By Jennifer J. Carroll and Taleed El-Sabawi
People who use drugs continue to die at staggering rates, due not only to overdose from contaminated drug supply, but also due to our persistent reliance on the carceral system to respond to behavioral health crises.
This approach stems from the state-sanctioned violence of the War on Drugs. It takes various forms, including the use of police officers as first responders to behavioral health crises (including welfare checks), the excessive police use of force, and the use of potentially lethal restraint methods to subdue agitated persons. It also manifests in police officers’ use of jail cells as tools for forced “detox” believing that coerced withdrawal while in custody will reduce overdose risk or help someone “go clean” (it very clearly does not).
Evidence-based alternatives to police response for behavioral health crises exist. However, despite being both feasible and effective, these alternatives to police intervention remain the exception, rather than the rule.
Dispatching law enforcement officers to the scene has become the de facto response to acute episodes of behavioral health crisis, including substance-related emergencies. This paradigm has fueled our collective inability to imagine public services differently.
Though a growing number of law enforcement organizations are celebrating the development of novel efforts to allow arresting officers to divert persons away from jail and into the substance use or mental health treatment systems, one cannot help but ask: Why are police officers, who have no relevant medical or mental health training, expected to transport, subdue, and otherwise “handle” persons experiencing an acute substance use or mental health emergency in the first place?
Police officers overwhelmingly report that their presence at the scene of behavioral health crises is essential for the safety of medical personnel. Putting faith into this claim, many local leaders have supported the development and implementation of “co-responder” programs, in which police officers and peer specialists or mental health professionals respond to behavioral health crises together. The quintessential co-responder program is the Crisis Intervention Team (CIT) model. CIT teams have been established in nearly three thousand law enforcement agencies across the United States.
Numerous studies have demonstrated that CIT training significantly improves officer knowledge and attitudes about mental health and substance use crises and the persons experiencing them.
Yet there is little-to-no evidence that these changes in attitude produce meaningful differences in officer behavior in the field. Thirty years after the development of the CIT model as an alternative to traditional police response, people who use drugs and/or are living with mental illness continue to be disproportionately subject to arrest, victimization by police, and more severe injury as a result of police use of force. In fact, some studies have shown that CIT training is linked to increases in police use of force against persons in acute behavioral health crises, exacerbating these long-standing problems with police response.
To date, no meaningful evidence exists to suggest that CIT programs reduce arrests, officer injuries, citizen injuries, or use of force. And yet, major supporters of the CIT model continue to insist that this approach “supports the safety of the individual in crisis.”
But there are evidence-based alternatives with demonstrated success. For example, the Crisis Assistance Helping Out On The Streets (CAHOOTS) program has dispatched non-law enforcement teams to behavioral health crises in Lane County, Oregon, since the late 1980s. CAHOOTS responds to a variety of calls for service — including behavioral health crises. They provide transportation to social services, substance use treatment facilities, and medical care providers.
Over 30% of the population served by CAHOOTS are persons with severe and persistent mental illness. Importantly, the CAHOOTS response teams faced unsafe situations that required police assistance in fewer than 2% of the nearly 24,000 calls for service they responded to in 2019.
Building on this success, we have developed a model law for establishing non-police behavioral health crisis responses at the municipal level — a model that can be tailored to accommodate a wide spectrum of local structures, cultures and priorities.
Given this evidence-base, the Biden Administration should prioritize technical assistance and financial support for localities interested in piloting non-police behavioral health response. Law enforcement response and co-response models, like CIT, do little more than perpetuate the violence to which people living with mental health concerns or substance use have long been subject.
State funding for mental health and substance use services has long been inadequate; public health experts have been sounding this alarm for decades. Better solutions are urgently needed. We have them at hand. It’s time to take action and put resources behind them.
Jennifer J. Carroll, PhD, MPH, is a medical anthropologist, research scientist, and subject matter expert on substance use and public health.
Taleed El-Sabawi, JD, PhD, is an assistant professor at Elon University School of Law.
