Dispatching Crisis Workers

When 911 is called the police often become the default first responders to the scene. These calls include people experiencing a mental health crisis. Although the intentions of the police may vary, for individuals such as Daniel Prude and Patrick Warren Sr., calling 911 led to further tragedy. They are only two out of the 6,000 individuals that were fatally shot in the six years of 2015 to 2021 after police responded to a mental health crisis or an erratic behavior call. A person who calls 911 when facing a mental health crisis is more likely to face jail time than getting proper mental health aid. This has unfortunately turned jails into behavioral health facilities for many while not receiving much assistance. While police are equipped to do their jobs they do not have much training in the area of mental health. Advocates across America have urged states to have an alternative service that responds to mental health-related 911 calls in place of the police. While cities look to move toward this proposal many take inspiration from Eugene, Oregon, and its Crisis Assistance Helping Out on the Streets (CAHOOTS) program.

The town of Eugene, Oregon took initiative and started the CAHOOTS program in 1989. When 911 is called relating to a mental health crisis CAHOOTS sends out a unit equipped with a Paramedic, EMT, or Nurse and a crisis worker. This unit can go out and provide basic care, crisis intervention, referrals, and more. Eugene’s CAHOOTS program is funded with two million dollars annually. But in return, this program has saved the city of Eugene an estimated 22 million in ambulance and emergency room costs, and public safety costs. In 2019 alone, CAHOOTS responded to around 17,700 calls while only calling for police backup 311 times.

Denver, Colorado has become another state to incorporate this type of system into its EMS. They started the Support Team Assisted Response (STAR) program in 2020. This program sends healthcare workers to mental health crises along with cases of homelessness and substance use. In 11 months alone STAR responded to 1,323 calls without requesting police backup a single time. Health care workers, EMS workers, and even the Denver Police Chief have accredited this program to a decreased number of mental health-related tragedies and said that this program “saves lives”.

A consultant with Eugene's CAHOOTS program, Time Black, realizes that in their predominantly white city more people have a better relationship with the police and are more likely to call the police when facing a mental health crisis in the first place. So in an area such as Harlem, New York where only 9.5% of the population is white not only does the city face the obstacles of starting the program but they also face the issue of getting people to trust and call them when needed. In 2020, Harlem, New York started a similar pilot program and officially started Behavioral Health Emergency Assistance Response Division (B-HEARD) program in July 2021. In the first month alone they faced 110 calls, 95% of which their three-person teams successfully helped. However, New York as a whole faces an estimated 170,000 calls annually related to mental health crises or erratic behavior but the city suspects that the number of people who face such events is much higher. As B-HEARD became more known throughout Harlem, the city kept seeing an increase in the number of calls they would get. Chirlane McCray, who is the leader of this initiative announced at a program, "This is the first time in our history that health professionals will be the default responders to mental health emergencies, an approach that is more compassionate and effective for better long-term outcomes”.

As these programs become more common, more calls in addition to mental health-related calls are being added to their list. In July of 2020, Portland, Oregon started its system slightly based on Eugene's CAHOOTS program. They respond to mental health-related calls, suicide prevention, grief and loss, housing crises, and substance abuse issues. Commissioner Chloe Eudaly stated that the main target of their Portland Street Response was to help the homeless population. People facing homelessness, mental health crises, or drug use are often sent to jail for committing a crime. Commissioner Chloe Eudal wants to enforce through this program that “being homeless is not a crime, having a mental illness is not a crime, and addiction is not a crime”.

These programs have been a step towards providing proper care to those facing mental health crises. As more cities such as Charlotte, Long Beach, Phoenix, and San Francisco begin to implement similar systems, we can see a future filled with programs such as these that properly promote public safety. Cities also recognize that along with starting these programs, reform of the police system is needed. The Mayor of San Francisco, London Breed acknowledged that “San Francisco has made progress reforming our police department, but we know that we still have significant work to do,”. She also stated in a later interview, “we know that a lack of equity in our society overall leads to a lot of the problems that police are being asked to solve”.