A community response approach to mental health and substance abuse crises reduced crime

T. S. Dee and J. Pyne

Science Advances, 8 Jun 2022

Vol 8, Issue 23

Abstract

Police officers often serve as first responders to mental health and substance abuse crises. Concerns over the unintended consequences and high costs associated with this approach have motivated emergency response models that augment or completely remove police involvement. However, there is little causal evidence evaluating these programs. This preregistered study presents quasi-experimental evidence on the impact of an innovative “community response” pilot in Denver that directed targeted emergency calls to health care responders instead of the police. We find robust evidence that the program reduced reports of targeted, less serious crimes (e.g., trespassing, public disorder, and resisting arrest) by 34% and had no detectable effect on more serious crimes. The sharp reduction in targeted crimes reflects the fact that health-focused first responders are less likely to report individuals they serve as criminal offenders and the spillover benefits of the program (e.g., reducing crime during hours when the program was not in operation).

From the Discussion Section

The evidence in this study indicates that the STAR community response program was effective in reducing police-reported criminal offenses (i.e., both reducing the designation of individuals in crisis as criminal offenders and reducing the actual level of crime). These results provide a compelling motivation for the continued implementation and assessment of this approach. However, successfully replicating the STAR program is likely to rely on key implementation details such as the recruitment and training of dispatchers and mental health field staff as well as the successful coordination of their activities with the police. Furthermore, the generalizability of the community response approach to a broader set of potentially preventable charges is uncertain and a design feature worthy of further study. There are also additional details about programs such as STAR that merit further investigation and clarification. For example, we are unsure of whether the existence of STAR may have increased the trust and the willingness of community members to call 911. However, we note that such an effect is likely to imply that our estimates underestimate the true effect of the STAR program. That is because increase in trust and willingness to call 911 is likely to increase measured crime in the short run as some of these calls would result in police engagement regardless of arrest status. Future studies may also consider the effects of programs like STAR on health-related outcomes, such as access to health services (e.g., counseling and therapy) and related measures of well-being.

The research is here.

988 becomes the new 3-digit suicide prevention hotline on July 16: What to know

Christine Fernando

USA Today

Originally posted 8 JUL 22

Here is an excerpt:

Here's what you need to know:

How does 988 work?

What to know: After dialing or texting 988, you'll be connected with a trained mental health professional at a local or regional crisis center. If your local center cannot connect you to a counselor, national backup centers can pick up the call. The lifeline is administered by the nonprofit Vibrant Emotional Health.

That's how it has worked for the National Suicide Prevention Lifeline number, and the setup will continue after 988 is launched.

What experts say: The shortened, more accessible lifeline marks "a transformative moment in terms of thinking about approaching crisis care," said Miriam Delphin-Rittmon, an assistant secretary at the Substance Abuse and Mental Health Services Administration, on Thursday.

The launch also comes amid what experts have called a mental health crisis in the U.S. amid the COVID-19 pandemic.

Are states prepared?

What to know: For many advocates, 988 represents an opportunity to expand services but also a challenge because of possible added pressure on already strained mental health crisis response systems. Some advocates have questioned whether states will be ready for the increased call volume projected after the switch to the 988 model.

In the first year of 988's implementation, the number of contacts for the lifeline is expected to increase to 7.6 million – a twofold increase compared with the 3.3 million calls, texts or chats in 2020, according to a report in December 2021 from SAHMSA.

What experts say: Delphin-Rittmon acknowledged that some crisis response centers are worried about the size of workforces in their states and about resources for this launch. She said she has been working with state representatives on funding and to "assess their overall readiness." .

The launch of 988 provides "an opportunity to expose gaps and weaknesses in our system," which would allow centers to see where additional investments may be needed, said Angela Kimball, national director of advocacy and public policy at the National Alliance on Mental Illness.

"Will it work perfectly?" she said. "No. Because changing crisis response won't happen overnight."

The info is here.

Rethink Crisis Response—People Who Call 911 Shouldn't Get an Ill-Trained Police Officer, Especially When They're Dealing With a Mental Health Emergency

Sally Satel
reason.com
October 2020

Here is an excerpt:

Miami-Dade is a large county that was able to follow the tripartite strategy. Shootings by police have declined by 90 percent since CIT training was implemented in 2010, but the program accomplished something more: It shined a light on the high incidence among police of depression and suicide. According to Judge Steven Leifman, who established the Miami-Dade program, officers who go through the training "have been more willing to recognize their own stress [and] reach out to the program's coordinator for mental-health advice and treatment for their own traumas."

Other cities deploy crisis teams that are solely mental health–based; police are not part of the first line at all. One of the nation's longest-running examples of this is CAHOOTS (Crisis Assistance Helping Out On The Streets). It was created 31 years ago as part of an outreach program of the White Bird Clinic in Eugene, Oregon—once a countercultural medical clinic founded in 1970 as a refuge for hippies on LSD trips and other drug-taking youth. Calls for help are routed to staff 24/7 by the local 911 dispatcher. A medic and a mental health professional respond as a team to incidents such as altercations, overdoses, and welfare checks. They wear jeans and hoodies and arrive in a white van stocked with supplies like socks, soap, water, and gloves. Should a situation spin out of control, they call for CIT-trained police back-up, though last year only 150 out of 24,000 field calls required back-up. People who need further attention are taken to a crisis care facility operated by the mental health department—no trips to jail or to overflowing emergency rooms.

Mental health teams can bring some much-needed relief to municipal budgets. According to TAC, police officers across 355 law enforcement agencies spent slightly over one-fifth of their time responding to people with mental illness or transporting them to jail or psychiatric emergency rooms, at a cost of $918 million in 2017. The CAHOOTS flagship program in Eugene operated on a $2 million budget in 2019 and saved the locale about $14 million in ambulance transport and emergency room care. Within the year, a number of cities (including San Francisco, Los Angeles, New York, and Durham, North Carolina) will be launching programs similar to CAHOOTS.

The best crisis intervention programs help reduce the toll of police involvement gone awry, but the only way to take encounters out of the hands of police in all but the most dangerous instances is to repair the mental health system itself, which is a notoriously tattered network of therapists, psychiatrists, hospitals, residential settings, and support services, and work to prevent ill people from lapsing into crisis in the first place.

The info is here.