The evolving landscape of public safety and behavioral health has necessitated a fundamental shift from reactive law enforcement responses to proactive, coordinated care models. In recent years, cities across the United States have implemented sophisticated co-response strategies designed to divert individuals in crisis away from the criminal justice system and toward therapeutic intervention. These initiatives represent a paradigm shift where public health, law enforcement, and community stakeholders collaborate to address the root causes of behavioral health crises, substance use disorders, and homelessness. The core objective is to provide a compassionate, timely, and safe response that prioritizes human dignity and long-term recovery over punitive measures.
At the heart of this movement is the concept of the Coordinated Response Team (CRT) and similar initiatives that bridge the gap between emergency services and specialized care. By integrating mental health clinicians, peer supporters, and law enforcement, these teams offer a unified approach to complex challenges. The strategy is not merely about responding to an emergency; it is about creating a seamless continuum of care that begins the moment a 911 call is placed and continues through stabilization, treatment, and long-term support. This comprehensive approach ensures that vulnerable populations receive immediate attention, avoiding the escalation into a full-blown crisis and preventing unnecessary incarceration.
The success of these models relies on a deep understanding of community needs, real-time data analysis, and robust inter-agency communication. Cities like Boston, San Francisco, Denver, Bellingham, and Albuquerque have pioneered distinct variations of this model, each tailored to local demographics and resource availability. Despite geographical differences, the underlying philosophy remains consistent: to replace punitive interventions with clinical and community-based support. This article explores the mechanics, operational frameworks, and strategic evolution of these co-response teams, drawing on real-world implementations and data-driven strategies that are reshaping how cities manage behavioral health emergencies.
The Architecture of Co-Response: Bridging Safety and Health
The foundation of modern crisis response lies in the integration of public safety and public health sectors. Traditional models often relegated mental health crises to police response, frequently resulting in arrests or hospitalizations. Co-response teams dismantle this siloed approach by pairing law enforcement with clinical specialists. This partnership allows for a dual-track response where safety is maintained while clinical expertise addresses the behavioral health component.
In Boston, the Coordinated Response Team (CRT) exemplifies this architecture. The team operates under a citywide approach that explicitly bridges public safety and public health. This integration is not theoretical; it is operationalized through daily coordination mechanisms. Each morning, the CRT hosts a citywide huddle. This daily meeting convenes high-level leadership from across city departments, including sanitation teams, specialized units within the Boston Police Department, district officers, community-based providers, Public Health-Recovery Services, Emergency Medical Services (EMS), and other first responders.
This huddle serves as a critical hub for sharing real-time information, discussing high-response locations, and coordinating immediate responses for individuals at elevated risk due to addiction, behavioral health, or public safety concerns. The morning huddle ensures that Boston’s most vulnerable individuals and the neighborhoods they impact receive a unified, cross-agency response focused on safety, stabilization, and care. This proactive coordination allows the city to anticipate needs rather than simply reacting to them.
The operational structure of these teams often involves a co-response model where a mental health clinician or peer specialist accompanies a uniformed officer. In the San Francisco Street Crisis Response Team (SCRT), for example, teams consist of three members: a San Francisco Fire Department community paramedic, a mental health clinician, and a peer counselor. This triad ensures that every call is addressed with a blend of medical, psychological, and lived-experience perspectives. Similarly, in Albuquerque, when potential danger exists, Mobile Crisis Team clinicians co-respond with a uniformed Crisis Intervention Unit (CIU) police officer. If the scene is secure, officers can request Alternative Crisis Service (ACS) responders to take the lead.
The goal is to divert individuals with complex needs away from the criminal justice system and into appropriate recovery services and treatment options. This diversion strategy is crucial for reducing the burden on emergency rooms and jails, redirecting resources toward therapeutic solutions. The model emphasizes that crisis avoidance should be as accessible and normative as any other health care service. By making pre-crisis services available, the system normalizes seeking help before a situation deteriorates.
Operational Frameworks and Team Composition
The composition of co-response teams varies by city, reflecting local resources and community demographics. However, common elements include a mix of clinical professionals, peer supporters, and law enforcement personnel. The table below outlines the structural differences across several leading programs:
| Program / City | Team Composition | Operational Scope | Key Feature |
|---|---|---|---|
| Boston CRT | Law enforcement, public health, sanitation, community providers | Citywide coordination, daily huddles | Proactive engagement, recovery campus planning |
| San Francisco SCRT | Paramedic, clinician, peer counselor | Lower priority behavioral health calls, 24/7 mobile response | Trauma-informed, data-driven dispatch |
| Denver STAR | EMTs, behavioral health clinicians | Mental health, poverty, homelessness, substance use | Community engagement, 911 integration |
| Bellingham ART | Two behavioral health specialists | Nonviolent behavioral health calls, unmet basic needs | Unarmed response, no casualty record |
| Albuquerque ACS | Clinicians, law enforcement | Crisis intervention, diversion | Co-response with CIU, scene security |
In Denver, the Support Team Assisted Response (STAR) program was developed through a collaborative process involving the Denver Police Department, city stakeholders, and community members. The team deploys emergency medical technicians and behavioral health clinicians to aid people experiencing crises related to mental health issues, poverty, homelessness, and substance use. The program aims to connect people with necessary supports while minimizing involvement with the justice system. To ensure seamless integration, the Denver Police Department worked with Denver 911 Communications to identify STAR-appropriate calls and integrate STAR response into the existing dispatch system.
The San Francisco SCRT model highlights the importance of data analysis in shaping response strategies. The team engaged with community-level groups to gather information about crisis response needs. They collected and analyzed data on 911 call volume and SCRT engagements across different zip codes to identify service needs. This data-driven approach allows for targeted interventions in high-need areas. SCRT operates six three-person response teams that provide rapid, trauma-informed response 24 hours a day, seven days a week. People can contact SCRT by dialing 911. The San Francisco Department of Emergency Management receives, codes, and sends calls to SCRT for review, ensuring that lower priority behavioral health crisis calls are routed to the appropriate team.
In Bellingham, the Alternative Response Team (ART) represents a highly specialized, unarmed model. Launched in January 2023, this program sends two behavioral health specialists to respond to specific nonviolent behavioral health-related 911 calls. ART also responds to people with unmet basic needs, such as those experiencing homelessness, those needing transportation to resolve a crisis, or individuals without adequate clothing in severe weather conditions. This allows the police to respond to other emergent calls that require law enforcement intervention. ART works closely with other programs within the county mental health system, including the Mobile Crisis Outreach Team operated by Compass Health and What-Comm 911 dispatch, to ensure the right response is deployed.
A critical aspect of these frameworks is the emphasis on "culturally responsive" and "person-centered" care. In Minneapolis, the Behavioral Crisis Response (BCR) team partners with the city to provide person-centered, culturally responsive crisis services. The crisis responders are members of the communities they serve, reflecting the wide range of cultural and racial identities and experiences of the people who need services the most. This demographic alignment fosters trust and improves the efficacy of the intervention.
Strategic Evolution: From Reactive to Proactive Engagement
The evolution of these programs is marked by a strategic shift from reactive crisis management to proactive, preventative engagement. The Boston Coordinated Response Team (CRT) illustrates this transition clearly. In February 2025, the CRT presented an updated "Next Phase" strategy to the Boston City Council, marking a significant step in the city's efforts to end congregate outdoor substance use following the successful implementation of the Encampment Ordinance. This strategy reflects a shift toward proactive, preventative engagement.
The updated strategy includes increased staffing to enhance real-time responsiveness and the launch of a formal co-response model with law enforcement. This coordinated approach is designed to ensure that individuals with the most complex needs are connected to appropriate recovery services, treatment options, and long-term stabilization support. The city works alongside the Boston Public Health Commission to expand access to treatment pathways across the city.
The Boston effort is co-led by a five-member Chair Leadership Team that includes elected officials, community stakeholders, neighborhood leaders, and the Coordinated Response Team. This leadership structure guides the vision, strategy, and community engagement. The initiative is guided by three core focus areas: - Recovery and Addiction: Working to expand access to acute treatment services, residential addiction treatment, and recovery housing to support long-term, sustained recovery. - Public Safety: Strengthening preventative co-response and enhancing coordinated strategies to protect the stability and well-being of neighborhoods and public spaces. - Judicial Initiatives: Focusing on diversion and deflection strategies to build stronger connections between the court system and addiction treatment, ensuring more effective alternatives to incarceration, including a centralized, universal Recovery Court model.
This strategic depth is mirrored in Denver's approach. The creation of the STAR program brought the Denver Police Department, city stakeholders, and members of the community together to develop a plan for how the new community response team would operate. This collaborative planning ensures that the program is grounded in community reality rather than imposed from the top down.
The San Francisco SCRT also emphasizes data-driven adaptation. By analyzing 911 call volumes and engagement data across zip codes, the team can identify specific service needs and adjust resources accordingly. This iterative process ensures that the response system evolves based on empirical evidence of what works and what does not.
Community Engagement and Governance
Public input is central to the success of these initiatives. In Boston, the Recovery Campus Working Group hosts bimonthly public meetings. These meetings serve as an open forum for sharing updates, hearing community concerns, proposing real-time implementable solutions, and offering feedback on how to improve Boston’s collective response to addiction and related safety issues. The Working Group brings together voices from across city and state government, law enforcement, service providers, and institutional partners.
Community engagement is not a one-time event but an ongoing process of dialogue and collaboration. In Denver, the Policing Alternatives and Diversion Initiative (PAD) led a community engagement process to help think through how to design, plan, and implement their Community Referral Services. This ensures that the programs are aligned with the actual needs and cultural contexts of the people they serve.
In Bellingham, the ART program is a collaborative effort by state, regional, and local leadership, including the Whatcom County Health and Community Services' Response Systems Division, City of Bellingham, What-Comm Dispatch, and Compass Health. This multi-level collaboration ensures that resources are leveraged efficiently and that the response is holistic.
The emphasis on community voice is also evident in the composition of the teams themselves. In Minneapolis, crisis responders are members of the communities they serve, reflecting the wide range of cultural and racial identities and experiences of the people who need services the most. This "insider" perspective is crucial for building trust and ensuring that interventions are culturally responsive and person-centered.
Safety, Efficacy, and Long-Term Outcomes
The ultimate measure of success for these co-response teams is their ability to ensure safety, provide effective intervention, and facilitate long-term recovery. The Alternative Response Team (ART) in Bellingham has maintained an impressive safety record. In more than three decades, the program has never had a casualty, and police and program staff are unable to remember an injury or close call. This track record underscores the efficacy of a non-punitive, trauma-informed approach.
The San Francisco Street Crisis Response Team (SCRT) and the Denver STAR program similarly prioritize safety for people in crisis. The STAR program provides emotional de-escalation strategies, crisis intervention support, and connection to appropriate resources. The goal is to connect people with necessary supports while minimizing involvement with the justice system.
In Boston, the Coordinated Response Team is working to organize a comprehensive Recovery Campus under the leadership of Mayor Michelle Wu. This campus is envisioned as a space for addiction treatment, stabilization, and long-term support. This initiative represents a significant step toward creating a physical and structural infrastructure for sustained recovery, moving beyond the immediate crisis response to address the long-term needs of individuals struggling with addiction.
The integration of these services into the 911 system is a critical component of safety and accessibility. In San Francisco, people can contact SCRT by dialing 911. The San Francisco Department of Emergency Management receives, codes, and sends calls to SCRT for review. This seamless integration ensures that individuals in crisis can access specialized help through the same universal access point as emergency services.
The efficacy of these models is also measured by their ability to reduce the burden on the justice system. By diverting people suffering from mental illness away from the criminal justice system and into mental health treatment, these programs reduce incarceration rates and improve health outcomes. The Crisis Intervention Teams (CIT) focus on law enforcement training and procedures, but the program is also designed to coordinate the efforts of law enforcement personnel, mental health providers, and community stakeholders to increase the safety of encounters.
The Role of Data and Continuous Improvement
Data analysis plays a pivotal role in the continuous improvement of these programs. The San Francisco SCRT engages with community-level groups to gather information about crisis response needs, in addition to collecting and analyzing data on 911 call volume and SCRT engagements in different zip codes to identify service needs. This data-driven approach allows for targeted resource allocation and strategic planning.
In Denver, the STAR program integrated into the existing dispatch system through collaboration with Denver 911 Communications. This integration ensures that the right type of call is routed to the appropriate team, optimizing the efficiency of the response. The ability to identify "STAR-appropriate calls" allows the system to triage effectively, ensuring that behavioral health crises are handled by specialists rather than general police forces.
The Boston Coordinated Response Team utilizes a daily huddle to share real-time information and discuss high-response locations. This mechanism allows for immediate adjustments to strategy based on current trends. The team's strategy is not static; it evolves based on real-time feedback and data. The updated "Next Phase" strategy presented to the Boston City Council reflects a shift toward proactive, preventative engagement, demonstrating a commitment to continuous improvement.
The use of data also informs the design of the Recovery Campus. By analyzing service gaps and community needs, the city can plan a comprehensive facility that addresses the full spectrum of recovery, from acute treatment to long-term housing. This data-informed planning ensures that the campus serves the actual needs of the population.
Conclusion
The movement toward co-response teams represents a transformative shift in how cities manage mental health and substance use crises. By integrating public health, law enforcement, and community stakeholders, these programs offer a compassionate, data-driven, and effective alternative to traditional emergency responses. The success of models in Boston, San Francisco, Denver, Bellingham, and Albuquerque demonstrates that a coordinated, person-centered approach can significantly improve safety, reduce incarceration, and support long-term recovery.
The core principle guiding these initiatives is that crisis response should be a seamless continuum of care. From the initial 911 call to long-term stabilization, the goal is to connect individuals with the right resources at the right time. Whether through daily huddles in Boston, mobile units in Denver, or unarmed specialists in Bellingham, these teams prioritize human dignity and community well-being. As these models continue to evolve, they offer a blueprint for a more humane and effective public safety system that addresses the root causes of crisis rather than merely managing the symptoms.