DA is Supporting Two Local U.S. Governments to Reimagine Crisis Response. Here’s Our Take on What Works.
A Call to Improve the System
Approximately 240 million 911 calls are made annually – but fewer than 4% of these result from violent crime. Instead, many 911 calls are related to homelessness, substance abuse, or mental health. Yet police officers often lack training and expertise to meet the needs of residents who require skilled crisis care.
To address these needs, local governments nationwide are testing new approaches to shift away from law enforcement as the primary responder to mental and behavioral health crises. These ‘alternative’ or ‘co-responder’ models deploy trained behavioral or mental health professionals instead of or alongside law enforcement to de-escalate crises and connect community members to care. Many programs operate in connection with the national 988 line, which launched in July 2022 and has already served over 9.6 million calls for assistance.
Since 2022, DA has supported two local governments in scaling up their alternative crisis response programs to better serve residents. Through this experience, we have identified four key design considerations for governments to keep in mind when developing crisis response models and four common implementation challenges to prepare for.
Four Points to Consider When Designing an Alternative Crisis Response System
Governments can begin by identifying who they want to serve, the intended outcomes, who will provide care, and how residents will access care. Specifically, governments should consider:
- What is the population you want to serve? To inform an area of focus, governments can review existing data on crisis cases in their jurisdiction to identify the types of crisis events they want to support, and then assess which residents typically experience those events. Some programs may choose to focus on specific populations, such as youth or unhoused residents. Others may aim to support historically underserved communities and address equity gaps. This analysis can also help to define where the population of interest spends time and when they require care, thus ensuring programs offer services at those specific times and locations.
- What is the intended outcome of care? Governments can implement alternative crisis response programs with public safety, justice, and/or healthcare goals. Programs with a public safety or justice focus may seek to avoid escalation or repetition of crises that could result in the individual in crisis’ entry into the justice system. This may involve handling more severe mental health crises, requiring the authority to involuntarily hospitalize individuals and/or connect them to facilities where they can safely receive care. A health-focused program could aim to reduce overdoses or suicides, requiring frontline workers to be trained in administering opioid overdose reversal medications. Identifying the intended outcome makes it possible to determine the activities required to achieve the end result and to measure progress during implementation.
- Who will provide care? Governments can choose between co-responder and alternative responder models. Co-responder models typically deploy a non-law enforcement mental health professional with the officer; alternative responder models replace law enforcement entirely. As a result, alternative responder models require greater caution when dispatching the responder to avoid potential high-risk scenarios, such as the presence of a weapon. However, alternative responder models can lower costs by reducing the number of responders on a scene. They may also align with community preferences to minimize avoidable engagements with law enforcement. To select the optimal responder style, governments should weigh community preferences, budget, and the outcome they wish to achieve for the target population.
- How will people request help? Residents in crisis need a simple, trusted way to access care. For some residents, 988 lines may be more attractive due to their non-law enforcement operation. But 988 calls are routed according to the caller’s area code, rather than their current geographic location. This means calls may be transferred to a provider in a different city or state, which risks losing the caller. In contrast, 911 systems, which have law enforcement operations, are often equipped with more robust dispatch technology that decreases the probability of being unable to locate the caller. To address this issue, some jurisdictions allow 988 callers to ‘opt in’ to mental health care by offering alternate crisis response directly to the caller, just like they offer an option to receive a police or fire response. Regardless of whether governments elect to use 911 or 988 as their primary line, residents may continue to call the other line – requiring deep planning and coordination between dispatch centers to respond to all residents needing care.
In addition, if there are multiple crisis response programs with an overlapping geographic or population mandate, it is critical for implementers to coordinate closely to ensure residents understand how to access the appropriate service or are connected to the right provider.
Common Implementation Challenges
After designing an alternative crisis response program, governments should prepare for potential implementation challenges. We highlight four techniques to overcome common challenges below.
- Begin planning for long-term talent needs before they become a constraint: Mental health and behavioral health professionals can be hard to recruit and retain for these demanding crisis response roles. Governments wishing to recruit local talent with community ties and lived experience face an even tighter labor market. Some governments are experimenting with using peer counselors or community health workers to address this gap. Building talent pipelines can take years and could require phasing program expansion over time.
- Coordinate with all actors within your delivery chain: Due to the complexity of the 988 / 911 landscape and the potential of overlapping programs, residents may have multiple service entry points and an unclear path to access care. It is critical to consider the many ways residents will access your program, how to increase their awareness, and how to streamline triage, dispatch, and care delivery.
- Involve all levels of your current institution: Alternative and co-responder programs require significant changes in how call centers assess risk and dispatch calls to responders, as well as in the acuity of cases that responders tackle. As a result, these programs require buy-in, from frontline staff up to top leadership, to operationalize new processes and realize program goals. Involving these stakeholders in program design, implementation planning, and problem solving will result in greater uptake, increasing the probability of successful program execution.
- Use data to monitor equity: Mental health programming may require new data collection and analysis approaches to protect confidential health information. This information and timely, accurate demographic data are necessary to assess if the program is reaching underserved and at-risk populations. Governments launching a program should evaluate whether their existing data systems record who is calling for service, who is being served, and their outcomes. Governments must also prepare to make investments in data collection, analysis, and reporting capacities to fill gaps.
Transforming Crisis Care in Your Community
Addressing mental and behavioral health crises requires a departure from traditional law enforcement responses towards more specialized care models. By implementing alternative and co-responder programs, local governments can better meet the needs of their communities, ensuring effective and compassionate crisis intervention. As our experience highlights, careful design and proactive management of these programs can overcome common challenges, paving the way for more equitable and effective crisis response systems. Ultimately, these innovative approaches not only improve individual outcomes but also foster safer, healthier communities.
DA offers expert program planning and implementation support, and has worked with two U.S. local governments to roll out alternative crisis response programs. Reach out to see how we can help your jurisdiction transform crisis care – and create meaningful change for residents.
