Issues in Law Enforcement Reform: Responding to Mental Health Crises
Congressional research reportOct 17, 2022
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Issues in Law Enforcement Reform:
Responding to Mental Health Crises
October 17, 2022
Congressional Research Service
https://crsreports.congress.gov
R47285
SUMMARY
Issues in Law Enforcement Reform:
Responding to Mental Health Crises
The manner in which police have handled mental health-related encounters has come under
increased scrutiny during the last few decades, especially regarding the use of force. Through
hearings and legislation, policymakers have demonstrated an interest in improving the police’s
response to individuals who are experiencing a mental health crisis.
When considering options for improving law enforcement’s response to people experiencing a
mental health crisis, policymakers have looked to specialized responses employed by local
governments across the country. These responses include the following:
Crisis Intervention Teams (CITs), in which specially trained law enforcement officers
respond to calls for service involving people having a mental health crisis and liaise with
mental health providers.
Co-Responder Teams (CRTs), which pair law enforcement officers with trained
clinicians who together respond to emergency calls involving individuals experiencing a
mental health crisis.
R47285
October 17, 2022
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Analyst in Crime Policy
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Isobel Sorenson
Research Assistant
Mobile Crisis Teams (MCTs), which utilize community-based mental health
professionals to respond to individuals experiencing mental health crises. These teams
typically do not involve the police initially, though police can be called upon when appropriate.
Research on specialized responses to people experiencing a mental health crisis suggests that CITs, CRTs, and MCTs may
improve some outcomes, such as improving police officers’ perceptions of and response to people with mental illness and
connecting people to mental health services. However, it remains less clear whether these changes translate into actual
improved outcomes for people with mental health needs, such as fewer arrests and reduced use of force against them.
The Department of Justice (DOJ) and the Substance Abuse and Mental Health Services Administration (SAMHSA) provide
funding that is intended to help improve law enforcement’s response to people experiencing a mental health crisis. For
example, DOJ’s Justice and Mental Health Collaboration programs provide grants to help state, local, and tribal governments
increase access to mental health care and other treatment services for people in need. SAMHSA’s Mental Health Awareness
Training grant program provides law enforcement and other first responders with training on how to recognize mental health
conditions, provide initial help to those experiencing a mental health crisis, and connect individuals to appropriate care.
There are several issues policymakers might consider if Congress were to take up legislation to improve law enforcement’s
response to people experiencing a mental health crisis, including the following:
aiding state and local governments with expanding their capacity to provide a continuum of mental health
services, such as psychiatric emergency receiving units and inpatient mental health services;
providing funding for preventative interventions to aid people before the onset of mental health conditions;
collecting data on law enforcement officers’ interactions with people experiencing a mental health crisis by
expanding current DOJ efforts to collect data on law enforcement activities;
providing additional funding for more staff and equipment to aid 911 call centers with handling calls for
service involving people experiencing a mental health crisis;
promoting more uniform laws and policies regarding training that law enforcement officers receive on how
to respond to individuals experiencing a mental health crisis and actions officers can take to divert them
from the criminal justice system; and
supporting research on CRTs and MCTs.
providing funding for law enforcement agencies that want to provide CIT training to their officers and
those that want to start CRT or MCT programs;
Congressional Research Service
Issues in Law Enforcement Reform: Responding to Mental Health Crises
Contents
Specialized Responses to Mental Health Crises .............................................................................. 3
Crisis Intervention Teams .......................................................................................................... 4
Co-Responder Teams ................................................................................................................ 5
Mobile Crisis Teams.................................................................................................................. 6
Other Models............................................................................................................................. 7
Research on the Mental Health Crisis Responses Models .............................................................. 9
Federal Programs Related to Law Enforcement and Mental Health Crisis Response................... 10
Department of Justice Grant Programs ................................................................................... 10
Justice and Mental Health Collaboration Program ........................................................... 10
Community Oriented Policing Services (COPS) Office CIT Program ............................. 12
Edward Byrne Memorial Justice Assistance Grant (JAG) Program ................................. 12
Substance Abuse and Mental Health Services Administration Grant Programs ..................... 12
Law Enforcement and Behavioral Health Partnerships for Early Diversion Grants......... 12
Mental Health Awareness Training ................................................................................... 12
Considerations for Congress.......................................................................................................... 13
Access to Mental Health Services ........................................................................................... 13
Inpatient Bed Availability ................................................................................................. 14
Identifying Available Bedspace in Treatment Facilities.................................................... 16
Expanding Capacity for Mental Health Services .............................................................. 16
Preventing Mental Illness and Mental Health Crises .............................................................. 18
Training for Law Enforcement Personnel ............................................................................... 19
Supporting Co-Responder and Mobile Crisis Teams .............................................................. 20
Data Collection........................................................................................................................ 21
Increasing the Capabilities of 911 Call Centers ...................................................................... 22
Promoting Consistency in Law and Policies ........................................................................... 23
Supporting Research on Crisis Response Models ................................................................... 24
Figures
Figure 1. Common Models of Mental Health Crisis Response ....................................................... 4
Figure 2. Mental Health Service Settings in the United States, 2018............................................ 15
Appendixes
Appendix. Examples of Mobile Crisis Teams ............................................................................... 25
Contacts
Author Information........................................................................................................................ 31
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Issues in Law Enforcement Reform: Responding to Mental Health Crises
aw enforcement officers1 are frequently the first responders to individuals experiencing a
mental health crisis.2 The manner in which police have handled mental health-related
encounters has come under increased scrutiny during the last few decades.3 For example,
people with mental illness and mental health advocacy groups have raised concerns about
interactions between individuals with mental health disorders and police officers, especially those
that involved the use of force.4 One study estimated that one in four people with a mental health
condition has been arrested at some point in their lifetime and 1% of calls for service for the
police involve people with a mental disorder.5
L
Law enforcement officers often have little training in mental health crisis management and
response.6 In general, police are not formally trained to recognize, assess, and treat mental health
conditions, relying instead on experiences learned on-the-job.7 This has led some to characterize
law enforcement officers as the so-called secret social service for their largely unrecognized role
in triaging individuals with mental health needs.8
Some research suggests that people with mental health conditions are more likely to be subjected
to violence by the police. For example, one study of police-public encounters in New York City
and Baltimore found that people with serious mental illness were more likely than the general
population to be involved in violent incidents with the police, even after controlling for criminal
behavior.9 Research also suggests that people with complex mental health needs are
disproportionately killed during interactions with law enforcement.10 One study found that the
death rate for people who had signs of a mental illness during police interactions (20 deaths per
million) is nearly seven times higher than it is for people without signs of a mental illness (3
deaths per million).11
1 Throughout this report, the terms law enforcement officer and police officer or police will be used interchangeably.
2 For the purposes of this report, a mental health crisis is defined as “any situation in which a person’s behavior puts
them at risk of hurting themselves or others and/or prevents them from being able to care for themselves or function
effectively in the community.” Teri Brister, Navigating a Mental Health Crisis: A NAMI Resource Guide for Those
Experiencing a Mental Health Emergency, National Alliance on Mental Illness, Arlington, VA, 2018, p. 5.
3 Jennifer D. Wood and Amy C. Watson, “Improving Police Interventions During Mental Health-Related Encounters:
Past, Present, and Future,” Policing and Society, vol. 27, no. 3 (2017), pp. 289-299 (hereinafter, “Wood and Watson,
‘Improving Police Interventions During Mental Health-Related Encounters’”).
4 James D. Livingston, “Contact Between the Police and People with Mental Disorders: A Review of Rates,”
Psychiatric Services, vol. 67, no. 8 (August 2016), p. 850 (hereinafter, “Livingston, ‘Contact Between the Police and
People with Mental Disorders’”).
5 Livingston, “Contact Between the Police and People with Mental Disorders.”
6 H. Richard Lamb, Linda E. Weinberger, and Walter J. DeCuir, Jr., “The Police and Mental Health,” Psychiatric
Services, vol. 53, no. 10 (2002), pp. 1266-1271 (hereinafter, “Lamb et al., ‘The Police and Mental Health’”).
7
Eddie Kane, Emily Evans, and Farhad Shokraneh, “Effectiveness of Current Policing-Related Mental health
Interventions: A Systematic Review,” Criminal Behavior and Mental Health, vol. 28 (2018), pp. 108-119; and Thomas
M. Green, “Police As Frontline Mental Health Workers: The Decision to Arrest or Refer to Mental Health
Agencies,” International Journal of Law and Psychiatry (1997).
8 Maurice Punch, “The Secret Social Service,” The British Police 102 (1979): 17.
9 Hyun-Jin Jun, Jordan E. DeVylder, and Lisa Fedina, “Police Violence Among Adults Diagnosed with Mental
Disorders,” Health and Social Work, vol. 45, no. 2 (May 2020), pp. 81-89.
10 Amam Z. Saleh, Paul S. Appelbaum, and Xiaoyu Liu et al., “Deaths of People with Mental Illness During
Interactions with Law Enforcement,” International Journal of Law and Psychiatry, vol. 58 (2018), pp. 110-116
(hereinafter, “Saleh et al., ‘Deaths of People with Mental Illness During Interactions with Law Enforcement’”).
11 Saleh et al., “Deaths of People with Mental Illness During Interactions with Law Enforcement,” p. 114.
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This body of research, along with recent high-profile incidents in which police responses to
individuals with mental health needs have had fatal outcomes, have led to a renewed interest in
improving police response to mental health crises.12 Congress has taken an interest in addressing
the role of law enforcement in the mental health crisis response system.13 For example, Congress
has supported grant programs that encourage police training or partnerships with behavioral
health professionals to improve the response to persons experiencing a mental health crisis.14
Mental Health and Violence
Law enforcement officers may respond to mental health-related emergencies because of the threat of harm or
violence (to the individual experiencing the crisis or to others). Most mental health crises do not involve the
threat of violence and most people with mental health conditions do not pose a significant threat of violence. 15
Some research suggests that a small segment of individuals with serious mental illness may be slightly more prone
to violence than those without a mental health condition, though acts of violence in this population are not
common.16 Data suggest that people with serious mental illness are more likely to be victims of violent crime
rather than perpetrators.17 Still, some mental health-related emergencies can be volatile, and in some situations it
may be most appropriate for a law enforcement officer to be present. Studies have found that law enforcement
officers believe that people with mental illness are significantly more prone to violence than people without mental
illness, which may result in higher levels of force being used during mental health emergencies. This suggests the
importance of appropriate training for responses to these situations.18
This report discusses specialized law enforcement programs for responding to individuals
experiencing mental health crises. Mental health crises can include various emergencies such as
suicidal ideation, symptoms of psychosis (e.g., hallucinations, delusions), threats of harm to
others, or other significant acute psychological or emotional distress. These situations can involve
individuals with serious mental illness, other diagnosed mental health conditions, or no
psychological disorders at all.19 The report begins by describing specialized responses that local
governments have employed to improve their responses to individuals experiencing mental health
crises. It briefly discusses the research on the effectiveness of these alternative responses and then
turns to a review of federal programs that could provide support for these programs. Lastly, the
report discusses some considerations for policymakers should Congress take up further legislation
to address this issue.
12 Minyvonne Burke, “Policing Mental Health: Recent Deaths Highlight Concerns Over Officer Response,” NBC News,
May 16, 2021, https://www.nbcnews.com/news/us-news/policing-mental-health-recent-deaths-highlight-concerns-overofficer-response-n1266935; and Lamb et al., “The Police and Mental Health,” pp. 1266-1271.
13 See, for example, U.S. Congress, Senate Committee on the Judiciary, Subcommittee on Criminal Justice and
Counterterrorism, Behavioral Health and Policing: Interactions and Solutions, subcommittee hearing, 117th Cong., 1st
sess., April 22, 2021.
14 See, for example, the Bipartisan Safer Communities Act (P.L. 117-159).
15 Tori DeAngelis, “Mental Illness and Violence: Debunking Myths, Addressing Realities,” Monitor on Psychology,
vol. 52, no. 3, (April/May 2021), p. 31 (hereinafter “DeAngelis, ‘Mental Illness and Violence’”).
16 See, for example, Richard Van Dorn, Jan Volavka, and Norman Johnson, “Mental Disorder and Violence: Is There a
Relationship Beyond Substance Use?,” Social Psychiatry and Psychiatric Epidemiology, vol. 47, no. 3 (2012), pp. 487503.
17 H. Khalifeh, S. Johnson, and L. M. Howard et al., “Violent and Non-Violent Crime Against Adults with Severe
Mental Illness,” The British Journal of Psychiatry, vol. 206 (2015), pp. 275-282.
18 Michael T. Rossler and William Terrill, “Mental Illness, Police Use of Force, and Citizen Injury,” Police Quarterly,
vol. 20, no. 2 (June 2017), p. 191.
19 See, for example, Deborah M. Stone, Thomas R. Simon, and Katherine A. Fowler et al., Vital Signs: Trends in State
Suicide Rates - United States, 1999-2016 and Circumstances Contributing to Suicide - 27 States, 2015, Centers for
Disease Control and Prevention, Morbidity and Mortality Weekly Report, vol. 67, no. 22, June 8, 2018.
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Specialized Responses to Mental Health Crises
Over the past several decades, local governments have adopted specialized approaches to respond
to calls involving individuals experiencing a mental health-related emergency. A survey of police
agencies found that these models tend to fall into one of three categories (see Figure 1):
1. Crisis Intervention Teams (CITs), in which specially trained police officers
provide initial crisis response in the field and liaise with mental health providers;
2. Co-Responder Teams (CRTs), in which mental health clinicians embedded in
police agencies respond alongside law enforcement officers in the field; and
3. Mobile Crisis Teams (MCTs), in which mental health clinicians responding with
or without law enforcement assistance or triage.20
Each of these models provides a type of street triage, aiming to incorporate mental health
expertise into crisis response.21 A primary goal of these programs is to connect individuals in
crisis with community mental health services and divert them from the justice system or acute
care health services (such as hospital emergency departments).22 Many observers believe that
decreasing the likelihood that an individual in crisis will end up in police custody is the most
appropriate way to support people with acute or chronic mental health needs and prevent
reoccurrence of a crisis and repeated contact with the criminal justice system.23
There is considerable variation in program design and heterogeneity in application of these
programs—even across communities employing the same model. One review identified 19
different approaches to street triage across these three models.24 For example, co-responder teams
might adopt a first response approach in which the CRT responds initially to a perceived mental
health crisis. They could also employ a second response (or post-response) approach in which
other emergency personnel (e.g., traditionally trained law enforcement officers or emergency
medical technicians) arrive to the scene first and call for the CRT if a mental health crisis is
identified.25 Some CRTs are only dispatched after a call is placed to an emergency control room
(e.g., 911), some take calls directly from police officers in the field, some are dispatched in
response to a call from either source, and some have their own independent line for receiving
calls.26
20 Randy Borum, Martha Williams Deane, and Henry Steadman et al., “Police Perspectives on Responding to Mentally
Ill People in Crisis: Perceptions of Program Effectiveness,” Behavioral Sciences and the Law, vol. 16 (1998), pp. 393405; and Martha Williams Deane, Henry Steadman, Randy Borum et al., “Emergency Partnerships Between Mental
Health and Law Enforcement,” Psychiatric Services, vol. 50, no. 1 (1999), pp. 99-101, as cited in Wood and Watson,
“Improving Police Interventions During Mental Health-Related Encounters.”
21 Stephen Putnis, Devon Perfect, and Abirami Kirumbarajan et al., “A Systematic Review of Co-Responder Models of
Police Mental Health ‘Street’ Triage,” BMC Psychiatry, vol. 18 (2018), p. 256 (hereinafter, “Putnis et al., ‘A
Systematic Review of Co-Responder Models’”).
22 G.K. Shapiro, A. Cusi, and M. Kirst et al., “Co-Responding Police-Mental Health Programs: A Review,”
Administration and Policy in Mental Health and Mental Health Services Research, vol. 42, no. 5 (2015), pp. 606-620
(hereinafter, “Shapiro et al., ‘Co-Responding Police-Mental Health Programs’”).
23 Shapiro et al., “Co-Responding Police-Mental Health Programs.”
24 Puntis et al., “A Systematic Review of Co-Responder Models.”
25 Katie Bailey, Staci Rising Paquet, and Bradley R. Ray et al., “Barriers and Facilitators to Implementing an Urban
Co-Responding Police-Mental Health Team,” Health and Justice, vol. 6, no. 21 (2018).
26 Puntis et al., “A Systematic Review of Co-Responder Models,” p. 261.
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Figure 1. Common Models of Mental Health Crisis Response
Source: CRS analysis.
Notes: Some areas may employ more than one model at a time.
Crisis Intervention Teams
CITs are a first responder model in which specially trained law enforcement officers respond to
calls for service involving people experiencing a mental health crisis. The CIT model is the most
widely used of the three most common mental health crisis response approaches. CITs originated
in Memphis, TN, in 1988 when the Memphis Police Department (MPD) partnered with the
Memphis chapter of the National Alliance on Mental Illness, the University of Memphis, and the
University of Tennessee to develop a specialized unit in response to public outcry over the death
of a man with schizophrenia during an encounter with MPD (hence, the CIT model is sometimes
referred to as the Memphis model). 27 The stated goal of the program is to reduce deaths that can
occur during interactions between the police and people experiencing a mental health crisis and to
divert these individuals, when appropriate, away from the criminal justice system and into
treatment.28
Police officers who serve on CITs typically undergo 40 hours of training, during which they learn
how to recognize symptoms of major mental health conditions, interact with and gain perspective
from people who have suffered mental health crises and their families, engage in role playing
27 Wood and Watson, “Improving Police Interventions During Mental Health-Related Encounters,” p. 292.
28 Michael S. Rogers, Dale E. McNeil, and Renee L. Bender, “Effectiveness of Police Crisis Intervention Training
Programs,” Journal of the American Academy of Psychiatry and the Law, vol. 47, no. 4 (2019), p. 415 (hereinafter,
“Rogers et al., ‘Effectiveness of CIT Programs’”).
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exercises to help them develop de-escalation skills, and conduct site visits of community facilities
that provide follow-up services to people with mental health needs after a treatment referral is
made by law enforcement.29 Police officers who serve on CITs traditionally volunteer for the
team.30
The Memphis model includes changes that go beyond training a portion of the agency’s officers
on proper responses to people experiencing a mental health crisis. The model also involves
training dispatchers to recognize calls for service that have a high probability of
being mental health-related and dispatching CITs;
developing partnerships between law enforcement agencies, mental health
services, mental health advocates, and other stakeholders; and
establishing a centralized drop-off emergency mental health care facility that will
accept all patients.31
According to the CIT Center at the University of Memphis, there are approximately 3,000 CIT
programs in the United States.32 However, it is not clear how many of these agencies are
implementing the full Memphis model (as opposed to just providing some of their officers with
the 40 hours of CIT training).33 It has been noted that the Memphis model was designed to be
flexible enough to “allow communities to tailor their efforts to local needs, resources, and
limitations,”34 though some fidelity to the model is required for effectiveness.
Co-Responder Teams
CRTs pair law enforcement officers with clinicians who respond to emergency calls involving
individuals experiencing a mental health crisis. CRTs are being implemented as a part of a larger
CIT effort, part of other police-mental health collaboration programs, or on their own.35 The goals
of CRTs are to (1) reduce unnecessary emergency department visits, psychiatric hospitalizations,
and arrests; (2) increase safety for officers and subjects; and (3) provide connections to
community-based mental health treatment.36 CRTs accomplish these outcomes by deescalating
crises, preventing injuries to individuals in crisis and the response team, linking individuals
experiencing psychiatric emergencies to appropriate care in the community, and reducing
29 Charles Dempsey, Cameron Quanbeck, and Clarissa Bush et al., “Decriminalizing Mental Illness: Specialized
Policing Responses,” CNS Spectrums, vol. 25, no. 2 (2020), p. 182, hereinafter “Dempsey et al., ‘Decriminalizing
Mental Illness.’”
30 Wood and Watson, “Improving Police Interventions During Mental Health-Related Encounters,” p. 292.
31 Amy C. Watson and Michael T. Compton, “What Research on Crisis Intervention Teams Tells Us and What We
Need to Ask,” Journal of the American Academy of Psychiatry and the Law, vol. 47, no. 4 (2019), p. 423 (hereinafter,
“Watson and Compton, ‘What Research on CITs Tells Us and What We Need to Ask’”). These drop-off emergency
mental health care facilities are sometimes referred to as psychiatric receiving units or crisis stabilization centers. See
“Access to Mental Health Services” later in this report.
32 University of Memphis, CIT Center, http://www.cit.memphis.edu/.
33 Wood and Watson, “Improving Police Interventions During Mental Health-Related Encounters,” p. 292.
34 Amy C. Watson, Michael T. Compton, and Leah G. Pope, Crisis Response Services for People with Mental Illness or
Intellectual or Developmental Disabilities: A Review of the Literature on Police-Based and Other First Response
Models, Vera Institute of Justice, New York, NY, 2019, p. 27 (hereinafter, “Watson et al., Crisis Response Services for
People with Mental Illness”).
35 Watson et al., Crisis Response Services for People with Mental Illness, p. 14.
36 Watson et al., Crisis Response Services for People with Mental Illness, p. 15.
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pressure on both the local justice and health care systems.37 The theory underlying CRT programs
is that a joint response is preferable as police are specialists in handling situations involving
illegal activity while mental health professionals are specialists in providing clinical care to
individuals in crisis.38
As mentioned previously, there are variations in how CRTs operate and how they are deployed.
Co-responding programs can differ greatly in the populations they serve, including regarding
funding levels, program guidelines, hours of operation, procedures, staff expertise, equipment,
and training.39 In some cases, CRTs include police officers and clinicians who ride together in the
same vehicle—either a squad car, unmarked police car, or ambulance.40 In other cases, the
clinician provides support to the police officer remotely, either via phone or police radio. With the
exception of models that utilize remote consultation, CRTs are not available to respond 24 hours a
day in most jurisdictions that have implemented them.41
Mobile Crisis Teams
MCTs utilize community-based mental health professionals to respond to mental health crises,
with law enforcement deployed as needed. Unlike CITs and CRTs, MCTs typically do not involve
the police initially, though police can be called upon when appropriate.42 Conversely, police can
request that an MCT respond if the circumstances are deemed appropriate. Calls for service can
be screened through a dedicated helpline or through a 911 call center.43 In either case, an MCT is
dispatched to respond to the call if it meets defined criteria (e.g., the subject of the call appears to
be experiencing a mental health crisis and there is no evidence he or she is engaged in violent
activity), as specified by the jurisdiction.44 MCTs are usually operated by a mental health agency
instead of a police department, and provide onsite crisis management through assessment,
intervention, consultation, referral to services, and follow-up to help ensure that the individual
connects with the recommended services.45
Several cities have implemented MCT programs, mostly on a pilot basis (see the Appendix for
examples). There are no comprehensive data on which cities use MCTs or the characteristics of
these teams. Most available accounts indicate that pilot programs offer teams in a specific portion
of the city during certain hours. Many cities take a layered approach to mental health calls by
utilizing an MCT for some calls but also maintaining a CIT and/or a CRT.
The CAHOOTS Program (Eugene, OR)
The oldest and most established MCT is the Crisis Assistance Helping Out on the Streets (CAHOOTS) in Eugene,
OR. The CAHOOTS program has been operating since 1989. CAHOOTS is not a part of the Eugene Police
Department (EPD), but it does use City of Eugene-marked vehicles and receives funding from the city through a
37 Shapiro et al., “Co-Responding Police-Mental Health Programs.”
38
Shapiro et al., “Co-Responding Police-Mental Health Programs.”
39 Shapiro et al., “Co-Responding Police-Mental Health Programs.”
40 Puntis et al., “A Systematic Review of Co-Responder Models,” p. 258.
41 Puntis et al., “A Systematic Review of Co-Responder Models,” p. 261.
42 Watson et al., Crisis Response Services for People with Mental Illness, p. 39.
43 Ashley Abramson, “Building mental Health into Emergency Responses,” Monitor on Psychology, vol. 52, no. 5, July
1, 2021, pp. 30-31 (discussing a model used in Long Island, NY, where 911 call takers can dispatch a team of clinical
professionals; and a model used in Austin, TX, where callers can opt for mental health services).
44 Watson et al., Crisis Response Services for People with Mental Illness, p. 39.
45 Watson et al., Crisis Response Services for People with Mental Illness, p. 39.
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contract with EPD.46 CAHOOTS teams are staffed by personnel from the White Bird Clinic, a mental health
services provider in the city. CAHOOTS is the primary responder in many cases involving people who are
intoxicated, mentally ill, or disoriented, and they transport people for necessary nonemergency medical care.
People can call the nonemergency police line or 911 and request CAHOOTS.47 EPD triages calls for service
through their call center and dispatches a CAHOOTS van (which has a paramedic and an experienced crisis
worker) to the scene when it is determined that a non-law enforcement response is warranted.48 Sometimes,
CAHOOTS will be called to a scene by a police officer who initially responded to a call when that officer
determines the situation would be better handled by mental health professionals.
The CAHOOTS program has served as a model for other cities exploring options for redirecting mental health
calls away from the police and to mental health professionals. It was reported that since the summer of 2020, over
400 municipalities contacted CAHOOTS organizers asking for advice on how establish their own programs.49
Other Models
In addition to the three most common mental health and law enforcement crisis response
programs discussed above, other strategies have also emerged. For example, one model used in
the United Kingdom embeds mental health specialists in contact control rooms (which are akin to
911 call centers in the United States) along with emergency dispatchers.50 These mental health
professionals advise call handlers and sometimes deal directly with individual callers. Other
models use street triage teams that conduct outreach with people with mental illness in the
community to connect them to services in hopes of preventing a mental health crisis.51
Some communities rely on emergency medical technicians (EMTs) or paramedics to provide
services to individuals with mental health needs. Some public safety agencies are embracing and
encouraging training for EMTs and leveraging outside resources to train EMTs to lead or support
a CRT or CIT. The National Association of Emergency Medical Technicians (NAEMT) serves as
a clearinghouse for training and education and provides information for first responders so they
can assist in a mental health crisis.52 NAEMT provides links to training offered by the
International Critical Incident Stress Foundation, Inc., (CISF), which trains individuals interested
46 Eugene Police Department, “CAHOOTS,” https://www.eugene-or.gov/4508/CAHOOTS.
47 Ben Adam Climer and Brenton Gicker, “CAHOOTS: A Model for Prehospital Mental Health Crisis Intervention,”
Psychiatric Times, January 29, 2021, https://www.psychiatrictimes.com/view/cahoots-model-prehospital-mentalhealth-crisis-intervention.
48 In Eugene, 911 call takers can dispatch Eugene Police, CAHOOTS, and local fire and emergency medical services
(EMS) response agencies. The decision on resources to send that a 911 call taker makes is “outlined by department
policy but is informed by the knowledge, training and experience of our dispatchers. Dispatchers must consider public
and responder safety, the presence of weapons, elements of criminal activity, and the needs of the citizens for every
emergency.” See https://www.eugene-or.gov/DocumentCenter/View/56581/911-Process-Infographic.
49 Julianne Hill, “Police Are Often the First Responders to Mental Health Crises, but Tragedies Are Prompting
Change,” ABA Journal, April 1, 2021.
50 Eddie Kane, Emily Evans, and Farhad Shokraneh, “Effectiveness of Current Policing-Related Mental Health
Interventions: A Systematic Review,” Criminal Behavior and Mental Health, vol. 108 (2018).
51 Several communities have explored various approaches to responding to mental health calls before deciding on a
single model. The City of Minneapolis, for example, developed and funded approaches such as sending non-police
response teams, including mental health workers and emergency medical technicians (EMTs) to mental health crisis
calls; training 911 dispatchers to assess mental health calls and dispatch the best response team; and embedding mental
health professionals in 911 call centers to triage mental health calls and identify the best response. See League of
Women Voters, “Reimagining Public Safety: Efforts to Reimagine Public Safety,” https://lwvmpls.org/2-04-reforming911-calls/.
52 National Association of Emergency Medical Technicians (NAEMT), “Awareness, Education, and Training,”
https://www.naemt.org/initiatives/wellness/ems-mental-health/awareness-education-and-training.
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in becoming a part of a crisis management team. The National Council for Mental Well Being
offers a course in Mental Health First Aid, a skills-based training course that teaches participants
about mental health and substance-use issues.
The International Association of Chiefs of Police (IACP) created the One Mind Campaign, which
encourages training and coordination across local mental health agencies, public safety agencies,
and community organizations to improve interactions between law enforcement officers and
individuals with mental health conditions. The goal of the initiative is for these agencies and
organizations to become “of one mind.”53 To join the campaign, law enforcement agencies must
pledge to implement four strategies over a 12-36 month timeframe, including (1) establishing a
partnership with one or more community health organizations, (2) developing and implementing
a model policy addressing law enforcement response to individuals with mental health conditions,
(3) training and certifying 100% of sworn officers (and selected non-sworn staff, such as
dispatchers) in mental health awareness courses by providing Mental Health First Aid training,
and (4) providing CIT training to a minimum of 20% of sworn officers (and selected non-sworn
staff).
988: Suicide Hotline or 911 for Mental Health?
On July 16, 2022, the 988 Suicide & Crisis Lifeline (988 Lifeline; formerly the National Suicide Prevention Lifeline)
transitioned from a 10-digit number (1-800-273-8255) to the 3-digit hotline number (988). The 988 Lifeline is a
national hotline that provides immediate crisis counseling and referral services for individuals experiencing suicidal
thoughts or other mental distress. Currently, the 988 Lifeline routes calls by area code to the crisis center nearest
that area code. The crisis center is staffed by trained crisis workers. Call center staff are equipped to counsel
callers, provide local referrals for follow-up treatment, or (in some cases) transfer callers to 911 to dispatch local
emergency personnel. There is an interest in some jurisdictions for potentially expanding the 988 Lifeline from a
counseling and referral hotline to a dispatching service able to deploy local crisis responders to mental health
emergencies, similar to 911.54 In 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA)
issued national guidelines for behavioral health crisis care, identifying the 988 Lifeline as a potential hub for
community crisis response.55 In this format, the 988 Lifeline would not only serve as a suicide counseling hotline—
as it does currently—but as a centralized call center able to dispatch mobile crisis response and link individuals
with community services. While some localities may begin piloting more comprehensive systems soon (such as
coordinated 911-988 programs),56 most communities would require significant efforts and additional resources to
achieve this goal.
53 International Association of Chiefs of Police (IACP), “One Mind Campaign,” https://www.theiacp.org/projects/one-
mind-campaign.
54 See, for example, Bipartisan Policy Center, Answering the Call 988: A New Vision for Crisis Response, Washington,
DC, June 2022.
55 Substance Abuse and Mental Health Services Administration (SAMHSA), National Guidelines for Behavioral
Health Crisis Care, Best Practices Toolkit, Rockville, MD, 2020.
56 In November 2021, a consortium of mental health providers produced a report, Consensus Approach and
Recommendations for the Creation of a Comprehensive Crisis Response System. The report made several
recommendations related to 911 and 988, including the need for planning “to ensure the two systems operate in a
complementary fashion, not as parallel or exclusive systems,” [and] “clarity on roles and protocols for cross-system
referrals.”
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Research on the Mental Health Crisis Responses
Models
Research suggests that CRTs and MCTs may improve some outcomes related to law enforcement
interactions with people experiencing a mental health crisis.57 For instance, CRTs and MCTs both
appear particularly effective at connecting people to mental health services.58 CRTs also appear to
improve outcomes for individuals experiencing a mental health crisis. 59 Research suggests that
CRTs reduced the number of people being taken into police custody and unnecessary emergency
department visits.60 An evaluation of a MCT pilot program in Denver, CO, suggests that the
program not only diverted people with mental health problems from the criminal justice system
by providing care to these individuals but it also decreased crime in the areas served by MCTs.61
CIT programs appear to be particularly effective at changing police officers’ perceptions of and
response to people with mental illness.62 Several studies found that CIT training has positive
effects on law enforcement participants. For example, CIT training appears to improve police
officers’ attitudes and behaviors towards people with mental health conditions. One study found
that CIT-trained officers
demonstrate improvements in knowledge, attitudes, and self-efficacy toward
interacting with people with mental illness;
have a greater understanding of stigmas associated with mental illness;
have beliefs about mental illness that are shaped by medical knowledge;
demonstrate a reduced preference for using force against people with mental
illness; and
show a preference for de-escalating situations and linking people with mental
illness to treatment. 63
While research suggests that CIT programs might be effective at changing police officers’
attitudes and approaches to interacting with people experiencing a mental health crisis, it is less
clear whether these changes translate into improved outcomes for people with mental health
needs who have contact with the police. One study found that arrests after CIT implementation
57 CITs are the most widely evaluated of the three models of specialized responses to people with mental illness. There
is less research on the effectiveness of and outcomes related to CRTs and MCTs. In addition, a significant proportion of
the CRT research comes from Canada, the United Kingdom, and Australia, where CRTs are more common and have
been in existence longer.
58 Watson et al., Crisis Response Services for People with Mental Illness.
59
Puntis et al., “A Systematic Review of Co-Responder Models,” pp. 256-266; and Watson et al., Crisis Response
Services for People with Mental Illness.
60 Puntis et al., “A Systematic Review of Co-Responder Models,” pp. 256-266; and Watson et al., Crisis Response
Services for People with Mental Illness.
61 Thomas S. Dee and Jaymes Pyne, “A Community Response Approach to Mental Health and Substance Abuse Crises
Reduces Crime,” Science Advances, vol. 8, no. 23 (2022).
62 Rogers et al., “Effectiveness of CIT Programs.”
63 Amy C. Watson, Michael T. Compton, and Jeffrey N. Draine, “The Crisis Intervention Team (CIT) Model: An
Evidence-Based Policing Practice,” Behavioral Sciences and the Law, vol. 35, no. 5-6 (September-December 2017),
pp. 431-441 (hereinafter, “Watson et al., ‘The Crisis Intervention Team (CIT) Model: An Evidence-Based Policing
Practice’”).
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declined over time,64 while a 2016 meta-analysis found that CITs do not reduce the arrest of or
use of force against people with mental illness.65
Despite the meta-analysis on CITs effects on the results of interactions between the police and
people in a mental health crisis, for most of these crisis response models, research remains limited
and evaluations looking at multiple outcomes of the models sometimes yield mixed results. For
example, in their review of research on crisis response services, several experts concluded that
overall, the literature demonstrates that MCT services have high rates of consumer and
provider satisfaction and can effectively increase community-based service use, reduce
reliance on psychiatric ED [emergency departments], and link people to community-based
care once discharged from an ED.66
The authors noted that most existing studies on crisis response models have methodological
limitations, hindering the ability to draw definitive conclusions for all outcomes related to these
programs. Many of the studies evaluate just one program in a single city, for example, limiting
the ability to generalize the results to other jurisdictions. Thus, more conclusive determinations
on the effectiveness of mental health crisis response programs await a more robust body of
research.
Federal Programs Related to Law Enforcement and
Mental Health Crisis Response
Both the U.S. Department of Justice (DOJ) and SAMHSA67 within the U.S. Department of Health
and Human Services (HHS) provide funding to state and local governments to help improve their
response to individuals experiencing a mental health crisis and those with mental health disorders.
Department of Justice Grant Programs
Justice and Mental Health Collaboration Program
Congress has appropriated funding for the Adult and Juvenile Collaboration program (34 U.S.C.
§10651) since FY2006 and DOJ awards these funds through its Justice and Mental Health
Collaboration program. Under the authorization for the program, grants can be awarded to state,
64 Stephanie Franz and Randy Borum, “Crisis Intervention Teams May Prevent Arrests of People with Mental
Illnesses,” Police Practice and Research, vol. 12, no. 3 (June), p. 2011.
65 The meta-analysis found that CIT-trained officers were less likely than non-CIT-trained officers to arrest people with
mental illness, but the result was not statistically significant. See Sema A. Taheri, “Do Crisis Intervention Teams
Reduce Arrests and Improve Officer Safety? A Systematic Review and Meta-Analysis,” Criminal Justice Policy
Review, vol. 27, no. 1 (2016), pp. 76-96. The conclusions of Taheri’s meta-analysis resulted in the National Institute of
Justice (NIJ) rating CITs as having “No Effects” on reducing arrests of or use of force against people with mental
illness. See https://crimesolutions.ojp.gov/ratedpractices/81#mao. Other experts assert that due to the limitations of the
research on CITs, it is too early to draw conclusions about their effectiveness in reducing arrests and use of force
against people with mental illness. See, for example, Watson and Compton, “What Research on CITs Tells Us and
What We Need to Ask,” pp. 422-426.
66 Watson et al., Crisis Response Services for People with Mental Illness, p. 44.
67 In addition to the two SAMHSA programs mentioned, there are a number of SAMHSA grants, such as the
Community Mental Health Service Block Grants (MHBG), that offer significant flexibilities when it comes to
allowable activities. Grants like the MHBG could be used to support activities such as response to mental health crises,
but they are not specifically dedicated to that purpose. Of note, Congress included a set-aside for “evidence-based crisis
systems” in the FY2021 and FY2022 annual appropriations for the MHBG.
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local, and tribal governments for a variety of purposes related to improving the criminal justice
system’s response to people with mental health disorders.
Under the program, grants can be awarded to plan and implement programs to promote public
safety by ensuring access to adequate mental health and other treatment services for adults or
juveniles with mental health disorders that are overseen cooperatively by (1) a criminal or
juvenile justice agency or a mental health court and (2) a mental health agency. Specifically,
planning and implementation grants can be used to
create or expand mental health courts or other court-based programs for
preliminarily qualified offenders;
offer specialized training to criminal and juvenile justice and mental health
professionals on identifying the symptoms of people with mental health disorders
in order to respond more effectively to these individuals;
support programs operated cooperatively by criminal and juvenile justice and
mental health agencies that provide mental health treatment, and where
appropriate, substance abuse treatment; and
support collaboration between state and local governments with respect to people
with mental health disorders in the justice system.
Grants under this program can also be awarded to improve law enforcement’s response to people
with mental health disorders. Grants can be used to
offer law enforcement and campus security personnel training in procedures to
identify and respond to incidents involving individuals experiencing a mental
health crisis;
implement receiving centers that assess people in law enforcement custody for
suicide risk and mental health and substance abuse treatment needs;
establish new or improve existing computerized information systems to provide
timely information to criminal justice system personnel so they can improve their
response to individuals with mental health disorders;
provide support for law enforcement academy, in-service, and continuing
education training and other programs that instruct law enforcement personnel on
how to identify and respond to people with mental health disorders or cooccurring mental health and substance use disorders; and
establish and expand cooperative efforts to promote public safety through the use
of effective intervention with individuals with mental health disorders.
Further, grants can be awarded for activities such as sequential intercept mapping, which is a
process for studying how people with mental health conditions work their way through the
criminal justice system. It also involves developing opportunities for the criminal justice and
mental health systems to collaborate on ways to address the risks and needs of these individuals.
The process includes identifying gaps in service for people with mental health conditions in the
criminal justice system and developing programs to address these gaps. These programs can
include emergency and crisis services; specialized police-based responses; court hearings and
disposition alternatives; reentry from jails and prisons; and community supervision, treatment,
and support services. Grants can also be used to implement intervention programs, which can
include hiring personnel and providing support services to prevent involvement in the criminal
justice system.
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Community Oriented Policing Services (COPS) Office CIT Program
For FY2021 and FY2022, the COPS Office has awarded grants for CIT under its Community
Policing Development program. Grants are awarded to law enforcement agencies to help them
implement CITs, which can include “embedding behavioral or mental health professionals with
law enforcement agencies, training for law enforcement officers and embedded behavioral or
mental health professionals in crisis intervention response, or a combination of these.”68 Grants
can be used to pay law enforcement officer overtime, mental health professionals’ salaries or
contracts, and personnel training costs.
Edward Byrne Memorial Justice Assistance Grant (JAG) Program
JAG is a formula grant program that provides funds to states, the District of Columbia, each
territory, and local and tribal governments for a variety of criminal justice initiatives.69 Grant
recipients can use their JAG funds for state and local initiatives, technical assistance, training,
personnel, equipment, supplies, contractual support, and criminal justice information systems for,
among other things, mental health and related law enforcement and corrections programs,
including behavioral programs and crisis intervention teams. The JAG program gives grant
recipients flexibility in deciding how to spend their funds, so while state, local, and tribal
governments could use JAG funding for programs to improve the criminal justice system’s
response to people with mental health needs, they are not required to do so.
Substance Abuse and Mental Health Services Administration
Grant Programs
Law Enforcement and Behavioral Health Partnerships for Early Diversion
Grants
SAMHSA administers the Law Enforcement and Behavioral Health Partnerships for Early
Diversion (or Early Diversion) grant program as part of its criminal and juvenile justice
programming. The purpose of this program is to establish or expand programs that divert adults
with a serious mental illness from the criminal justice system to community-based services prior
to arrest and booking.70 SAMHSA’s Early Diversion grant program supports three programs in
Colorado, Connecticut, and Tennessee.71
Mental Health Awareness Training
SAMHSA’S Mental Health Awareness Training (MHAT) grant program provides resources for
training law enforcement and other first responders on how to recognize a mental health
condition, provide initial help in a mental health crisis, and connect individuals to appropriate
care. The MHAT program—also known as Mental Health First Aid—is structured similarly to
68 U.S. Department of Justice (DOJ), Community Oriented Policing Services Office (COPS), FY2022 Crisis
Intervention Teams Program, Community Policing Development, fact sheet, May 2022, p. 1.
69 For more information on the JAG program, see CRS In Focus IF10691, The Edward Byrne Memorial Justice
Assistance Grant (JAG) Program.
70 U.S. Department of Health and Human Services (HHS), SAMHSA, Fiscal Year 2023 Justification of Estimates for
Appropriations Committees, https://www.samhsa.gov/sites/default/files/samhsa-fy-2023-cj.pdf.
71 SAMHSA, Law Enforcement and Behavioral Health Partnerships for Early Diversion, https://www.samhsa.gov/
criminal-juvenile-justice/grants-grantees/early-diversion.
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standard first aid training: an eight-hour course that instructs participants in how to identify,
understand, and respond to the signs of a mental health crisis. SAMHSA partners with the
National Council for Mental Wellbeing to administer MHAT grants. Originally part of Project
AWARE, the MHAT program received its own authorization in Section 9010 of the 21st Century
Cures Act (P.L. 114-255).
Considerations for Congress
If policymakers choose to take steps related to supporting specialized law enforcement responses
to mental health crises, there are several issues Congress could consider, including the following:
further aiding state and local governments with expanding their capacity to
provide mental health services,
providing funding for preventative interventions to aid people before the onset of
mental health conditions,
promoting more training for law enforcement officers on how to respond to
people experiencing a mental health crisis,
promoting responses that utilize mental health professionals,
collecting data on law enforcement officers’ interactions with people
experiencing a mental health crisis,
providing additional funding to aid 911 call centers with handling calls for
service involving people experiencing a mental health crisis,
promoting more uniform laws and policies regarding how law enforcement
agencies respond to mental health crises, and
supporting research on alternative law enforcement responses.
Access to Mental Health Services
There is a growing sentiment that diverting individuals to mental health services during a crisis
would reduce burdens on both the criminal justice and local health care systems.72 Cities that
have implemented specialized law enforcement mental health crisis response programs have
found the availability of adequate community mental health resources to be essential to program
effectiveness.73 However, research suggests that police officers have perceived the mental health
resources in their area as “inadequate, cumbersome, or absent altogether.”74 Improving law
enforcement’s response to individuals experiencing a mental health crisis depends on the
availability of appropriate mental health services. As one study noted, even if appropriate police
intervention occurs, without adequate supportive housing programs, short and long-term mental
health bed availability, and sufficient mental health and substance use disorder treatment
72 See, for example, Katie Bailey, Staci Rising Paquet, and Bradley R. Ray et al., “Barriers and Facilitators to
Implementing an Urban Co-Responding Police-Mental Health Team,” Health and Justice, vol. 6, no. 21 (2018).
73 See, for example, William Wells and Joseph A. Schafer, “Officer Perceptions of Police Responses to Persons with a
Mental Illness,” Policing: An International Journal of Police Strategies & Management, vol. 29, no. 4 (2006), pp. 578601 (hereinafter, “Wells and Schafer, ‘Officer Perceptions of Police Responses to Persons with a Mental Illness’”).
74 Wells and Schafer, “Officer Perceptions of Police Responses to Persons with a Mental Illness,” p. 581.
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programs, many individuals will likely continue to experience crises that require police
response.75
For individuals needing mental health services, acute care medical facilities such as hospital
emergency departments or incarceration in jails are often the only options in many
communities.76 In areas with few psychiatric inpatient beds or limited mental health services,
treatment may actually be more accessible in jail than in the community.77 With limited options
for custodial care of individuals with mental health needs, law enforcement and other first
responders are often left with few resources when encountering people experiencing a mental
health crisis.78
Inpatient Bed Availability
Effective treatment for individuals experiencing a mental health crisis typically involves a
spectrum of services provided at continuum of care facilities. For many individuals, mental health
needs can be met through community-based outpatient services. For those with complex mental
health conditions or a serious mental illness, or those in an acute crisis, inpatient care may be the
most effective care.79 Most estimates suggest that the supply of psychiatric inpatient beds in
hospitals in the United States is not adequate to meet the demand for institutional care. While
there is no agreed-upon number for system adequacy, experts have recommended 40-60
psychiatric inpatients beds per 100,000 people.80 According to a Pew Charitable Trusts study, the
national average for states is 11.7 beds per 100,000.81 A 2015 study conducted by the National
Association of State Mental Health Program Directors found that most states (35 of the 46 with
available data) were experiencing shortages of psychiatric hospital beds.82 The psychiatric bed
75 Jacqueline B. Helfgott, Matthew J. Hickman, and Andre P. Labossiere, “A Descriptive Evaluation of the Seattle
Police Department’s Crisis Response Team Officer/Mental Health Professional Partnership Pilot Program,”
International Journal of Law and Psychiatry, vol. 44 (2016), pp. 109-122.
76 Emergency department (ED) care must be provided regardless of a patient’s ability to pay under the Emergency
Medical Treatment and Labor Act (EMTALA) requirements. Thus, local EDs often become a safety net when other
alternatives are unavailable. See David Bender, Nalini Pande, and Michael Ludwig, A Literature Review: Psychiatric
Boarding, HHS, Assistant Secretary for Planning and Evaluation (ASPE), Office of Disability, Aging and Long-Term
Care Policy, October 29, 2008, https://aspe.hhs.gov/sites/default/files/migrated_legacy_files//43101/PsyBdLR.pdf; and
Wood and Watson, “Improving Police Interventions During Mental Health-Related Encounters.”
77 One report described a practice referred to as mercy booking, in which law enforcement officers perceived detention
in jail as the only available access point to psychiatric treatment, even when officers recognize that it would likely not
serve the person in need as well as other services. See Lamb et al., “The Police and Mental Health,” pp. 1266-1271.
78 Walid Fakhoury and Stefan Priebe, “Deinstitutionalization and Reinstutionalization: Major Changes in the Provision
of Mental Healthcare,” Psychiatry, vol. 6, no. 8 (August 2007), pp. 313-316.
79 See, for example, National Association of State Mental Health Program Directors, Beyond Beds: A Series of Working
Papers, 2017-2021, https://nasmhpd.org/content/tac-assessment-papers.
80 California Hospital Association, California’s Acute Psychiatric Bed Loss, Sacramento, CA, February 2019,
https://calhospital.org/wp-content/uploads/2021/04/psychbeddata2017.pdf; and The Pew Charitable Trusts, Amid
Shortage of Psychiatric Beds, Mentally Ill Face Long Waits for Treatment, Stateline Article, August, 2, 2019,
https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/08/02/amid-shortage-of-psychiatric-bedsmentally-ill-face-long-waits-for-treatment (hereinafter, “Pew, Amid Shortage of Psychiatric Beds, Mentally Ill Face
Long Waits for Treatment”).
81 Pew, Amid Shortage of Psychiatric Beds, Mentally Ill Face Long Waits for Treatment. The Treatment Advocacy
Center—a nonprofit advocacy organization—has estimated that the country needs an additional 123,300 state
psychiatric beds to meet current demand. See Doris A. Fuller and Elizabeth Sinclair, Treatment Advocacy Center,
Going, Going, Gone: Trends and Consequences of Eliminating State Psychiatric Beds, 2016,
82 Ted Lutterman, Robert Shaw, and William Fisher et al., Trends in Psychiatric Inpatient Capacity, United States and
Each State, 1970 to 2014, National Association of State Mental Health Program Directors, Beyond Beds Assessment
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shortage is due, in part, to a lack of mental health treatment facilities offering inpatient care.
According to SAMHSA’s National Mental Health Services Survey (N-MHSS), approximately
15% of mental health treatment facilities offered inpatient care in 2018 (Figure 2).
Figure 2. Mental Health Service Settings in the United States, 2018
Percentage of Mental Health Treatment Facilities that Offer Certain Treatment Formats
Source: Substance Abuse and Mental Health Services Administration (SAMHSA), National Mental Health Services
Survey (N-MHSS): 2018, Data on Mental Health Treatment Facilities, Rockville, MD, 2019, available at
https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NMHSS-2018.pdf
Notes: Outpatient mental health facilities provide only outpatient mental health services to ambulatory clients (i.e.,
<3 hours daily), residential treatment centers provide treatment in residential care settings, partial hospitalization/day
treatment facilities provide partial day services to ambulatory clients (i.e., >3 hours daily), and inpatient facilities are
hospitals that primarily provide 24-hour inpatient care to persons with mental illness. See the source cited above
for more information.
Experts and other stakeholders debate whether to add more psychiatric beds to meet demand or
enhance community-based care to reduce demand for psychiatric beds by preventing mental
health crises.83 While lawmakers have pursued both paths, current federal policies primarily
support community-based outpatient care, with states responsible for most inpatient psychiatric
care.84 SAMHSA has noted that the core structural elements of an optimal crisis response system
#2, Alexandria, VA, August 2017, https://nasmhpd.org/sites/default/files/TACPaper.2.Psychiatric-InpatientCapacity_508C.pdf.
83 See CRS In Focus IF10870, Psychiatric Institutionalization and Deinstitutionalization.
84 For example, the Medicaid Institutions for Mental Disease (IMD) rule limits the use of Medicaid payment for
psychiatric inpatient care in hospitals for much of the adult population; see CRS In Focus IF10222, Medicaid’s
Institutions for Mental Disease (IMD) Exclusion for more information. Also, federal statute prohibits use of Mental
Health Block Grant (MHBG) funds for inpatient services in any setting; see CRS Report R46426, Substance Abuse and
Mental Health Services Administration (SAMHSA): Overview of the Agency and Major Programs for more
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include a regional call center, crisis mobile response teams, and crisis receiving and stabilization
facilities with inpatient capacities or referral options.85 Crisis response programs that train law
enforcement officers to respond to people with mental health needs—or partner officers with a
mental health provider—may only be as effective as the community mental health services
available to individuals in need after crisis response triage occurs. The role of the federal
government in psychiatric inpatient care remains up for debate: some believe more federal
resources are necessary to promote adequate care while others believe this is the responsibility of
the states, citing increased costs to the federal government, among other reasons.86
Identifying Available Bedspace in Treatment Facilities
In addition to an inadequate number of beds, identifying available beds in mental health treatment
facilities can also be a challenge. The mental health treatment system is largely a patchwork of
independently operated public and private facilities that rely primarily on limited informal
communication networks. Some states have begun to create psychiatric bed registries or bed
tracking systems as tools for providers, patients, and caregivers to identify open hospital beds
more efficiently.87 In 2016, Section 9007 of the 21st Century Cures Act (P.L. 114-255) required
the HHS Secretary to award competitive grants to states to, among other things, develop and
maintain a database of beds at inpatient behavioral health treatment facilities. In 2019, SAMHSA
announced a pilot initiative to help select states establish or expand psychiatric crisis bed registry
programs.88 A study by HHS’s Office of the Assistant Secretary for Planning and Evaluation
found that while state bed registries experience significant challenges—such as the reluctance of
hospitals to update information frequently enough to be useful—states report that the registries
can be helpful in locating open beds and identifying the need for additional psychiatric beds.89
Expanding Capacity for Mental Health Services
For law enforcement agencies to effectively divert certain people with mental health conditions
from the criminal justice system, most jurisdictions would need to increase the capacity of their
community mental health services. An effective crisis response system requires access to a
spectrum of available services across a continuum of providers. Trained law enforcement officers
may be able to effectively respond to certain situations involving persons experiencing a mental
health crisis, but officers may be limited in their response without access to adequate follow-up
information. Other public policies also play a role, such as regulations related to implementation of the Supreme
Court’s 1999 decision in Olmstead v. L.C.; see CRS In Focus IF10870, Psychiatric Institutionalization and
Deinstitutionalization for more information.
85 SAMHSA, National Guidelines for Behavioral Health Crisis Care, Best Practice Toolkit, Rockville, MD, 2020.
86 See, for example, U.S. Government Accountability Office (GAO), Medicaid: States Fund Services for Adults in
Institutions for Mental Diseases Using a Variety of Strategies, GAO-17-652, September 8, 2017, https://www.gao.gov/
products/gao-17-652; Jennifer Mathis, “Medicaid’s Institutions for Mental Diseases (IMD) Exclusion Rule: A Policy
Debate—Argument to Retain the IMD Rule,” Psychiatric Services, vol. 70, no. 1 (January 1, 2019), pp. 4-6; and Aaron
Glickman and Dominic Sisti, “Medicaid’s Institutions for Mental Diseases (IMD) Exclusion Rule: A Policy Debate—
Argument to Repeal the IMD Rule,” Psychiatric Services, vol. 70, no. 1 (January 1, 2019), pp. 7-10.
87 Laurel Fuller, Tami Mark, and Shilpi Misra et al., Inpatient Bed Tracking: State Responses to Need for Inpatient
Care, HHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE), Final Report, Washington, DC,
August 2019, https://aspe.hhs.gov/sites/default/files/migrated_legacy_files//190716/IPBedTrack.pdf.
88 SAMHSA, “Crisis Bed Registries to Assist People with Urgent Mental Health Needs,” press release, January 24,
2019, https://www.samhsa.gov/newsroom/press-announcements/201901240130 (hereinafter, “SAMHSA, ‘Crisis Bed
Registries to Assist People with Urgent Mental Health Needs’”).
89 SAMHSA, “Crisis Bed Registries to Assist People with Urgent Mental Health Needs.”
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care for those persons. Without mental health receiving facilities, individuals with further mental
health needs are more likely to end up in emergency departments or jails. Increasing acute
inpatient beds or establishing psychiatric crisis stabilization centers, for example, may improve
outcomes for individuals in crisis, reduce the burden on health care or justice facilities, and
reduce overall costs.90
Mental health services have historically been the responsibility of states. The federal government,
primarily through Medicaid and discretionary grants administered by HHS, provides financial
support to states for mental health treatment. Both Medicaid and discretionary grant programs
have limits on funding inpatient mental health care. For example, SAMHSA’s Community
Mental Health Services Block Grant (MHBG) is the largest federal grant provided to states for
mental health services. Each state may distribute MHBG funds to provide community mental
health services and has flexibility in the use of funds within the framework of a state plan and
federal requirements. The authorization for MHBG prohibits the use of block grant funds “to
provide inpatient services.”91 Similarly, Medicaid, the single largest payer of mental health
treatment services in the United States,92 has a long-standing policy that prohibits the federal
government from providing federal Medicaid funds to states for services rendered to patients in
health care facilities (of more than 16 beds) that primarily provide treatment for mental health
disorders. Known as the IMD exclusion, this policy prevents the federal government from
providing federal Medicaid funds to states for any service delivered to individuals aged 21
through 64 in an “institution for mental diseases (IMD).” 93 States can provide Medicaid coverage
for services rendered in facilities that do not meet the definition of an IMD, such as facilities with
16 or fewer beds and facilities that are not primarily engaged in providing care to individuals with
mental diseases.94 Options to enhance mental health crisis response and treatment services could
involve Congress amending the MHBG authorization or changing Medicaid rules to expand
support for crisis response services and psychiatric inpatient care.95 Tradeoffs to this approach,
however, would include higher costs for inpatient care incurred by the federal government.96
Congress has recently increased federal support for crisis response programs. For example,
Congress included a set-aside for “evidence-based crisis systems” in the FY2021 and FY2022
annual appropriations for the MHBG.97 Similarly, the American Rescue Plan Act of 2021 (ARPA,
90 Wells and Schafer, “Officer Perceptions of Police Responses to Persons with a Mental Illness.”
91 Public Health Service Act (PHSA) §1916 (42 U.S.C. §300x-5).
92 Medicaid.gov, Centers for Medicare and Medicaid Services, Behavioral Health Services, Baltimore, MD,
https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/index.html.
93 The term institution for mental diseases means a “hospital, nursing facility, or other institution of more than 16 beds,
that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical
attention, nursing care, and related services” (SSA §1905(i)).
94 States may also request waivers to receive federal Medicaid funds for services provided to individuals who are
patients in IMDs or make monthly payments to managed care organizations for enrollees aged 21 through 64 who are
patients in an IMD under Medicaid managed care coverage. For more information, see CRS In Focus IF10222,
Medicaid’s Institutions for Mental Disease (IMD) Exclusion.
95 Of note, the MHBG represents a small percentage of state spending on behavioral health activities. The MHBG funds
an average of 1% of the expenses for state mental health agencies. See SAMHSA, Funding and Characteristics of
Single State Agencies, 2017.
96 See, for example, U.S. Government Accountability Office (GAO), Medicaid: States Fund Services for Adults in
Institutions for Mental Disease Using a Variety of Strategies, GAO-17-652, August 2017, https://www.gao.gov/assets/
gao-17-652.pdf.
97 Rep. Rosa DeLauro, “Explanatory Statement Submitted by Ms. DeLauro, Chair of the House Committee on
Appropriations, Regarding the House Amendment to the Senate Amendment to H.R. 2471, Consolidated
Appropriations Act, 2022,” Proceedings and Debates of the 117th Congress, Second Session, Congressional Record,
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P.L. 117-2) provided flexibilities related to Medicaid coverage of community-based mobile crisis
intervention services and appropriated $15 million for these efforts.98 Other options for Congress
to enhance crisis response systems could include direct funding for these activities or further
flexibilities for use of existing funds. Congress made use of both of these approaches when it
appropriated $340 million for emergency substance use or mental health needs in COVID-19
supplemental appropriations measures, for instance.99 Some states are using ARPA funds to
bolster the continuum of mental health services as well. Massachusetts, for example, used $31
million of ARPA funds to support inpatient psychiatric acute facilities.100
California’s Psychiatric Health Facilities
To create receiving facilities for individuals experiencing a mental health crisis—other than jails or emergency
departments—California established alternative nonhospital 24-hour acute treatment facilities beginning in the
1980s. This strategy was designed to meet the need for inpatient services while also controlling costs.101
California’s psychiatric health facilities (PHFs) provide short-term mental health treatment to individuals in crisis or
those with acute mental health needs. Similar to other short-term residential settings, psychiatric acute care
facilities, or crisis stabilization units, PHFs provide short-term mental health treatment in less medically intensive,
nonhospital settings.102 PHF services utilize an interdisciplinary team that includes psychiatry, clinical psychology,
psychiatric nursing, and social work personnel who provide crisis services, medication management,
psychotherapy and other counseling, rehabilitation, drug administration, and pharmacy and basic support services,
among others.103 Initial estimates suggested that PHFs were associated with reduced costs compared to
emergency department or other acute hospital admissions.104 As of 2021, California had over 20 PHFs in
operation throughout the state.
Preventing Mental Illness and Mental Health Crises
Some experts have argued that an emphasis on psychiatric service expansion would be an
insufficient way to address mental health crisis response, and would perpetuate an already
inadequate “standard, reactive psychiatric consultation model.” 105 A more upstream approach to
addressing mental health crises would invest in prevention interventions prior to the onset of a
mental health condition. Some proponents of this model note that prevention efforts, and more
targeted programming, are more efficient uses of finite criminal justice and mental health
vol. 168, part No. 42, Book IV (March 9, 2022), pp. H2477-H3215.
98 For more information, see CRS Report R46777, American Rescue Plan Act of 2021 (P.L. 117-2): Private Health
Insurance, Medicaid, CHIP, and Medicare Provisions.
99 For more information, see CRS Report R46711, U.S. Public Health Service: COVID-19 Supplemental
Appropriations in the 116th Congress.
100 National Academy for State Health Policy, How States Are Spending American Rescue Plan Funds, October 8,
2021, https://www.nashp.org/how-states-are-spending-american-rescue-plan-state-fiscal-recovery-funds/.
101 Sally Moltzen, Howard Gurevitz, and Maurice Rappaport et al., “The Psychiatric Health Facility: An Alternative for
Acute Inpatient Treatment in Nonhospital Setting,” Hospital and Community Psychiatry, vol. 37, no. 11 (November
1986) (hereinafter, “Moltzen et al., ‘The Psychiatric Health Facility’”).
102 HHS, ASPE, Office of Disability, Aging, and Long-Term Care Policy, Inpatient Bed Tracking: State Responses to
Need for Inpatient Care, Washington, DC, August 2019, https://aspe.hhs.gov/sites/default/files/migrated_legacy_files//
190716/IPBedTrack.pdf.
103 California State Department of Health Care Services, Psychiatric Health Facilities, May 4, 2021,
https://www.dhcs.ca.gov/psychiatric-health-facilities.
104 Moltzen et al., “The Psychiatric Health Facility.”
105 Mara Laderman, Amrita Dasgupta, and Robin Henderson et al., “Tackling the Mental Health Crisis in Emergency
Departments: Look Upstream for Solutions,” Health Affairs Blog, January 26, 2018, https://www.healthaffairs.org/do/
10.1377/forefront.20180123.22248/full/.
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resources.106 An upstream approach to preventing mental health crises could focus efforts on
economic initiatives,107 education and school-based programs,108 interventions addressing social
determinants of mental health,109 community development,110 or medical care earlier in life (i.e.,
prenatal care, early childhood interventions).111 Given the dearth of mental health providers,
generating enough treatment services might not be feasible, suggesting an opportunity for
investments in prevention.112 Additionally, outcome research on law enforcement crisis response
models is nascent. If future research suggests ineffectiveness, resources to address mental illness
and mental health crises may be better used elsewhere.
Training for Law Enforcement Personnel
Jurisdictions that want to establish a specialized response for individuals experiencing a mental
health crises face potential challenges with developing that capacity, including finding the time
and resources necessary to provide initial and then ongoing training for selected officers. For
example, the CIT model requires 40 hours of training for law enforcement officers to be certified.
The core elements of the model state that 20%-25% of patrol officers be CIT-certified to fully
implement a CIT program.113 For smaller law enforcement agencies, extended training sessions
and continuing education can pose significant burdens. Data from the Bureau of Justice Statistics
indicates that three-quarters of police departments in 2016 employed 24 or fewer officers and
about half employed 9 or fewer officers.114 In addition to staffing challenges, the cost of travel,
per diem, and training might not be easily accommodated given limited budgetary resources. The
Council of State Governments Justice Center and International Association of Directors of Law
Enforcement Standards and Training noted that “for law enforcement agencies, there is also a
concern with how to meet minimum deployment needs while officers are in training and how to
cover any associated overtime costs, particularly for specialized training courses.”115
106 Jennifer D. Wood and Laura Beierschmitt, “Beyond Police Crisis Intervention: Moving ‘Upstream’ to Manage
Cases and Places of Behavioral Health Vulnerability,’ Psychiatry, vol. 37, no. 5 (September-October 2014), pp. 439447.
107 Anna Macintyre, Daniel Ferris, and Briana Concalves et al., “What has Economics Got to Do with It? The Impact of
Socioeconomic Factors on Mental Health and the Case for Collective Action,” Palgrave Communications, vol. 4,
article no. 10 (2018).
108 Amanda Sanchez, Danielle Cornacchio, and Bridget Poznanski et al., “The Effectiveness of School-Based Mental
Health Services for Elementary-Aged Children: A Meta-Analysis,” Child & Adolescent Psychiatry, vol. 57, no. 3
(March 2018), pp. 153-165.
109 Deidre M. Anglin, Sandro Galea, and Peter Bachman, “Going Upstream to Advance Psychosis Prevention and
Improve Public Health,” JAMA Psychiatry, vol. 77, no. 7 (April 1, 2020).
110 Laura Choi, Moving Upstream to Promote Mental Health: The Role of Community Development, Center for
Behavioral Health Statistics and Quality, 2018, https://www.frbsf.org/community-development/wp-content/uploads/
sites/3/moving-upstream-choi-mental-health-and-community-development-cdir-13-1.pdf.
111 Celso Arango, Covadongo Diaz-Caneja, and Patrick McGorry et al., “Preventive Strategies for Mental Health,” The
Lancet Psychiatry, vol. 5, no. 7 (July 2018), pp. 591-604.
112 Corey L. M. Keyes, Satvinder S. Dhingra, and Eduardo J. Simoes, “Change in Level of Positive Mental Health as a
Predictor of Future Risk of Mental Illness,” American Journal of Public Health, vol. 100, no. 12 (2010), pp. 23662371.
113 Randoph Dupont, Sam Cochran, and Sarah Pillsbury, Crisis Intervention Team Core Elements, University of
Memphis, Memphis, TN, September 2007, p. 10, http://cit.memphis.edu/CoreElements.pdf.
114 Shelley S. Hyland and Elizabeth Davis, Local Police Departments, 2016: Personnel, DOJ, Office of Justice
Programs, Bureau of Justice Statistics, NCJ 252835, Washington, DC, October 2019, p. 3.
115 Martha Plotkin and Talia Peckerman, The Variability in Law Enforcement State Standards: A 42 State Survey on
Mental Health and Crisis De-Escalation Training, Council of State Governments Justice Center, New York, NY,
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In addition to training law enforcement officers to provide specialized responses to people with
mental illness, there is also a need to train civilian staff at 911 call centers to appropriately
navigate mental health emergencies. Call center operators are frequently the first point of contact
for people who are suffering a mental health crisis. The 911 system is decentralized, with over
5,000 call centers across the country, each with their own standards regarding training, how calls
are handled, dispatch protocols, and data management and reporting systems.116 A “key insight”
presented in a Pew study of call center capacity to handle mental health emergencies was that
about two-thirds of respondents reported that their call center operators have not received any
specialized mental health crisis training.117 Even though the findings of this study cannot be
generalized to all call centers, due to a small sample size and low response rate, it does reveal
some potentially important insights. Barriers to accessing training included high staff turnover,
staffing shortfalls resulting from the amount of time that a call taker is unavailable while he or
she is in training and lack of funding or staff for backfilling call center shifts, budgetary
constraints preventing staff from going to training that requires travel, and lack of awareness that
training is available.118 Given the lack of widespread specialized training in some jurisdictions,
having access to mental health professionals who could assist call center operators with handling
calls involving people with mental illness could be a valuable resource, though it may be
prohibitively costly and cumbersome for some areas and centers, and lead to increased response
times if additional mental health screening questions are added to 911 scripts.119 Federal agencies
involved in the transition to the new three-digit 988 Suicide & Crisis Lifeline have expressed
ambitions to situate that crisis hotline in the center of a robust crisis response system. 120 However,
building such a system would require substantial effort and considerable resources, and few areas
are currently well positioned to establish this network.
Supporting Co-Responder and Mobile Crisis Teams
While CIT is the most widely used model, anecdotal evidence suggests that more jurisdictions are
adopting CRTs and MRTs in order to improve their response to people with mental illness. As
discussed previously, CRTs and MCTs employ mental health professionals in some capacity,
while CITs consist entirely of law enforcement officers, albeit specially trained officers.
Policymakers might consider whether the federal government could support jurisdictions that
want to start new or expand the capacity of existing CRTs or MCTs.
A key question might be whether funds under DOJ’s Justice and Mental Health Collaboration and
JAG programs could be used to support CRTs and MCTs. The authorization for the Justice and
Mental Health Collaboration program specifically authorizes funds to be used for CIT programs,
though the authorization states that the “appropriate use” of funds also includes “law enforcement
January 2017, p. 7 (hereinafter, “Plotkin and Peckerman, 42 State Survey on Mental Health and Crisis De-Escalation
Training”).
116 Pew Charitable Trusts, New Research Suggests 911 Call Centers Lack Resources to Handle Behavioral Health
Crises, online issue brief, October 26, 2021, https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/10/
new-research-suggests-911-call-centers-lack-resources-to-handle-behavioral-health-crises (hereinafter, “Pew, 911 Call
Centers Lack Resources”).
117 Pew noted that the results of the survey are not representative of call centers nationally (Pew sent their questionnaire
to 233 call centers, only 37 responded), but it asserts that the results provide “key insights” into the mental health crisis
system resources of 911 call centers. Pew, 911 Call Centers Lack Resources.
118 Pew, 911 Call Centers Lack Resources.
119 Jonathan Levinson, “Dying on hold: How new software is creating a logjam at Portland’s 911,” Oregon Public
Broadcasting News, May 6, 2022, https://www.opb.org/article/2022/05/06/portland-911-calls-hold-times-multnomahcounty-emergency-response-system-issues/.
120 SAMHSA, 988 Appropriations Report, Rockville, MD, December 2021.
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diversion” (34 U.S.C. §10651(a)(4)(B)). The authorization for the program defines diversion as
“the appropriate use of effective mental health treatment alternatives to juvenile justice or
criminal justice system institutional placements for preliminarily qualified offenders” (34 U.S.C.
§10651(a)(4)(A)). In addition, the authorization for the JAG program allows funds to be used for
“mental health programs and related law enforcement and corrections programs, including
behavioral programs and crisis intervention teams” (34 U.S.C. §10152(a)(1)(H)).
Congress might consider whether to amend the authorizations for the Justice and Mental Health
Collaboration and JAG programs to make it explicit that funds under both programs can be used
for CRTs and MCTs. However, some might question whether MCTs should be funded with grants
from DOJ, which largely focus on law enforcement-based programs and responses. Supporters of
MCTs argue that law enforcement does not need to be or should not be involved in responding to
calls for service that involve people with mental health problems who are not engaging in violent
behavior. There also might be a question about whether supporting MCTs through grants from
DOJ, a prominent law enforcement agency, could harm their legitimacy in communities that want
to separate responses to people with mental health problems from law enforcement. Policymakers
might consider whether MCTs should be supported through grants from SAMHSA rather than
DOJ.
Other questions regarding financial support for crisis response services surround the shared
commitment between federal, state, and local governments and the private sector. If the
responsibility for mental health emergency response shifts from law enforcement to health
services, then it may be prudent to utilize the existing systems of health care financing—such as
private health insurance and public programs like Medicaid and Medicare—rather than annual
discretionary funding and competitive grants to fund such a system. A substantial share of
behavioral health costs have historically been borne by states—an anomalous arrangement
relative to other health conditions. Congress may consider options to incorporate payment for
crisis response services into mainstream health care financing systems, and determine the
appropriate balance between mandatory and discretionary funding streams.
Data Collection
Policymakers might consider whether there is a need for a requirement for DOJ to collect and
report data on a broader range of contacts between law enforcement officers and people in mental
health crises. DOJ currently collects data on some interactions between law enforcement officers
and people experiencing mental health crises through its National Incident Based Reporting
System (NIBRS) and its Use-of Force Data Collection program, but the data collected through
these systems are limited, and in the case of the Use-of-Force Data Collection program, the data
are hampered by limited participation on the part of law enforcement agencies. More complete
data (e.g., collecting data on the situation surrounding the contact between the police and a person
in a mental health crisis and the outcome of that interaction) could aid federal, state, and local
policymakers with decisions about how to respond to people with mental illness. For example,
policymakers could examine whether people in mental health crises in cities with CRTs or MCTs
are less likely to be arrested or injured while they are experiencing a mental health crisis.
A potential mandate for DOJ to collect and report data on a wider variety of law enforcement
interactions with people experiencing mental health emergencies does not mean that state and
local law enforcement agencies will participate in a data collection program absent an incentive,
and even then, that the incentive would be enough to induce law enforcement agencies to submit
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the required data.121 Potential incentives could include making participation a condition of
accessing grant funds from DOJ, requiring states to collect and report data from their law
enforcement agencies or face reduced funding under the JAG program, giving preferential
consideration for competitive grants to law enforcement agencies who can demonstrate that they
submit the required data, or awarding bonus allocations under the JAG program to states that
participate in the data collection program.
Increasing the Capabilities of 911 Call Centers
A Pew study of 911 call centers suggested that these centers might require additional resources to
increase their capacity to respond to mental health-related calls.122 Many of the call centers that
responded to the survey reported that their operators did not have training on how to handle
mental health-related calls and lacked access to mental health professionals to aid in handling
these calls.
To address these issues, policymakers may consider whether to authorize funding for research on
how to improve 911 response to mental health calls, and to identify options and best practices that
could be shared with 911 centers.123 Policymakers may choose to authorize funding that would
support hiring of mental health professionals to handle mental health-related 911 calls or to assist
911 call takers with those calls. While Congress has established programs to fund certain
positions (e.g., police, firefighters), traditionally it has not funded 911 positions (state and local
governments typically fund these). Further, it does not typically fund positions in perpetuity. For
example, for the Department of Homeland Security Staffing for Adequate Firefighter Emergency
Response (SAFER) program, federal funding is limited to three years, with localities assuming a
higher percentage of the salaries each year. Policymakers may consider supporting the
development of and providing funding for training programs, including train-the-trainer programs
and other training to assist 911 operators responding to mental health calls.124
Call centers have also reported several logistical issues preventing effective response, such as
inconsistencies in software used to manage 911 calls. These technological barriers prevent centers
from collecting consistent data on the number of mental health-related calls they receive and the
outcomes of these calls. Policymakers may consider authorizing funding to help upgrade local
911 systems to assist them in collecting data on the number of, responses to, and outcomes of
mental health related calls. If Congress were to authorize a grant program to assist jurisdictions
with data collection, policymakers may also consider the merits of requiring a federal agency to
coordinate with industry stakeholders or lead a public-private effort to develop data collection
standards for 911 call centers regarding mental health-related calls (and require any jurisdiction
that receives funding to report data based on these standards). A challenge with this approach is
that only 911 centers that have standardized software and receive grant funding would likely
121 For a more in-depth discussion of the issues involved with crafting incentives for law enforcement agencies to
submit data on their activities to the federal government, see CRS Report R46443, Programs to Collect Data on Law
Enforcement Activities: Overview and Issues.
122 Pew, 911 Call Centers Lack Resources.
123 The National 911 Program office in the National Highway Traffic Safety Administration at the U.S. Department of
Transportation used this approach to improve survivor rates for those experiencing heart attacks. Based on research
from the National Academies, the National 911 Program office created “CPR Lifelinks”—a national initiative to train
911 call takers to help others administer CPR before professional help arrives.
124 The National 911 Program Office lists several (non-governmental) organizations that provide training for 911 call
takers including the 911 Training Institute, which offers training for managing calls from those experiencing a mental
health crisis, available at https://www.911training.net/.
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report, meaning that any collected data would be incomplete. Even if funding is not tied to
implementing data collection standards, requiring a federal agency to encourage such standards,
even as advisory guidance, might help promote more consistent data on mental health-related
calls.
A final issue for consideration is coordination between 911 call centers and 988 calling services.
Currently, the two systems are separate.125 Industry stakeholders have encouraged greater
planning, coordination, and shared protocols between 911 and 988 systems and have called for
increased definition of roles, responsibilities, and procedures for managing and referring calls
between the two systems.
Promoting Consistency in Law and Policies
States have a range of laws and policies regarding the training law enforcement officers receive
on how to respond to people with mental illness.126 States also have varying laws regarding what
actions law enforcement officers can take when they encounter someone experiencing a mental
health crisis, such as who can initiate a temporary hold so someone can be evaluated by a mental
health professional or whether officers can issue a citation in lieu of an arrest, thereby diverting
someone experiencing a mental health crisis from potential incarceration.127
Policymakers might consider whether the federal government should take any steps to promote
more consistency in these laws and policies among states. One possible step might be for
Congress to require DOJ to publish recommended standards regarding the type and amount of
academy and in-service training law enforcement officers should receive. Policymakers might
consider whether to authorize a new grant program to help support efforts to provide more
academy-based and in-service mental health training to law enforcement officers for state or local
governments that agree to meet the requirements of the recommended training standards. Federal
agencies such as DOJ and HHS could issue model laws that states could adopt to improve how
people with mental illness interact with the criminal justice and mental health systems. Due to the
federalized system of government in the United States, it is unlikely that Congress could directly
require states to adopt any recommended changes to their laws or policies, so Congress might
consider providing an incentive for states to do so.128 Policymakers might also consider whether
to make adoption of any proposed changes to policies regarding mental health training for law
enforcement officers or actions law enforcement officers can take when they encounter a person
with mental illness a condition of receiving federal funding.
125 In some areas, the 911 and 988 systems may have formal relationships, but the infrastructure and routing systems
remain separate.
126 For an overview of mental health and de-escalation training provided to law enforcement officers, see Plotkin and
Peckerman, 42 State Survey on Mental Health and Crisis De-Escalation Training.
127 For an overview of state laws that might affect law enforcement officers’ ability to respond to people experiencing a
mental health crisis, see Lars Trautman and Jonathan Haggarty, Statewide Policies Relating to Pre-Arrest Diversion
and Crisis Response, R Street Policy Study #187, November 2019. The R Street Institute is described as a “nonprofit,
nonpartisan, public policy research organization that promotes center-right solutions to public policy problems.”
MacArthur Foundation, R Street Institute, https://www.macfound.org/grantee/r-street-institute-10097751/.
128 For a review of federalism and congressional influence over state and local law enforcement policy, see CRS Report
R43904, Public Trust and Law Enforcement—A Discussion for Policymakers.
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Supporting Research on Crisis Response Models
There is a dearth of high-quality research on the effectiveness of MCTs and CRTs, and to some
extent CITs (though studies on CITs are more numerous than studies on the other two
approaches). Concerns about how law enforcement officers handle calls for service involving
people with mental health problems have led many jurisdictions to consider alternatives to
traditional law enforcement responses.129 This might provide an opportunity for the federal
government to support more research on MCTs and CRTs. Policymakers could consider
authorizing a new grant program that would help jurisdictions either start MCTs or CRTs or
expand them beyond the pilot stage with the condition that jurisdictions evaluate their programs
and make the results available to the granting agency. Congress could also provide funding for
evaluation research on MCTs and CRTs through the National Institute of Justice (NIJ) or the
National Institutes of Health (NIH).
129 David A. Graham, “The Stumbling Block to One of the Most Promising Police Reforms,” The Atlantic, February
22, 2022.
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Appendix. Examples of Mobile Crisis Teams
Members of Congress who want to learn more about responses to people in a mental health crisis
that do not involve law enforcement might be interested in which jurisdictions have MCTs. While
there is no comprehensive accounting of cities that utilize MCTs, this appendix provides
examples of cities that are using them on either a permanent or pilot basis.
Albuquerque, NM
In September 2021, Albuquerque launched the Albuquerque Community Safety Department
(ACS) to respond to emergency nonmedical calls that are not believed to involve violence or the
threat of violence.130 Unlike some of the other pilot programs highlighted below, ACS is now a
cabinet-level city department, acting as a third public safety agency alongside the Albuquerque
police and fire departments.131 911 dispatchers route calls for disturbances, issues involving
mental health or homelessness, possible suicides, welfare checks, and other calls believed to be
nonviolent and nonmedical to ACS.132 ACS responses to 911 calls for service are in lieu of a
response from firefighters, EMTs, or law enforcement, preserving these first responders for other
emergency calls.133 ACS has several different types of responders. MCT clinicians are dispatched
in joint responses with law enforcement and respond exclusively to ACS’ 911 calls. Behavioral
Health Responders (BHR) and Community Responders (CR) resemble traditional MCTs, and are
dispatched in teams of two to respond to nonviolent 911 calls and tickets created by the city’s
nonemergency request line, 311.134 Street Outreach and Resource Coordinators (SO) respond to
311 tickets, and do not respond to 911 dispatches. BHR, CR, and SO teams may also proactively
aid individuals in need, resulting in a self-dispatch.135 As of July 2022, the department has
received nearly 14,000 calls for service from 911 dispatch, 311 tickets, and self-dispatch, and
estimates that over 7,000 calls have been diverted from the Albuquerque Police Department to
ACS. The majority of calls for service are taken by BHR teams, which are also the largest group
of ACS responders.136
Denver, CO
The Supported Team Assistance Response (STAR) Program is a collaborative effort between the
Caring for Denver Foundation, Denver Police Department, WellPower (Mental Health Center of
Denver), Denver Health Paramedic Division, Denver 911, and other organizations offering
community supports and resources. 911 dispatchers redirect certain calls related to individuals
130 Colleen Heild, “ABQ’s Community Safety Department Launches Patrols,” Albuquerque Journal, September 11,
2021.
131 City of Albuquerque, Albuquerque Community Safety Department FY2022 Organizational Plan, Albuquerque
Community Safety Department, December 2021, p. 9 (hereinafter, “Albuquerque Community Safety Department
FY2022 Organizational Plan”).
132 “Albuquerque Community Safety Department FY2022 Organizational Plan,” p. 24.
133 City of Albuquerque Mayor Tim Keller, “Albuquerque Community Safety Responders Hit the Street,” press release,
October 13, 2021.
134 311 is a specialized phone number supported by many cities in the United States that provides access to
nonemergency municipal services and is intended to divert calls from 911.
135 “Albuquerque Community Safety Department FY2022 Organizational Plan,” p. 17-23.
136 City of Albuquerque, Albuquerque Community Safety Monthly Informational Report: July 2022, Albuquerque
Community Safety Department.
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experiencing problems with mental health, poverty, homelessness, and/or substance abuse issues
to STAR.137 A STAR mobile crisis response team (e.g., a social worker and paramedic) can
provide medical assessment, crisis intervention, de-escalation, transportation, and connections to
community resources.138 STAR only responds to incidents in which there is no evidence of
criminal activity or violence, weapons, threats, injuries, or serious medical needs. The STAR pilot
program operated from June 1 to November 30, 2020. During the pilot phase, STAR operated one
van staffed with a paramedic and a clinician that offered services from 10:00 a.m. to 6:00 p.m. on
weekdays in high-demand neighborhoods. An evaluation of the STAR pilot found that the
program reduced reports of less serious crimes in covered neighborhoods by 34% overall, and it
found evidence of reduced crime levels outside of STAR operating hours.139 Denver continued to
operate STAR after the pilot phase and the program has secured additional funding to expand
service. STAR currently operates from 6:00 a.m. to 10:00 p.m., and is in the process of trying to
secure several new vans and expand service citywide.140
Anchorage, AK
The municipality of Anchorage launched an MCT program in the summer of 2021. MCT teams
comprised of a mental health clinician and a paramedic from the Anchorage Fire Department
(AFD) respond to 911 or 311 calls involving a mental health crisis that are believed not to involve
a weapon, an active suicide attempt, or any other threat of violence toward the patient or
responders. The program is housed in AFD, and initially received calls exclusively through the
fire department’s dispatch center. Police dispatchers have since been trained on how to use and
dispatch MCTs, increasing dispatch volume for the teams. 911 callers may request an MCT
response, and dispatchers screen and connect appropriate requests. The MCT program currently
operates from 10:00 a.m. to 8:00 p.m., seven days a week, and responds to calls citywide.
However, in May 2022 the city assembly approved additional funding for the program with the
intent to expand service to 24 hours a day.141
Olympia, WA
The Crisis Response Unit (CRU) in Olympia, WA, was started in 2019 as a unit within the
Olympia Police Department and is staffed by six behavioral health specialists who work in pairs.
The Olympia Police Department works with the Thurston County 911 Communications Center to
identify calls where CRU might be an appropriate response. However, rather than dispatching
137 STAR Program Evaluation; Li Cohen, “Health Care Workers Replaced Denver Cops in Handling Hundreds of
Mental Health and Substance Abuse Cases—And Officials Say it Saved Lives,” CBS News, February 6, 2021; David
Sachs, “In the First Six Months of Health Care Professionals Replacing Police Officers, No One They Encountered was
Arrested,” Denverite, February 2, 2021.
138 City of Denver, “Support Team Assisted Response (STAR) Program,” https://www.denvergov.org/Government/
Agencies-Departments-Offices/Agencies-Departments-Offices-Directory/Public-Health-Environment/CommunityBehavioral-Health/Behavioral-Health-Strategies/Support-Team-Assisted-Response-STAR-Program (hereinafter,
“Support Team Assisted Response (STAR) Program”).
139 Thomas S. Dee and Jaymes Pyne, “A community response approach to mental health and substance abuse crises
reduced crime,” Science Advances, vol. 8, no. 23 (June 8, 2022).
140 “Support Team Assisted Response (STAR) Program.”
141 Municipality of Anchorage, Anchorage Fire Department, “What is the Mobile Crisis Team (MCT)?,”
https://www.muni.org/Departments/Fire/Pages/Mobile-Crisis-Team.aspx; Tess Williams, “A new team of Anchorage
first responders focuses on mental health crises. Officials say it frees up hospital beds and public safety resources,”
Anchorage Daily News, November 6, 2021; and Wesley Early, “Anchorage’s Mobile Crisis Team hopes funding to
operate 24/7 will expand ability to address mental health crises,” Alaska Public Media, August 15, 2022.
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CRU directly to calls based on certain criteria, the 911 call center shares all potentially eligible
calls over the police radio frequency and CRU decides whether to respond. Alternatively, police
officers can refer the call to CRU if they determine that a non-law enforcement based response
would be better and the threat to first responders is minimal. CRU also provides a secondary
response at the request of the first responding police officer. As CRU has become more
established, some callers have started asking for CRU to respond. In addition to responding to
calls for service, CRU also does proactive outreach to develop trust with the community, such as
having a presence at the city-sanctioned encampment for people who are homeless.142 With
increased funding, Olympia expanded CRU operations to 24 hours a day, seven days a week. As
of 2021, the program was working on hiring additional crisis response specialists and medical
staff.143
Stockton, CA
In July 2022, the Stockton City Council approved the pilot of the Care Link Response Program.
The program is to create a behavioral health first responder system to divert mental health crises
calls to 911 that are believed to be nonviolent from the city’s police and fire departments. Created
by a partnership between the city and a local nonprofit, Community Medical Centers, the pilot
program is to begin in late 2022 with one team, comprised of a licensed mental health clinician,
an outreach worker, and a case manager. Programs goals include decreasing recidivism,
decreasing repeat callers on emergency lines, increasing community trust, decreasing costs related
to emergency calls, decreasing fears of calling the police, and diverting people from the criminal
justice system.144
Austin, TX
The Expanded Mobile Crisis Outreach Team (EMCOT) in Austin, TX, is staffed with mental
health providers from Integral Health, the mental health authority for Travis County (the county
in which Austin is located). EMCOT started in 2013 and EMTs and law enforcement agencies in
Travis County can request EMCOT assistance with calls through the county’s 911 call center.
EMCOT connects people with treatment appropriate for psychiatric crises with the intent of
diverting people from emergency rooms or jail.145 The city increased the budget for EMCOT in
2020 with the intention of increasing staffing, thereby allowing all mental health-related 911 calls
that do not involve a threat to public safety to be diverted to EMCOT. (EMCOT is not involved in
cases where there is evidence that a crime has been committed, a weapon is present, someone is
in need of medical assistance due to use of drugs or alcohol, someone is at risk of hurting
themselves or someone else, or someone’s life or property are under threat.) Law enforcement
officers still have to be involved in some mental health calls because under Texas law only law
enforcement officers can initiate an involuntary commitment of someone at risk of harming
142 Jackson Beck, Melissa Reuland, and Leah Pope, Case Study: CRU and Familiar Faces, Vera Institute of Justice,
November 2020, https://www.vera.org/behavioral-health-crisis-alternatives/cru-and-familiar-faces.
143 Elizabeth Fleming, “Staffing Community Responder Programs: Q&A with the Olympia (WA) Crisis Response
Unit,” The Council of State Governments Justice Center, October 7, 2021, https://csgjusticecenter.org/2021/10/07/
staffing-community-responder-programs-qa-with-the-olympia-wa-crisis-response-unit/.
144 Gabriel Porras, “Stockton City Council approves pilot program to send crisis intervention team to some police
calls,” ABC 10 News (Stockton), July 28, 2022.
145 Jennifer Kendall, “Crisis Counselors Responding to More Mental Health Calls in Austin,” Fox 7 (Austin) News,
November 2, 2020.
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himself/herself or others.146 The increased funding allowed for EMCOT mental health clinicians
to be added to local 911 call centers. All callers now have the option to choose from police, fire,
EMS, or mental health services when they begin a 911 call. If callers request mental health
services, the 911 call taker screens the call to try to ensure that police, EMS, or fire department
responses are not needed, and then transfers the caller to an onsite health clinician for additional
screening.147 EMCOT services are currently available 24 hours a day, seven days a week.148
New York, NY
New York City piloted an MCT program in three police precincts in Harlem starting in February
2021.149 The program, called the Behavioral Health Emergency Assistance Response Division (BHEARD), has since been expanded to include additional areas of Harlem, Washington Heights,
Inwood, and parts of the South Bronx, with plans to expand to central Brooklyn and eastern
Queens in New York City’s FY2023. Under the program, teams comprised of two paramedics
from the fire department’s Emergency Medical Services and one mental health professional from
NYC Health + Hospitals respond to mental health emergencies. Teams respond to 911 calls
involving a range of behavioral health issues, such as suicide attempts, substance use, and serious
mental illness. However, if the subject is known to be armed or presents a danger, a police officer
responds with or in place of the B-HEARD team. B-HEARD operates 16 hours a day, seven days
a week.150 Between January 1, 2022, and March 31, 2022, approximately 2,400 mental health
calls to 911 were diverted to B-HEARD. Of those calls, 23% were routed to B-HEARD teams,
and B-HEARD responded to 68% of calls routed to them. Of the calls routed to B-HEARD that
B-HEARD was not able to respond to, it was typically because the B-HEARD teams were
responding to another call or otherwise unavailable. Although most mental health calls in the BHEARD operating area still receive a law enforcement response, of the calls that B-HEARD
teams responded to, assisted individuals were more likely to accept help and less likely to be
transported to a hospital than individuals assisted by traditional first responders.151
Portland, OR
Portland Street Response (PSR) launched in February 2021 as a pilot program that dispatches a
paramedic, a mental health clinician, and, if necessary, one or more community health workers to
146 Ryan Thorton, “Integral Care Set to Address Most Mental Health Emergency Calls Without Involving APD,” Austin
Chronicle, August 18, 2020; and Integral Care, Expanded Mobile Crisis Outreach Team, https://www.austintexas.gov/
edims/document.cfm?id=302634.
147 Amanda Ruiz, “Austin 911 adds fourth option for mental health services,” Fox 7 (Austin) News, February 10, 2021;
and The Council of State Governments Justice Center, “Integral Care’s Expanded Mobile Crisis Outreach Team –
Austin, TX,” https://integralcare.org/program/mobile-crisis-outreach-team-mcot/.
148 Integral Care, “Mobile Crisis Outreach Team (MCOT),” https://integralcare.org/program/mobile-crisis-outreachteam-mcot/
149 Associated Press, “Mental Health Workers to Take the Lead in Some NYC 911 Calls,” November 10, 2020; City of
New York, “New York City Announces New Mental Health Teams to Respond to Mental Health Crises,” press release,
November 10, 2020; and Lauren Cook, Nicole Johnson, and the Associated Press, “Social Workers, EMS—Not
NYPD—to Respond to Non-Violent Mental Health Calls Citywide,” Pix 11 (New York) News, updated April 30, 2021.
150 New York City Mayor’s Office of Community Mental Health, “Re-Imagining New York City’s Mental Health
Emergency Response: FAQ,” https://mentalhealth.cityofnewyork.us/b-heard.
151 New York City Mayor’s Office of Community Mental Health, B-HEARD: Transforming NYC’s Response to Mental
Health Emergencies, January-March 2022 (FY22 Q3), https://mentalhealth.cityofnewyork.us/wp-content/uploads/
2022/06/FINAL-DATA-BRIEF-B-HEARD-FY22-Q3.pdf.
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911 calls involving people who are homeless or have serious mental health issues. The paramedic
and mental health clinician are dispatched first for mental health calls or when a wellness check is
needed. Community health workers are dispatched if the individual expresses need for additional
services such as shelter or housing.152 PSR is dispatched only if the individual in crisis is believed
to be in a publicly accessible space, not obstructing traffic, is nonviolent, does not have a weapon,
and is not suicidal. PSR is coordinated through Portland Fire and Rescue because the program
needs a connection to the current 911 system. Portland Fire and Rescue’s Community Health
Division focuses on preventive healthcare intervention, and the arrangement aligns with the intent
to keep the program separate from the police department. The program was expanded citywide in
March 2022. PRS currently operates 10 to 14 hours a day, seven days a week, but hopes by fall of
2022 to operate 24 hours a day with a staff of 58 full-time employees.153 An evaluation of the first
year of the PSR pilot found that the calls responded to by PSR represented a 4% reduction in total
calls that police would have traditionally responded to in the PSR operating area and service
hours, despite PSR operating with a single team for two-thirds of the first year. The reduction in
nonemergency calls was larger, representing a 27% decline in police responses to nonemergency
welfare checks and unwanted persons calls,154 and a 12.4% decline in fire department responses
to behavioral health and illegal burn calls.155
San Francisco, CA
San Francisco launched its Street Crisis Response Team (SCRT) as a pilot program in November
2020.156 The program is a joint effort between the San Francisco Fire Department and the San
Francisco Department of Public Health, in collaboration with the Department of Emergency
Management. SCRT started by exclusively serving the Tenderloin neighborhood, but it became a
citywide 24-hour, seven days a week service by July 2021. Five teams are assigned to each
respond to a specific neighborhood, and two teams provide overnight coverage and dispatch
citywide as needed. SCRT teams are dispatched to 911 calls involving “mentally disturbed
persons” experiencing behavioral health crises that are believed not to involve weapons or
violence. Each team is staffed with a community paramedic, a behavioral health clinician, and a
peer specialist. Teams are supported by the newly created Office of Coordinated Care, which
staffs a special team of care coordinators that follows up with all SCRT contacts within 24 hours
to help ensure connections to mental health care and substance use services.157 In June 2022,
Phase 2 of the SCRT program began with transitioning from police dispatch to Emergency
Medical Dispatch. This change further separates behavioral health crisis response from law
enforcement, allows an EMS rather than a police response if SCRT is unable to respond to a call,
152 Nicole Hayden, “Portland Street Response Launches, Pairing Medics with Clinicians on Mental Health Calls,” The
Oregonian, February 17, 2021.
153 City of Portland, “Portland Street Response Frequently Asked Questions,” https://www.portland.gov/streetresponse/
psr-faq; and KATU 2 (Portland) News, “Portland Street Response sees surge in call volume with citywide expansion,”
June 22, 2022.
154 An unwanted persons call involves an individual refusing to leave a location when asked. City of Portland, “Police
Dispatched Calls Dashboard,” https://www.portland.gov/police/open-data/police-dispatched-calls.
155 Greg Townley and Emily Leickly, Portland Street Response: Year One Evaluation, Portland State University, April
2022.
156 City of San Francisco, Mayor’s Office, “Mayor London Breed Announces Plan to Create Street Wellness Response
Team To Expand Services For Those In Need,” press release, May 10, 2021.
157 Harder+Company Community Research, Street Crisis Response Team Pilot: Final Report, May 2022.
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and expands the range of calls for SCRT response. As of July 2022, SCRT has responded to
11,324 calls, with 5,508 client engagements on-scene.158
Minneapolis, MN
In December 2021, the City of Minneapolis launched the Behavioral Crisis Response (BCR)
program to divert mental health crisis calls from law enforcement. The city contracted with
Canopy Roots, a local private mental health services organization, to staff the BCR teams. Teams
of mental health practitioners respond to mental health crisis calls to 911 in which there are
believed to be no firearms involved and the person in need appears nonviolent. Two teams are
available to respond citywide, 24 hours a day, Monday through Friday. If both BCR units are
unavailable, then 911 dispatch sends a traditional police response to the mental health crisis
call.159 In the first six months of operation, BCR diverted an estimated 1,400 calls from the
Minneapolis Police Department.160
Chicago, IL
The City of Chicago first launched its Crisis Assistance Response and Engagement (CARE)
Program in September 2021 as a co-responder program with a Chicago Fire Department
community paramedic, a Chicago Department of Public Health (CDPH) mental health
practitioner, and a Chicago Police Department CIT officer on each team. CARE teams receive
and respond to mental health crisis calls placed to 911 that are believed to be nonviolent. In May
2022, Mayor Lori E. Lightfoot announced that, with the approval of a new 911 routing and
response protocol by the Illinois Department of Public Health, CARE teams of paramedics and
mental health clinicians can respond to nonviolent mental health calls without involving police
officers. As part of the CARE initiative, mental health professionals from CDPH are embedded in
the 911 emergency communications center to provide support and mental health consultation to
dispatchers. CARE teams operate in the Lakeview, Uptown, Auburn Gresham, Chatham, Chicago
Lawn, Gage Park, West Elsdon, and West Lawn neighborhoods between 10:30 a.m. and 4:00
p.m., Monday through Friday.161
Baltimore, MD
In partnership with Baltimore Crisis Response, Inc. (BCRI), the City of Baltimore launched the
Behavioral Health 9-1-1 Diversion Pilot Program in June 2021. The program diverts certain
behavioral health related calls to 911 to the Here2Help hotline operated by BCRI. The mental
health professionals staffing the BCRI line either resolve calls over the phone or dispatch a team
of mental health clinicians to respond. MCTs are available 24 hours a day, seven days a week.
The city collects data on 911 calls and mental health related diversions and displays it on a
158 City and County of San Francisco, Street Crisis Response Team (SCRT): July 2022 Update.
159 City of Minneapolis, “Behavioral crisis response,” https://www.minneapolismn.gov/resident-services/public-safety/
unarmed-public-safety/behavioral-crisis-response; and City of Minneapolis, “Behavioral health crisis,”
https://www.minneapolismn.gov/report-an-issue/behavioral-health-crisis.
160 CBS News Minnesota “Behavioral Crisis Response Team Diverted 1,400 Calls from MPD In The Last 3 Months,”
CBS News, May 4, 2022.
161 City of Chicago, Office of the Mayor, “Mayor Lightfoot and the City of Chicago Announce Expansion of 911
Alternate Crisis Response and Engagement Program,” press release, May 26, 2022; Chip Mitchell, “A glimpse inside
mental health crisis response teams as Chicago creates versions without cops,” WBEZ Chicago, April 6, 2022
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frequently updated, interactive dashboard.162 Currently, the program is only able to provide
mobile crisis response for adults; however, the city has announced an upcoming expansion that
will create youth-focused MCTs. The expansion is also expected to place mental health clinicians
in the 911 call center to assist dispatchers with de-escalation and screening.163
Washington, DC
In May 2021, Mayor Muriel Bowser announced the pilot launch of a Mental Health Emergency
Dispatch Program in Washington, DC. The program is a partnership between the Office of the
Deputy Mayor for Public Safety and Justice, the Office of the Deputy Mayor for Health and
Human Services, the Office of the City Administrator, the Office of Unified Communications,
and the Department of Behavioral Health (DBH). The pilot builds on city resources by
dispatching existing Community Response Teams from DBH to mental health crisis calls
received by 911 that are not believed to involve drug use, alcohol use, or any perceived threat to
patient or responder safety.164 The mental health response program also complements the city’s
existing Right Care, Right Now program, which triages nonemergency medical calls received by
911 to registered nurses who advise on treatment options or dispatch resources.165 In November
2021, the city announced additional pilot phases of the Mental Health Emergency Dispatch
Program. The second and third pilot phases aim to increase the number of available responders,
increase service hours from 12 hours a day to 24 hours a day, and allow teams to respond to a
wider range of calls, including those involving substance use. In phase one of the pilot, teams
responded to an estimated 2% of all behavioral health calls placed to 911. By phase three, the
program hopes to respond to one-third of all behavioral health calls.166
Author Information
Nathan James, Coordinator
Analyst in Crime Policy
Jill C. Gallagher
Analyst Telecommunications Policy
Johnathan H. Duff
Analyst in Health Policy
Isobel Sorenson
Research Assistant
162 City of Baltimore, Mayor’s Office, “Behavioral Health 9-1-1 Diversion,” https://mayor.baltimorecity.gov/
behavioral-health-and-consent-decree/9-1-1-diversion.
163 Kevin Kinally, “Baltimore City Expanding Behavioral Health 9-1-1 Diversion Program,” Conduit Street, July 1,
2022.
164 Rachel Weiner, “D.C. to divert some mental health calls away from police,” The Washington Post, May 17, 2021;
City of Washington, DC, Office of Unified Communications (OUC), “DBH and OUC Mental Health Emergency
Dispatch Program,” https://ouc.dc.gov/page/dbh-and-ouc-mental-health-emergency-dispatch-program; and Sarah
Holder, “D.C. Extends Program Diverting Mental Health Calls From Police,” Bloomberg CityLab, November 12, 2021,
(hereinafter, “Holder, ‘D.C. Extends Program Diverting Mental Health Calls From Police’”).
165 City of Washington, DC, Fire and EMS Department, “Frequently Asked Questions Right Care, Right Now,”
https://fems.dc.gov/page/frequently-asked-questions-right-care-right-now.
166 Holder, “D.C. Extends Program Diverting Mental Health Calls From Police.”
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This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.