When Behavioral Health Emergencies Arise, Who Responds Can Affect Outcomes

This fact sheet is one in a series outlining questions that local officials can ask and resources they can use to prioritize potential improvements to behavioral health emergency responses.

A person threatens to end his or her life. Someone experiencing homelessness creates a public disturbance. A bystander perceives a threat of violence from a patient who has stopped taking medication for a mental illness.

First responders encounter a range of scenarios when a behavioral health-related emergency is unfolding. The potential variability is limitless, yet each situation requires specialized responses in which trained personnel must quickly assess needs, defuse the situation, and know what to do next. These actions might include resolving the crisis on the scene and referring individuals for further help.

And yet, today, overburdened police officers are typically tasked with responding to these types of emergencies. They often rely on traditional law enforcement approaches that can unintentionally escalate the situation and on officers who may not have the training to recognize and manage an individual’s complex health and social needs. This mismatch often leads to missed opportunities and sometimes leads to tragedy: Between 25% and 50% of law enforcement fatalities involve a person with a mental illness.

Policymakers hoping to address these challenges are often stuck between two realities. Vocal champions for change insist that police should not be part of responses to behavioral health crises. Yet public safety concerns inevitably arise in some of these types of emergencies. How, then, can the health of people in crisis be better addressed, while also ensuring the safety of all those who are present on the scene?

Many options exist, as various models and promising practices have emerged from different jurisdictions—large and small, urban and rural. Some promote civilian-only responses featuring outreach workers and medics. Others pair crisis-trained law enforcement officers with mental health clinicians. And emerging approaches show promising signs of striking a balance with teams that combine a paramedic or a nurse, a behavioral health professional, and a police officer.

Regardless of the approach, localities seeking to rethink the way they handle behavioral health crises also face a variety of barriers, from developing and financing these enhanced approaches to tracking outcomes. Each city and county encounters its own challenges when reconsidering who could best respond to these emergencies and what they must know to achieve positive outcomes. But communities can ask the following straightforward questions as they explore improvements.

What training is mandated or offered to law enforcement officers and other potential first responders, and how is their own mental well-being preserved?

The past 15 years have seen significant strides in training law enforcement officers in the signs of behavioral health crises and effectively de-escalating these incidences. In Pew’s study on 911 call centers, most of the 37 survey respondents reported having crisis intervention-trained officers available for dispatch to at least some calls. And some law enforcement agencies have prioritized getting every officer, as well as other staff members, trained. Still, important questions remain for any local jurisdiction about what behavioral health-related training is mandated for any potential first responders (including police officers, paramedics, behavioral health clinicians, and others), how often it is updated, and what types of services localities offer to maintain first responders’ own health and well-being.

Related resources:

• Crisis Intervention Team (CIT) International focuses on building programs and prioritizing training that improves police encounters with people who have mental health disorders.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a guide to evaluating your community’s existing CIT program.
• Mental Health First Aid, developed by the National Council for Mental Wellbeing, is a skills-based training course that teaches any range of participants—from police to civilians—about mental health and substance use issues so that they are able to detect the signs and symptoms of specific behavioral health disorders.
• The Congressional Research Service provides information on federal programs aimed at the mental health of first responders themselves—police, firefighters, and emergency medical personnel.

What local options exist to create a team of specialized first responders who can take a more tailored approach to a behavioral health-related emergency?

Partnerships among law enforcement, behavioral health providers, emergency medical staff, and social services are key to ensuring that appropriately specialized staff lead the response to these particular emergencies. As each community faces different needs and opportunities, local officials should be informed about the benefits and challenges associated with each response option available to determine the best fit for their jurisdiction.

Related resources:

• Crisis Now offers a scorecard to assess a community’s existing mobile response options. The tool also offers similar checklists to help review the operations of local call centers and crisis stabilization services.
• Policy Research Inc. and the National League of Cities offer a brief detailing a collection of different “co-responder models”—pairing law enforcement officers with clinicians—­that local leaders could consider.
• An article in the Journal of Emergency Medical Services provides information to help shift how EMS responds to behavioral health crises, offering helpful examples and data from several communities and laying a foundation of vital elements that communities can consider when developing their approaches.
• The Meadows Mental Health Policy Institute breaks down the components of Multi-Disciplinary Response Teams, which bring together licensed mental health professionals, paramedics, and specialized law enforcement officers to respond to behavioral health-related emergencies.
• The Vera Institute of Justice provides a toolkit for “equitable alternatives to police,” sharing guidance on how to establish civilian approaches to these emergencies. The Council of State Governments (CSG) Justice Center offers its own toolkit on the approach, which highlights four common sources that can specifically fund and sustain civilian-led responses.
• The Police-Mental Health Collaboration Toolkit, developed by the CSG Justice Center and the Bureau of Justice Assistance, offers a range of resources to help law enforcement partner with key mental health stakeholders, including a tool that helps assess progress with implementing those partnership-based interventions.

What barriers at the state, county, and municipal levels limit opportunities for alternative responses to behavioral health crises?

Existing state laws may pose challenges to establishing and dispatching certain response approaches. Particular training needs or responses could be the right fit for a community, but many communities face funding and staffing shortages that can impede action. And progress can be derailed if key agency and community leaders have been left out of planning discussions or haven’t reached consensus on existing response challenges and proposed solutions.

Related resources:

• The Treatment Advocacy Center provides a state-by-state snapshot of laws and standards related to a psychiatric emergency, including state-specific information on who is authorized to initiate mandatory treatment and standards for an emergency psychiatric evaluation.
• Crisis Now’s interactive Crisis Resource Need Calculator can help communities understand the potential funding needed to build effective dispatch responses, as well as other elements within individual crisis systems.
• The Centers for Medicare and Medicaid Services issued policy guidance in 2021 related to funding for mobile crisis services. While developed for state policymakers, the guidance could help local leaders understand the landscape for building services with an eye toward sustainability.
• The International Association of Chiefs of Police’s One Mind Campaign aims to help communities unite around common goals that enhance law enforcement’s engagement with people who have mental health disorders. The campaign’s structure could offer ideas on how to build areas of consensus within individual communities.

How is on-scene data collected and analyzed to inform potential improvements?

First responders can provide significant information about individual behavioral health-related emergencies that goes beyond the initial data that emergency call-takers potentially collect. Logging and sharing information related to approaches used on-site (for example, the use of police force, medications administered, etc.), key elements observed in the midst of the response (such as whether weapons were present), and demographic and geographic data can help identify trends in local emergencies, shortcomings with existing responses, and potential disparities and inequities with responses based on race, gender, location, or other elements.

Related resources:

• As part of its expansive National Guidelines for Behavioral Health Crisis Care, SAMHSA offers recommendations to track specific types of data, including the number of people served during an eight-hour shift, mobile response teams’ average response times, and metrics for evaluating call center responses.
• The CSG Justice Center offers guidance on data collection and analysis as part of a toolkit to help develop community responder approaches. Although the resource and a corresponding webinar focus on data related to civilian-only responses, the steps they offer can be helpful whether or not local officials are pursuing that approach.
• The FBI began a data collection initiative to examine trends in use of force among law enforcement, which could help inform considerations for determining the types of data that first responders can target for collection.
• The National Emergency Medical Services Information System recognizes the need for national data on EMS responses and offers an annual report that breaks down a variety of data types, including medication administered on the scene.

This publication is funded in part by The Pew Charitable Trusts with additional support from The John D. and Catherine T. MacArthur Foundation.