The American Psychological Association estimates that 20% of all police calls in the United States involve service for mental health or substance abuse emergencies, but our conception of public safety has long ignored mental health. Since 2015, nearly a quarter of all people killed by police officers in America have had a known mental illness. Many police departments do not provide adequate training for law enforcement officers to determine if an individual is in crisis, make judgments about the individual’s intent, and deescalate the situation because there is no central authority to define and implement protocols for these emergencies.
Individuals experiencing crises like mental illness, drug addiction, or homelessness often do not receive the help they need because police treat them with carceral tactics. Carceral tactics focus on control and deterrence instead of a trauma-informed response. These negative interactions further stigmatize victims and escalate police encounters to a dangerous or life-threatening level. Our police forces have long failed to respond appropriately to individuals in distress, and we now face a new public health emergency that has slipped through the cracks of the policing crisis: a crisis of care.
Crisis intervention teams first came about in 1987 after police officers in Memphis shot an individual under the influence of substances and suffering from mental illnesses. Although these teams exist in local police departments across the country, the programs have had mixed success for a variety of reasons. Policing is not federalized, so the rigor of training and the selection method for crisis intervention officers vary widely by jurisdiction. These issues can lead to the selective or wrongful use of de-escalation tactics and create difficulties gathering reliable data on the effectiveness of the programs. Another issue is the difficulty of quantifying the level of safety individuals feel during police encounters. The most common metric in existing research is the fatality rate of citizen-officer interactions, but this measure cannot reliably account for physical or verbal violence that stops mere inches short of death.
Evidence on the effectiveness of crisis intervention in terms of lower fatalities is lacking, but early research shows measurable positive effects of higher officer satisfaction, self-perceived reduced use of force, and increased diversion to psychiatric services instead of jails. One study, in which half of the subject pool was trained in crisis intervention, showed an increase in verbal negotiation as the highest level of force used by crisis-intervention-trained officers. This study reviewed 1,063 police encounters with distressed individuals. It also showed that crisis intervention training increased referrals to mental health units and decreased the likelihood of arrest, which could provide a step toward dismantling a justice system that overwhelmingly targets vulnerable individuals.
The mixed success of crisis intervention has highlighted the urgent need to invest in alternatives to carceral outcomes for distressed individuals. Activists are hopeful that reforms could include the use of mental health-based specialized response or street triage, more funding for comprehensive community outreach programs, or an increase in the number of beds at inpatient acute or long-term residential facilities. Long-term alternatives could also include increased research and intervention on the social determinants of mental health, such as racism and poverty, or additional resources devoted to preventative mental health care.
The People’s Response Act, introduced in the House of Representatives by Rep. Cori Bush, D-Mo., would address the crisis of care by reframing crisis response as a public health issue. The bill aims to reduce the rate of violence and death in police encounters with individuals experiencing a mental health emergency, substance abuse, or homelessness by reframing crisis response as a public health issue. To accomplish this goal, the bill creates a Division on Community Safety within the Department of Health and Human Services (HHS). This proposed division would develop and implement federal crisis intervention teams that address mental health-related 911 calls in police departments across the country.
The proposed federal crisis intervention unit would train and dispatch mental health first responders to serve within local law enforcement departments. In addition, the division would coordinate research on police encounters with distressed individuals, provide technical assistance to law enforcement units, and fund grant programs related to non-carceral, health-centered investments in public safety. The $10 billion proposal hopes to eventually move policing entirely out of the purview of the Department of Justice and into the jurisdiction of HHS.
The proposal would allocate $7.5 billion to HHS to fund state and local governments’ crisis response efforts. The act would also establish a $2.5 billion First Responder Hiring Grant to create crisis response jobs, hire trained mental health professionals, support non-carceral approaches to public safety, and fund research on alternative approaches to public safety across the federal government. The measure will expire on December 31, 2022, if the bill fails to pass in Congress and make it to the president’s desk for signing.
Mental illness and addiction are not crimes. They are diseases that society should meet with care, not the presumption of guilt. Transforming our conception of policing to center public health and safety will deliver more equitable criminal justice outcomes, and more importantly, save lives. If administered through a centralized, well-monitored federal authority with generous funding, crisis intervention teams could be one of the most effective tools we have to combat a set of concurrent epidemics: addiction, racism, and mental health stigmatization.