Psychologists have long played an important role in policing, including assessing the mental health of officer candidates, counseling officers who may be struggling after suffering traumatic incidents, and informing efforts to reduce aggressive and biased policing. Now, after an increase in mental health–related cases and incidents that have brought into question the adequacy of officers’ training to respond to mental health crisis calls, police and clinicians are collaborating more closely on emergency call responses.

While George Floyd’s murder at the hands of an aggressive and biased police officer in May 2020 and widespread concerns about police brutality are part of what is prompting more departments to adopt a different approach, concerns about law enforcement’s relationship with mentally ill individuals aren’t new.

It’s estimated that at least 20% of police calls for service involve a mental health or substance use crisis, and for many departments, that demand is growing. In a nationwide survey of more than 2,400 senior law enforcement officials conducted by Michael C. Biasotti, formerly of the New York State Association of Chiefs of Police , and the Naval Postgraduate School, around 84% said mental health–related calls have increased during their careers, and 63% said the amount of time their department spends on mental illness calls has increased during their careers. More than half reported the increased time is due to an inability to refer people to needed treatment. Referring to appropriate mental health resources—and following up on progress—takes time and resources that already strained police, especially those from smaller departments, don’t always have.

As a result, more police departments are teaming with mental health clinicians—including psychologists—out in the field or behind the scenes via crisis intervention training. When these groups collaborate well, people with mental illness in crisis can access mental health care more easily, police experience less trauma and stress, and clinicians have an opportunity to make an even bigger difference in the community. Early data also indicate that these partnerships are making communities healthier, safer, and more financially secure.

“Problems come up when mental health and law enforcement only work side by side but not together,” said Joel Fay, PsyD, ABPP, a former police officer who is now a police psychologist in San Rafael, California. “The more they can work together with people with mental illness, the better off we’ll all be.”

Crisis intervention training

One of the most common models police departments use to fold mental health expertise into emergency calls is crisis intervention training. In this system, psychologists and other clinicians train police officers on how to determine if an incident they are responding to involves mental illness, apply appropriate de-escalation skills, and triage cases that require psychological intervention rather than making arrests and incarcerating the mentally ill.

In Miami-Dade County, Florida, for example, police officers attend a 40-hour program led by a mental health counselor and facilitated by other relevant experts. A representative from the National Autism Association teaches officers about how to interact with neurodivergent individuals, for example, and several local psychologists and psychiatrists offer background about mental illness—such as how to differentiate between schizophrenia and bipolar disorder.

Miami-Dade County liaison police officers also meet frequently with local clinicians to improve continuity of care. It can be frustrating for officers to respond to call after call involving the same members of the community and see that they aren’t getting the care they need, said Steven Leifman, JD, a judge in Miami-Dade County who works closely with the officer training program and is an advocate for keeping people with mental illness out of jail. “This ongoing communication empowers police to want to do the [mental health] program because they know we’re listening,” Leifman said.

So far, the Miami-Dade Police Department has trained more than 7,600 officers in crisis intervention training with positive results. Unnecessary arrests and shootings have declined because officers have learned ways to extend empathy and compassion to those with mental illness and how to stay calm as situations escalate. The city has also found that workers’ compensation claims have decreased among police because officers are involved in fewer physical altercations.

Some departments triage mental health calls during dispatch. The community of Long Island, New York, recently proposed an initiative to give 911 operators the choice to dispatch a team of “clinical professionals” to mental health emergencies, the result of a collaboration with the Center for Policing Equity, led by psychologist Phillip Atiba Goff, PhD.

And as of February 2021, 911 callers in Austin, Texas, can opt for mental health services when they seek help for an emergency. Each caller can request the assistance of police, firefighters, medical responders, or mental health support, and dispatchers route those calls accordingly

Still, not all callers recognize they’re in need of mental health services, said Andy Hofmeister, assistant chief of Austin–Travis County Emergency Medical Services. Someone might dial 911 reporting a possible prowler in their backyard when they are actually experiencing paranoia. Common signs of mental crisis in this scenario, Hofmeister said, include repeat calls and outrageous claims. For example, the caller might think they’re being followed by the FBI.

To that end, Hofmeister says it’s important to train call takers and dispatchers to properly route calls. Every call taker in the Austin Police Department undergoes mental health first-aid training to help them recognize mental health emergencies and get critical information from people experiencing a mental health crisis. Call takers learn how to recognize signs of suicidal or homicidal ideation, self-injurious behavior, mood disorders, psychotic disorders, and substance misuse—and just as important, how to take a person-centered, compassionate approach that ultimately de-escalates the person until help arrives.

The city of Austin also hired an outside consultant, who is a master’s-level clinician with a law enforcement background, to help implement the city’s mental health first response initiative, including equipping call takers with additional training for de-escalating people in crisis over the phone. Dispatchers also draw on these skills to prepare officers for what they can expect at the scene. Typically, Hofmeister said, the call taker transcribes details from the person in crisis that officers can access in real time to help them determine the caller’s state of mind.

All of Austin’s officers have crisis intervention training, but the department also sends master’s-level clinicians out on calls they believe will require significant mental health assessment, de-escalation, or referral to mental health services.

“What we’re working toward as a system is sending law enforcement only when it is absolutely necessary and sending clinicians alone on nonviolent calls that don’t pose a risk to the public, so people have as direct of a door to mental health services as possible,” said Hofmeister.

Mental health crisis teams

Other police departments delegate specific law enforcement officers to mental health calls and involve mental health professionals whenever necessary. One of the oldest programs in the United States is the CAHOOTS public safety system in Eugene, Oregon, started in 1989, a model that many police departments and cities have looked to for guidance in developing their own programs. When a call involving a mental health crisis come s in to the CAHOOTS non-emergency line, responders send a medic and a trained mental health crisis worker; if the call involves violence or medical emergencies, they involve law enforcement. In 2019, out of 24,000 CAHOOTS calls, mobile teams only requested police backup 150 times. The city estimates that CAHOOTS saves taxpayers an average of $8.5 million per year by handling crisis calls that would otherwise fall to police.

In San Francisco, members of the Street Crisis Response Team, like the CAHOOTS units, serve as a first response to nonviolent mental health calls and only involve law enforcement interventions when necessary. As of November 2020, the city’s fire department and public health department contract with a local behavioral health organization to deploy these psychologist-trained response teams, which are made up of a community paramedic, a mental health clinician, and one peer counselor. That peer counselor must also have some sort of personal experience with mental illness, substance use, or homelessness to build trust with people experiencing mental health or behavioral crises.

The team members use trauma-informed, harm-reduction techniques to de-escalate crises and, if necessary, transport clients to outpatient care, reducing unnecessary emergency room visits and jail time.

Psychologist Joanne Chao, PsyD, HealthRIGHT 360’s director of San Francisco Behavioral Health Training, oversees the five clinical supervisors who manage the doctoral and master’s-level clinicians responding to emergency mental health calls. She said that so far, no call has escalated to the point where a team has had to request police support. “Instead of having police respond, why not bring in a team that specializes in working with these clients so police can focus on public safety?” Chao said.

The San Antonio Police Department has an internal mental health unit with an assigned sergeant, two detectives, 10 patrol officers, and three civilian clinicians who are master’s-level professional counselors. One counselor in the unit specializes in drug and alcohol treatment.

Each law enforcement member on the team has been trained in crisis intervention techniques and how to de-escalate people in crisis and connect them with necessary mental health resources.

Jon Sabo, a patrol officer in the mental health unit, says the officers trained in crisis intervention on his team can respond directly to calls with or without clinicians. For any follow-up visits, clinicians always come along to ensure people are accessing necessary services and adhering to treatment plans. In 2020, the department made more than 21,000 visits to people in mental health crisis. “The reality is, if we can get them into service and get them the help they need, we’re not making calls there anymore. They’re able to progress,” said Sabo.

The police department in Tucson, Arizona, has a similar structure, known as the Mental Health Support Team—a mobile team of civilian mental health counselors with training from the police academy to handle themselves in the field. Officers assigned to the team work with mental health clinicians to de-escalate people in crisis. “There are calls we go on where clinicians do almost everything and we’re in the background,” said Sergeant Jason Winsky, an officer on the support team. Other times, when there’s a safety threat, police apply their expertise.

The Mental Health Support Team also serves court orders for mental health treatments. While most police departments send patrol officers to serve such orders, Tucson has found that the support team has the time and the skill set needed to resolve such visits effectively and without force. “If they need to talk to someone for 3 hours for a peaceful resolution, that’s what they’ll do, and they’re not distracted by the 911 radio going off,” Winsky said.

Reducing police and community stress

In cities without such programs, police are among the first responders to 911 calls that involve a mental or behavioral health crisis like a psychotic episode, and officers may not be adequately trained to handle these incidents.

“On average, over the course of their career, police officers encounter 188 critical incidents that overwhelm their normal coping skills,” such as serious bodily injuries or near-death experiences, said David Black, PhD, a clinical psychologist and president and founder of Cordico, a wellness app for high-stress professionals, like law enforcement officers. “Over time, they encounter an enormous amount of stress, pressure, and trauma.”

This internal stress, paired with lack of mental health training, can cause officers to unintentionally escalate mental health crises, said Black. Since 2015, close to a quarter of people killed by police officers in the United States had a known mental health condition, and a November 2016 study in the American Journal of Preventive Medicine estimated that 20% to 50% of law enforcement fatalities involved an individual with a mental illness.

According to Fay, when police don’t know how to recognize and de-escalate such crises, they also can’t advocate for appropriate long-term treatment. This can result in a continuing cycle of unnecessary arrests that frustrate police and harm people who need care.

“There’d be many times I’d want to take someone to a hospital due to mental illness, only to have that person released,” Fay said. “Then, if they cause trouble in the community, I have no choice but to arrest that person to solve the problem because I’m responsible for community safety.”

Officers also feel better about their work when they have the training and resources they need to help the people they encounter. Winsky, for example, said his team once reported to an elderly woman living in her car. Because all her belongings were in the vehicle, she was hesitant to leave for a psychiatric evaluation. The mental health team and law enforcement officers worked together to find a psychiatric placement for the woman that would also accept her vehicle, alleviating her fear and allowing for a more productive evaluation and better outcome. Ultimately, Winsky said, this type of comprehensive, compassionate treatment of people with mental illness has resulted in better mental health outcomes and fewer arrests in Tucson. The street team interacts with thousands of people a year and, on average, only arrests one or two people.

Besides harming people with mental illness, unnecessary arrests can become financially costly for cities as well. At one point, Miami-Dade County spent $636,000 a day to incarcerate 2,400 people, said Leifman. Once a person is released, they often continue calling 911 if they are in crisis, which further drains community resources. “We wouldn’t put someone in jail who has dementia or cancer because they acted out in an inappropriate way,” Leifman said. “We’d work to get them treated, and we should take the same attitude with mentally ill people instead of using tax money to jail them.”

Better support on campus

With built-in services like mental health clinics and police departments, college campuses are also uniquely positioned to have mental health professionals involved with crisis response. The University of Utah recently partnered with the Huntsman Mental Health Institute, an inpatient facility on campus, to form a team of Mental Health First Responders made up of master’s-level crisis workers supervised by a psychologist. The clinicians respond to mental health calls after hours, when students are more likely to have crises, including incidents of self-harm or substance misuse.

“Our housing and residential education team noticed students can make it through the day because they’re preoccupied and have support in place, but when they’re back in their residence hall, overwhelming feelings of isolation can kick in,” said Rachel Lucynski, of Huntsman’s Community Crisis Intervention and Support Services.

At the University of Colorado Boulder, the campus police department partners with the counseling center to prevent escalation and unnecessary hospitalization for students with mental illness.

If a crisis does occur, a campus clinician responds along with police to assess and de-escalate the situation. After hours, campus police can contact clinicians via iPads on a secure connection to work together via phone or text to determine the best course of action. “It’s all part of our culture of being guardians in the community and making sure we can provide continuity of care,” said Mark Heyart, commander of the campus police.

Sabo, too, sees his crisis intervention training and partnerships with clinicians as an important part of his oath to community service. “ People say police aren’t cut out to deal with these calls, but whether we are or not, we’re doing it,” he said. “So we need the training to recognize a client in a mental health crisis and get them help.”