The intersection of mental health crises and law enforcement has become one of the most pressing public safety and human rights challenges in the United States and globally. When a person is experiencing a mental health crisis, the default response in many jurisdictions remains the dispatch of armed police officers. However, extensive evidence suggests that this model is often ill-suited to the unique needs of individuals in psychological distress. The presence of police, while intended to provide security, frequently exacerbates the crisis, leading to unnecessary use of force, trauma, and in tragic instances, death. As communities and policymakers seek solutions, a paradigm shift is underway: moving from a security-first model to a health-led response system where specially trained civilians, medics, and mental health professionals take the lead in managing these emergencies. This transition is not merely about changing who responds to 911 calls; it is a fundamental reimagining of how society cares for its most vulnerable members during moments of profound vulnerability.
The High Stakes of Police Involvement in Mental Health Crises
In many regions, the statistics reveal a startling frequency of police interaction with individuals experiencing mental health crises. In New South Wales, Australia, police respond to triple zero calls regarding mental health issues every nine minutes, and in Victoria, the interval is every ten minutes. These numbers highlight the sheer volume of these encounters. Yet, the outcome of these interactions is frequently negative. Research indicates that about one in ten people who access mental health services have previously had an encounter with law enforcement. For many, these interactions are not neutral; they are often traumatic.
The primary driver for police taking individuals to hospital emergency departments is self-harm or suicidal distress, not violence toward others. Despite the non-violent nature of most crises, the response often involves aggressive tactics. Interviews conducted between 2021 and 2022 with 20 individuals in Australia revealed a pattern of excessive force. Respondents described being subjected to pepper spray, tasers, police dogs, batons, handcuffs, and restraints, even when they were not under arrest. One individual, Alex, recounted being pepper-sprayed during an anxiety attack and suffering bruises from roughly applied handcuffs despite not being accused of a crime. These accounts illustrate that the mere presence of armed, uniformed officers can escalate heightened emotional situations rather than de-escalate them.
The consequences of this mismatch between the problem and the response can be fatal. In March 2020, Daniel Prude in Rochester, New York, was behaving erratically. Police arrived, restrained him, placed a mesh hood over his head, and pinned him to the pavement. He stopped breathing within two minutes and fifteen seconds and died a week later. This is not an isolated incident. In 2021 alone, at least 104 people were killed after police responded to someone behaving erratically or having a mental health crisis. Another tragic case involved Daniel K. McAlpin, who was killed in his home in 2022 after an officer used a stun gun and then shot him five times in less than four seconds.
These fatalities represent the worst-case outcomes, but the more common result is a failure to provide necessary care. Interactions often end in handcuffs and jail time. Consequently, some U.S. jails hold more people with serious mental health conditions than any dedicated treatment facility in the country. This criminalization of mental illness creates a cycle where individuals in crisis are treated as security threats rather than patients in need of medical and psychological support.
The Limitations of Traditional Police-Only Response
The core issue is that police officers are rarely equipped to deal with the complexities of mental health crises. While law enforcement agencies acknowledge they are ill-equipped to intervene effectively, the structural reality is that they remain the default first responders. The International Association of Chiefs of Police (IACP) notes that responding to persons in crisis (PIC) requires officers to make difficult judgments about mental state and intent. The goal is to de-escalate and minimize violence, but the tools available to police—firearms, restraints, and aggressive tactics—are inherently mismatched for therapeutic intervention.
Studies on the current police-led model reveal significant inefficiencies. When police take people experiencing mental health crises to hospital emergency departments, the admission rate is low. One study found that only 23% of those taken to the emergency room—usually after expressing intentions to self-harm—were admitted to the hospital. The remaining 77% are released, often without adequate follow-up care, meaning the underlying crisis remains unresolved.
Furthermore, the strain on police resources is significant. When police are the sole responders, they are pulled away from their primary duties to manage situations that require clinical expertise. In Australia, research indicates that people with mental health issues prefer an ambulance-led response without police attending at all. They desire linkage to therapeutic and community-based services, including mental health peer support, housing, disability support, and family violence services. The current system fails to provide these connections, often leaving individuals in a state of limbo after a police encounter.
The Co-Responder Model: Bridging Security and Care
To address these failures, a new model has emerged: the co-responder program. This approach involves mental health clinicians—such as social workers, counselors, or psychologists—attending mental health incidents alongside police. The objective is to de-escalate incidents, reduce emergency department presentations, and link individuals to appropriate services.
Evidence supports the efficacy of this model. An evaluation of a co-response program in Victoria found that when mental health clinicians are present, the response is quicker and of higher quality compared to police attending alone. The presence of a clinician allows for immediate therapeutic engagement, reducing the need for physical restraint or force.
| Feature | Traditional Police Response | Co-Responder Model |
|---|---|---|
| Primary Responder | Police Officer(s) | Police + Mental Health Clinician |
| Primary Goal | Security and Arrest | De-escalation and Care |
| Outcome | High rate of restraints, low hospital admission | High rate of community linkage, reduced arrests |
| Use of Force | Frequent, often unnecessary | Minimized, focused on safety only if absolutely required |
| Service Connection | Limited, often results in jail | Strong, links to housing, peer support, and therapy |
The co-responder model acknowledges that while police may still be present for safety, the mental health professional leads the clinical aspect of the intervention. This dual approach aims to resolve the situation constructively and humanely. However, the success of these programs is often limited by under-resourcing. Without sufficient funding and staffing, these initiatives struggle to scale, leaving many crises still handled by police alone.
Civilian-Led Crisis Response: The CAHOOTS Model
A more radical shift is the complete removal of police from the equation, replacing them entirely with civilian crisis teams. This approach has broad support and is operating in more than a dozen cities, including Rochester, New York, the site of the Daniel Prude tragedy. The most prominent example is Crisis Assistance Helping Out on the Streets (CAHOOTS) in Eugene, Oregon.
Operated by Eugene’s White Bird Clinic, CAHOOTS has functioned for over 30 years. The program dispatches two-person teams consisting of a medic and a crisis worker. These teams respond to behavioral health crisis calls, providing: - Crisis intervention - Counseling - Basic emergency medical care - Transportation to appropriate facilities - Referrals to long-term services
In 2019, CAHOOTS responded to an estimated 17,700 calls, representing 17% of all service calls in the city. This demonstrates that a significant portion of 911 calls related to mental health, substance use, homelessness, and quality of life concerns can be effectively managed without police involvement. A recent analysis of eight cities found that between 21% and 38% of 911 calls fall into these categories.
The CAHOOTS model addresses the root cause of the problem: the mismatch of tools. By sending medics and crisis workers, the response is therapeutic rather than punitive. This aligns with the desires of those with lived experience, who often report trauma from police encounters and a strong preference for health-led responses.
Emerging Initiatives: The B-HEARD Program
New York City has attempted to implement a similar model through its Behavioral Health Assistance Response Division (B-HEARD). Administered by the city’s fire department and the Department of Health and Mental Hygiene, B-HEARD dispatches teams composed of two emergency medical technicians and a mental health professional. This program was launched in 2021 and responds to calls from New Yorkers experiencing psychological distress, specifically in cases not involving weapons or violence.
However, the program faces significant challenges. A major obstacle is the lack of comprehensive data collection, making it difficult to fully assess efficacy and scope. Currently, the response depends heavily on geography and time of day within the five boroughs, leading to inconsistent service delivery. While the intent is to provide a humane alternative, the program is described as "well-intended but deeply flawed" due to these structural limitations. The lack of data hinders the ability to measure success and identify areas for improvement.
The Path Forward: Data, Training, and Systemic Reform
The transition from a police-centric model to a health-led system requires more than just new teams; it demands a fundamental change in how society perceives mental health crises. The evidence suggests that criminalizing mental illness is ineffective and dangerous. Jails have become de facto mental health facilities, a reality that highlights the failure of the current system.
To move forward, several key actions are necessary: - Data Collection: Establish robust data tracking to understand the volume and nature of calls, as seen in the limitations of B-HEARD. - Funding: Allocate resources to ensure co-responder and civilian programs are fully staffed and not limited by budget constraints. - Training: While police training is important, the priority should shift to training the civilian responders and ensuring police know when to defer to health professionals. - Policy Reform: Legal frameworks must be updated to support civilian response and limit police involvement in non-violent mental health calls.
The IACP Policy Center is currently reviewing guidelines for responding to persons in crisis, emphasizing that the law must guide the detention of PIC (Persons in Crisis). However, the focus must shift from "detention" to "support." The goal is to resolve situations in the most constructive, safe, and humane manner possible.
The Human Cost of Inaction
The human cost of maintaining the status quo is measured in trauma and death. The cases of Daniel Prude and Daniel McAlpin serve as grim reminders of what happens when police are the only option. But beyond the fatalities, the cumulative trauma inflicted on individuals with mental health issues is profound. Excessive use of force, the threat of arrest, and the lack of appropriate care create a cycle of fear and avoidance.
People with lived experience consistently report that they want to be linked to community-based services. They do not want to be criminalized. The current system, by defaulting to police, often results in the opposite: increased hospitalizations that lead nowhere, or time in jail. The co-responder and civilian models offer a path to break this cycle. By prioritizing health professionals and medics, the system can focus on de-escalation and connection to care, ensuring that the response to a mental health crisis is one of healing rather than punishment.
Conclusion
The evidence is clear: the traditional police response to mental health crises is frequently inadequate, dangerous, and traumatic. While police may be the first responders in many jurisdictions, they are not trained to handle the nuanced needs of individuals in psychological distress. The shift toward co-responder programs and civilian-led initiatives like CAHOOTS and B-HEARD represents a critical evolution in public safety and mental health care. These models prioritize de-escalation, therapeutic support, and community linkage over security and arrest.
However, these solutions face hurdles, including under-resourcing, inconsistent implementation, and a lack of comprehensive data. The path forward requires sustained political will, adequate funding, and a commitment to collecting and analyzing data to refine these programs. The goal is to create a system where a person in crisis receives compassionate, clinical care rather than a police encounter. As demonstrated by the tragic outcomes of police-only responses, the stakes are too high to maintain the status quo. A health-led approach is not just an alternative; it is a necessity for the safety and well-being of individuals experiencing mental health crises.