this new model, the police should serve as backup for calls that involve violence, serious criminal events, or risk of escalation.
Events of the last few years have sharpened the focus on what it is like to be the community’s designated first response to situations involving complex issues of mental health, drug and alcohol addiction, and chronic homelessness. In many circumstances, these issues are so deeply interwoven that they are indistinguishable from one another to a responding police officer or a community member calling the police for assistance. (17) Most often, calls for service and the police’s responses are associated with quality-of-life or social disorder concerns from businesses and residents around a person’s conduct. A recent analysis conducted by the Center for American Progress (CAP) and the Law Enforcement Action Partnership (LEAP) estimates that anywhere between 33 and 68 percent of police calls could be handled without dispatching an armed officer, between 21 and 38 percent could be met with civilian first responders, and between 13 to 33 percent could be dealt with administratively. (18) Despite this, many cities continue to rely on the police as the government’s designated first responder for such calls or when the police directly observe related issues when proactively engaging with members of their community.
However, heightened and focused awareness of the need for a holistic response from local governments seems to be on the horizon. According to a recent article in Government Financial Review,
Considerable attention has focused on the role of police as first responders to reports of individuals with serious mental health issues. This role for the police has been the result of the absence of adequate investments in community-based mental health services. More broadly, the criminal justice system has become the point of service for the provision of a large percentage of mental health services. In most cases, the local jail is the largest mental health provider in the community. (19)
In many U.S. cities, efforts are underway to reimagine the community and government’s response to persons in need and calls for service. Recently, San Francisco announced plans to create a response led by “fire and health officials—not the police—to respond to most calls for people in a psychiatric, behavioral, or substance abuse crisis.” (20) There are other prominent examples, such as the CAHOOTS program of Eugene, Oregon, or the Tucson, Arizona, Police Mental Health Support Team. (21) And consistent with the community policing philosophy, many police agencies have created Homeless Outreach Teams (HOT) and taken other proactive measures to serve these populations. (22) Another example is the Harris County Sheriff’s Office (HCSO) in Texas, which has created a Clinician and Officer Remote Evaluation CORE program that utilizes a Telehealth for Patrol tool. The initiative allows licensed health professionals to offer health services remotely through the use of telecommunication or information technology. (23) The HCSO is also actively engaged in pairing trained mental health professionals with law enforcement officers in responding to appropriate calls for service, either virtually through telehealth or with a practitioner riding in a police vehicle. There are, however, significant logistical challenges in pairing professionals with officers in their vehicles.
“Cities are now examining whether they can use social workers instead of police officers as the first responders to calls related to individuals with mental health issues and homeless individuals.”
While the use of new technology and pairing of health professionals provide a substantial advantage over the absence of such assistance, the police are still designated as the government’s first responder in the listed examples above (excluding CAHOOTS for the majority of their calls). (24) This must change.
There are at least three general ways in which persons in need of service due to mental illness, drug and alcohol abuse, or chronic homelessness are identified by the government:
Proactive efforts of community groups or government. This strategy helps identify those in crisis before a call for service is necessary. Under this approach, with few exceptions, such as CAHOOTS, the police often remain the government’s designated first responder to calls that do come in.
Reactive efforts (nonviolent). Police typically are dispatched based on a call for service regarding low-level, nonviolent crime associated with an individual, or become involved due to police observation of behavior by a person in crisis that could put the person or others at risk. In this case, police are designated as the first responder by the government.
Reactive efforts (violent). Police respond to calls for service that involve violent acts or serious violent crime. In this case, police are also designated as the first responder by the government.
Critical Questions to Consider When Creating a Public Safety Model
If one accepts the premise that the government’s designated first response to these groups should be health professionals—so as to divert individuals who have committed nonviolent and non-serious crimes away from the police and broader criminal justice system—how can this be accomplished? As recently noted by management consultants Seth Williams and David Eichenthal, “cities are now examining whether they can use social workers instead of police officers as the first responders to calls related to individuals with mental health issues and to calls related to homeless individuals.” (25)
As the idea of a public health first responder organization is developed, a series of questions should be considered, including but not limited to:
Will a government designate another appropriate agency staffed with health professionals as the first responders to nonviolent and low-level crime calls involving persons experiencing mental illness, drug and alcohol addiction, and chronic homelessness, thereby removing the first responder designation from the police and deflecting cases away from the broader criminal justice system?
How will a government ensure that the police remain readily available to assist in cases where their specific skills, training, and responsibilities apply, similar to the police’s role when supporting fire departments, EMS, and other urgent government response services?
What proactive strategy will this new first responder agency of health professionals, which may also be a partnership with community members, provide before a situation escalates to the point of requiring a call for service from the community members?
What reactive strategies can be designated to this new agency of health professionals to actively engage involved persons after a call for service from a person or business who is concerned about nonviolent and low-level criminal violations (e.g., trespassing, public intoxication, panhandling, people who may be dangers to themselves)?
Do the local government and community-based providers have the capacity to meet the needs of this population so that they can effectively support the new first responders?
What are the gaps in relevant service providers’ capacity?
Is there available data on local law enforcement’s experience when serving as the first responder to calls relating to mental health, addiction, and homelessness that can inform the creation and staffing of this newly established and proactive agency composed of public health professionals?
What screening mechanism can be implemented in call centers to direct 911 calls for service to this new agency when appropriate?
While creating a team of mental health first responders is a promising public safety strategy, indiscriminately cutting law enforcement budgets to do so may harm community policing efforts that are already underway. Although community policing requires significant investments in personnel, there is near-universal support for community-led policing strategies among local, state, and federal political leaders. Communities may be reluctant to lose the gains realized from years of work implementing these strategies. At the same time, the expansion and creation of a new, more appropriate, governmental and community-based group of first responders to individuals experiencing mental health issues, drug and alcohol addiction, and homelessness could have a significant positive impact on the lives of those who are in need of help, while also offering the government a financial savings from decreased policing and criminal justice system costs. As communities weigh these options and choose a path forward, they should be careful to implement a specific, focused strategy to meet the distinctive needs of their community without undermining advancements made possible by community policing models.
These fundamental questions, and others, will allow localities to develop a framework for thoroughly reexamining the “whole of government” and “communities of support” response for the populations identified herein—with the ultimate goal of removing the police as the government’s designated first responder to public health issues. Partnering medical and social science experts with the police might not be as effective as developing new and fully resourced designated first responder health professionals, who would, as needed, be supported by the police—not the other way around.
INNOVATIVE APPROACHES
CAHOOTS
(Eugene, Oregon)
CAHOOTS (Crisis Assistance Helping Out On The Streets) offers mobile crisis intervention 24/7 in the Eugene-Springfield, Oregon, metro area.
CAHOOTS teams, consisting of a medic and a crisis worker, are dispatched through the Eugene police-fire-ambulance communications center, and, within the Springfield urban growth boundary, dispatched through the Springfield non-emergency number. CAHOOTS provides immediate stabilization in cases of urgent medical need or psychological crisis; assessment; information; referrals; advocacy; and, in some cases, transportation to the next step in treatment. In 2017, 17 percent of an estimated 130,000 calls were diverted from police to CAHOOTS teams, freeing up police officers to handle higher-level emergencies.
Sources: White Bird Clinic “CAHOOTS”; LJ Dawson, “Taking Police Officers Out of Mental Health-Related 911 Rescues,” NBC News, October 10, 2019.
*******
Mental Health Support Team
(Tucson, Arizona)
Established in 2014, the Tucson Police Mental Health Support Team (MHST) aims to prevent behavioral health incidents through early intervention. Representing a philosophical shift in law enforcement response, the team’s mission is to “provide improved public safety and service through the utilization of mental health services. Primarily a follow-up unit, MHST strives to decrease the number of incarcerated mentally ill individuals by acting as an entry point into mental health treatment and prevent incidents through early intervention with speedy and thorough case follow-up.”
Source: City of Tucson, “Tucson Police: Mental Health Support Team.”
NOTES
Vic DiGravio, “The Last Bill JFK Signed—And the Mental Health Work Still Undone,” WBUR, October 23, 2013. See also, Gary Cordner, People with Mental Illness, Problem-Oriented Guides for Police, Problem-Specific Guides Series, no. 40 (Washington, DC: Office of Community Oriented Policing Services, 2006), 7.
“50 Years Later: President John F. Kennedy’s Vision for Mental Health in U.S. Never Realized,” Deseret News, October 21, 2013, https://www.deseret.com/2013/10/21/20458258/50-years-later-president-john-f-kennedy-s-vision-for-mental-health-in-u-s-never-realized; Alisa Chang, “Insane: America’s 3 Largest Psychiatric Facilities are Jails,” NPR, April 30, 2018.
Two million individuals with mental illness are booked into jails every year and the vast majority are nonviolent. National Alliance on Mental Illness (NAMI), “Jailing People with Mental Illness.”
NAMI, “Jailing People with Mental Illness.”
Jennifer Bronson and Marcus Berzofsky, Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-12, Special Report (Washington, DC: Bureau of Justice Statistics, 2017).
Quint Thurman, Jihong Zhao, and Andrew Giacomazzi, Community Policing in a Community Era: An Introduction and Exploration (Los Angeles: Roxbury Publishing Co., 2001).
Community Oriented Policing Services, Community Policing Defined (Washington, DC: U.S. Department of Justice, 2014).
Violent crime rates have fallen 51 percent between 1993 and 2018. Property crime rates were three times higher in 1993 than in 2018, 351.8 per and 108.2 per 100,000 households, respectively. Federal Bureau of Investigation, “Violent Crime,” 2019 Crime in the United States; John Gramlich, “5 Facts About Crime in the U.S.” Pew Research Center, October 17, 2019.
Seth A. Williams and David R. Eichenthal, “The Debate Over Defunding the Police,” Government Financial Review (October 2020).
Joel Rubin and Ben Poston, “LAPD Responds to a Milloion 911 calls a Year, But Relatively Few Relate to Violent Crimes,” Los Angeles Times, July 5, 2020;. Jeff Asher and Ben Horwitz, “How Do the Police Actually Spend Their Time?” The New York Times, June 12, 2020; Amos Irwin and Betsy Pearl, “The Community Responder Model: How Cities Can Send the Right Responder to Every 911 Call,” Center for American Progress, October 28, 2020.
S. Rebecca Neusteter et al., Understanding Police Enforcement: A Multicity 911 Analysis, (Vera Institute of Justice, September 2020).
Neusteter et al., Understanding Police Enforcement.
Mike Maciag, “The Daily Crisis Cops Aren’t Trained to Handle,” Governing (May 2016).
Jennifer D. Wood, Amy C. Watson, and Anjali J. Fulambarker, “The “Gray Zone” of Police Work During Mental Health Encounters: Findings from an Observational Study in Chicago,” Police Quarterly 20, no. 1 (March 2017): 81–105.
Similarly, the Center for American Progress (CAP) and the Law Enforcement Action Partnership (LEAP) recommend that cities establish Community Responders — a “new branch of civilian first responders” who would be dispatched in response to calls for service that do not require police response. Irwin and Pearl, “The Community Responder Model.”
National Coalition for the Homeless, “Substance Abuse and Homelessness,” fact sheet, July 2009. See also, Cordner, People with Mental Illness.
Irwin and Pearl, “The Community Responder Model.”
Seth A. Williams and David R. Eichenthal, “The Debate Over Defunding the Police,” Government Financial Review, October 2020.
Eric Westervelt, “Removing Cops From Behavioral Crisis Calls: ‘We Need to Change The Model,’” NPR, October 19, 2020.
White Bird Clinic “CAHOOTS”; LJ Dawson, “Taking Police Officers Out of Mental Health-Related 911 Rescues,” NBC News, October 10, 2019; City of Tuscon, “Tuscon Police: Mental Health Support Team.”
Daniel McDonald, “The Top 10 Reasons to Start a Police Homeless Outreach Team” (webinar from Bureau of Justice Assistance, Washington, DC, October 2, 2019).
Frank Webb, “Model Telehealth Program For Law Enforcement: Another First For Harris County,” National Alliance on Mental Illness,” NAMI Greater Houston; Telehealth Implementation Guide (Harris County Sheriff’s Office, February 2020), 24.
Scottie Andrew, “This Town of 170,000 Replaced Some Cops with Medics and Mental Health Workers. It’s Worked for Over 30 Years,” CNN, July 5, 2020.
Williams and Eichenthal, “The Debate Over Defunding the Police.”
Ronal Serpas, PhD, is senior advisor to the Center for Justice & Safety Finance and a professor of practice in the Loyola University New Orleans Criminology and Justice Department, which he joined after a 34-year career in law enforcement. His career included leading three large police agencies, serving as an elected IACP vice president, and being designated as an honorary president of the IACP.