BACKGROUND INFORMATION ON CIVILIAN EMERGENCY FIRST RESPONDERS
In the best of times, local communities struggle to meet the health needs of highly vulnerable people, including those who struggle with mental health or substance use disorder, poverty, or housing insecurity, or otherwise lack access to traditional health care resources. Because most communities do not have the kind of services necessary to assist someone experiencing a mental or behavioral health crisis, law enforcement has served as the default first responder. Police officers are not drug counselors, social workers, or health care professionals. They are trained to aggressively enforce criminal codes and thus their response to individuals experiencing a mental or behavioral health crisis or who otherwise appear agitated or upset all too often leads to the arrest and incarceration of these individuals. Particularly when a person is suffering from a mental or behavioral health crisis, police confrontations regularly involve force—and often deadly force. This not only depletes public safety resources, but also makes communities and officers less safe when law enforcement must take the place of trained experts.
Many vulnerable populations lack access to traditional health care resources. According to a 2016 report by the CDC, nearly 1 in 5 patients (17%) don’t have a regular place to access health care. These individuals need solutions that will come to them. Communities should mobilize health care resources to identify and prevent health care crises for vulnerable populations. To that end, crisis response teams should remove law enforcement from their strategies and instead build teams with medical and crisis workers who respond to emergency calls that indicate mental and behavioral health issues.
Across the country, different jurisdictions have enacted policies that have addressed the problem in various ways; however, to date no jurisdiction has enacted all the pieces. Included in this packet are examples of what different jurisdictions have done.
A model program should ensure the following:
Responses to 911 calls for mental health and substance abuse crisis should be diverted to a non-law enforcement crisis response team. Another non-911 number should be made available that goes directly to the crisis response team.
- The crisis response team should be composed of non-law enforcement mental health experts, including crisis-trained social workers.
- The crisis response team should be trained on the use of narcan, and carry narcan with them.
- 911 staff should receive mental health and substance use disorder training, and have clear guidance on when to direct the crisis response team to respond to a call.
- Emergency call centers should be staffed with mental health experts.
- If there is a non-911 number, it should be widely and consistently publicized.
The crisis response team should respond to all calls for help involving mental health crises or indications, along with substance overdose, including:
- In hospitals, when a person is refusing physical restraints, medication, or their physical health is being put at risk. The crisis response team can then make the decision to call the police.
- All domestic calls where the caller indicates the person is having a mental health crisis.
- All calls indicating an overdose or potential overdose shall be responded to by the crisis response team and appropriate medical health providers.
- Crisis response teams may request law enforcement support in cases where there is a clear and imminent threat to a person present at the scene.
Mobile Response Team
- The crisis response team should strive to prevent crises before they occur and engage with vulnerable populations to provide referrals for preventive care.
Crisis Response Team Oversight
- The crisis response team is managed by the city, county, or state outside of law enforcement.
- The crisis response team will be responsible for collecting and producing data on call responses, including all calls responded to and outcomes.
- Law enforcement will be responsible for collecting and producing data on any call response for which the decision was made not to transfer the response to the crisis response team.
- The crisis response team shall be fully funded by money diverted out of (not through) the police and/or sheriff department budget.
- Appropriate law enforcement staff reductions should be made once the crisis response team is in place.
- Localities should ensure that these teams are staffed by full-time employees and eventually become employees of the city or county. Volunteer teams, as is happening in some jurisdictions, may be a necessary first step but are not an adequate long-term solution to the problem.
Examples of Local Programs
- The Crisis Assistance Helping Out On The Streets (CAHOOTS) program, in Eugene, Oregon, is a mobile crisis intervention team that responds to calls related to behavioral health.
- Teams consist of a medic and a crisis worker and provide “immediate stabilization in case of urgent medical need or psychological crisis, assessment, information, referral, advocacy and (in some cases) transportation to the next step in treatment.”
- Portland, Oregon’s Street Response is a joint effort of Portland Fire and Rescue, Portland Police Bureau, Portland Bureau of Emergency Management, and the Bureau of Emergency Communications, with outside support from Street Roots and Portland State University.
- The pilot program was funded by Portland City Council in June 2019 and was set to start in March 2020. Its launch was delayed by COVID. In June 2020, the City Council funded a large expansion of the program, and it is set to launch in March 2021.
- Portland Street Medicine embraces the objective of providing “ quality medical care to Portlanders who are facing unstable housing or are sleeping on the streets.” Consisting of a volunteer coalition of medical providers, social workers, care managers, and lay people, these teams go to unhoused or housing unstable populations to identify those in need and provide care.
- Denver, Colorado’s Support Team Assisted Response is a “community response program modeled after CAHOOTS.”
- The program is in its pilot phase and is currently being supported by funds generated from sales tax revenue in Denver. The STAR program addresses mental health and substance use calls.
Contra Costa, California
- Contra Costa’s “Mobile Crisis Response Team” visits clients and their families to prevent acute psychiatric crises from becoming emergencies that require law enforcement involvement or involuntary hospitalization.
- Austin Expanded Mobile Crisis Outreach Team responds to 911 calls with mental health telehealth services if certain criteria are met (misdemeanor charge, non-violent, no outstanding warrants or immediate threat).
Salt Lake City, Utah
- Salt Lake County, Utah’s Mobile Crisis Outreach Units can be dispatched by calling a hotline that serves Salt Lake County residents or by referrals from law enforcement. Teams include a licensed mental health professional and a Certified Peer Specialist. The teams conduct a psychiatric assessment, help stabilize the person, and refer them to appropriate community mental health resources.
Warren County, Iowa
- Warren County, Iowa’s mobile crisis response teams were designed to intervene before the police. The service helps alleviate the number of calls local law enforcement officials are receiving and provides people with an alternate route of care and will provide a follow-up after 24 hours.
TEMPLATE ORDINANCE: EMERGENCY NON-LAW ENFORCEMENT RESPONDERS
This template funding legislation is inspired by bills that have been introduced in CA, IL, and FL, as well as in consultation with experts who have studied effective community based responses to crises.
Sec. 1. Findings: The [Legislature/Council/Governing Entity] finds and declares all of the following:
- The complexities of emergency issues surrounding crises in mental health, intimate partner violence, community violence, substance abuse, and natural disasters can, at times, be addressed more safely, with greater impact, and more cost-effectively and efficiently with community organizations/non-law enforcement responders staffed by mental and behavioral health care specialists, social workers, or counselors, who often have deeper knowledge and understanding of the issues, trusted relationships with the people and communities involved, and specific knowledge and relationships surrounding the emergency.
- Furthermore, young people of color, people with disabilities, people who are gender nonconforming, people who are formerly incarcerated, people with immigration status issues, and people who are unhoused or homeless, face significant barriers to engaging with law enforcement and other first responder personnel. Data demonstrates that these populations often do not reach out for needed help when dealing with crises in their communities because of their fear and challenges with engaging law enforcement, which puts lives and families at risk for continued harm and trauma. People who specializein working with these populations, understanding their issues, and maintain deep relationships in their communities have a more successful track record of engaging and supporting them.
- Government entities from the national to the local level have defunded systems of care, including health care and mental health care, over decades. Governments have not invested in systems that address many people’s individual and community needs. We have come to rely on police officers to respond to calls for people who are in crisis, as well as for calls that should not and cannot be addressed by law enforcement. Such calls include, but are by no means limited to: complaints that people are unhoused and should be moved; complaints involving disputes between neighbors; complaints that a person looks “suspicious” or is doing something that the caller believes to be incorrect; or complaints regarding parking, and requests that cars be ticketed or towed.
- Further, when people are experiencing distress or crisis, there are limited resources available to assist them through the crisis, including facilities where they can be transported to and cared for. In the absence of these facilities, people have been taken to county jails or hospital emergency rooms. Incarceration and emergency rooms are not only the most expensive responses to meet people’s needs, they are often entirely inappropriate responses.
- People in cities and counties throughout the state have recognized the need to expand innovative approaches to both emergencies and social problems and have created programs to do so.
- These alternative approaches have strengthened non-law enforcement responses to emergencies and other needs in places throughout the [state/county/city] by deepening the involvement of peer counselors, preventing violence, deescalating volatile situations, protecting property and the environment, reducing law enforcement use of force, and ensuring the health and safety of communities while, at the same time, saving money by decreasing calls for law enforcement services and the sole reliance upon officers or the use of emergency hospitalization for situations that do not present a threat of physical harm to others.
- Despite the innovative approaches led by community organizations and local governments the [state/county/city] does not have a policy, a set of protocols, or dedicated funding to support appropriate responses to calls for assistance or to create [the state/county/city’s] own crisis and support team to address people’s needs that do not require a police response.
- This funding seeks to remedy those issues by articulating a policy framework and grant process to support innovative approaches to build capacity and to make grants [ for community organizations or local governments] to support appropriate and humane responses to the multitude of people’s needs.
- It is the intention of this funding to reduce the over-reliance on armed law enforcement to respond to crises that do not require law enforcement. As a result, it is the intention that as local governments establish and scale up civilian crisis response systems, they should dramatically reduce their reliance on law enforcement and reduce those budgets accordingly.
Sec. 2. Program Requirements: Crisis Response
Funds should be provided to [local governments, departments within local governments, community-based organizations, non-profits, or a combination of these entities].
The core components of any program funded under this Act should include the following:
- Crisis response teams must be entirely independent of law enforcement systems, including through their funding structure and oversight.
- The local government who is either receiving the grant or dispersing the funds to a community based organization must have a clear set of restrictions in place, or be willing to adopt a clear set of restrictions, as to when law enforcement officers shall be summoned to respond to calls. These restrictions should ensure that emergency 911 calls are only routed to law enforcement officers when:
- a. There is a threat of immediate physical injury or death to another;
- b. There was a violent crime committed and immediate investigation by law enforcement is required;
- c. The civilian crisis response team calls for law enforcement; or
- d. Sufficient other circumstances dictate that the only appropriate response to an unfolding situation requires an immediate response by law enforcement officers.
- The crisis response team should respond to all calls for help involving mental health crises or indications of mental or behavioral health distress, along with substance overdose, including:
- a. In hospitals, when a person is refusing physical restraints, medication, or any person’s physical health is being put at risk;
- b. All domestic calls where the caller indicates the person is having a mental health crisis;
- c. All calls indicating an overdose or potential overdose.
- A crisis response team that responds to calls involving mental or behavioral health issues must be staffed with mental health care experts or crisis-trained social workers. Calls indicating an overdose or potential overdose shall be responded to by the crisis team and the appropriate medical health response, such as an EMT.
- Crisis response teams should be mobile and capable of providing on-site, on-demand services and transportation.
- Crisis response teams must be equipped to provide referrals for community services or treatment.
- The crisis response team should strive to prevent crises before they occur and engage with vulnerable populations to provide referrals for preventive care.
- The crisis response team should strive to create the technical capacity to identify and engage with frequent users of the crisis system in order to determine what resources they need so as to reduce their use of emergency systems of care.
- a. Any such information collected shall be subject to all privacy laws, including HIPAA, [other relevant state laws]
- b. The fact that a person is a frequent user of the crisis system may not be used to deny services to that person.
- Crisis response teams should also respond to calls that involve disputes between people or other calls that do not require law enforcement. Such calls include, but are not limited to:
- a. responding to an unhoused person;
- b. addressing behavior by somebody who is unhoused;
- c. calls regarding a “suspicious person” or other calls not indicating a present and immediate threat of violent behavior;
- d. disputes between parties.
- A local government should provide that their Emergency Response Communication Systems, such as 9-1-1, have staff trained to route calls to the appropriate response team.
- Staff at the Emergency Response Communication Systems should receive mental health and substance use disorder training, and have clear guidance on when to direct the crisis response team to respond to a call.
- If the grantee has authority to amend an existing Emergency Response Communication System or to create a separate Emergency Response Communication System, a non-9-1-1 number that goes directly to the crisis response team should be made available. If a non- 911 number is created for the crisis response team, calls to 911 shall still be routed to crisis response teams in the appropriate situations as detailed here.
- Data Collection and Reporting. The grantees, whether a local government entity or community-based organization, shall produce data to be provided on a yearly basis:
- a. The number of calls responded to by the crisis response team;
- b. The nature of the calls responded to by the crisis response team;
- c. The number of individuals served by the crisis response team; and
- d. The number of instances where the crisis response teams requested law enforcement back-up.
- e. This data must be anonymized so as not to identify any individual who has used the system.
- f. [Other information, i.e. race, gender, age of people served]
- Any grantee must ensure that crisis response teams are managed outside of law enforcement. Grantees must ensure that an oversight committee is in place, ensure adequate training programs and protocols, and ensure that care is being provided appropriately.
- a. Committees must include advocates from health and disability communities and must reflect the racial demographics of the jurisdiction.
- b. The Committee should prepare annual reports to compile the data and assess the effectiveness of the program.
- [If grant made to local government] Appropriate law enforcement staff reductions should be made within one year of the crisis response team’s operation.
- a. Funding should instead be directed to supporting and maintaining the crisis response team or creating a non-law enforcement city department to run the crisis response teams.
- b. Law enforcement must also track and report data for all calls as provided under subsection 13.
Section 3. Funding for Referral Services
- Local governments and community-based organizations may also apply for funding for continued care for people in need in order to facilitate the operation of the crisis response team and to ensure that people who are in crisis receive appropriate care. Such funding may include:
- a. Temporary day or overnight shelters for people who are experiencing homelessness.
- b. Technical assistance to identify and engage with frequent users of services.
- c. Mental health and substance use disorder facilities in order that the crisis response team has the ability to transport individuals in a problematic situation or in need of treatment to a safe facility.
- d. Temporary housing or supportive housing for individuals who are unhoused.
- e. Resources to ensure that schools and other programs that serve children, homeless youth, or other young adult populations are able to communicate with the crisis response team.
- f. A coordinated system of care for children and schools, including a wellness center for children, whether located at a school or other facility that serves children, homeless youth, or young adults, who are experiencing crisis or trauma.
- g. Technical and other assistance to ensure that there is a direct line of communication between the crisis response teams and hospitals, and to support the mental health services provided by these hospitals.
THIS IS THE PRODUCT OF THE JUSTICE COLLABORATIVE POLICING TASK FORCE
Austin City Councilmember Gregorio Casar
Harris County Commissioner Rodney Ellis
Philadelphia City Councilmember At-Large Helen Gym
Portland Commissioner Jo Ann Hardesty
Rochester City Councilmember Mary Lupien
San Francisco Supervisor Hillary Ronen
Professor Jody Armour, Roy P. Crocker Professor of Law, University of Southern California
Professor Alex S. Vitale, Professor of Sociology, Brooklyn College, CUNY