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From Crisis to Care

For alternative responses to policing to work and reduce the footprint of the criminal legal system, they must work in concert and holistically to address both immediate and longer-term social needs.


Daniel Prude. Nicolas Chavez. Linden Cameron. All of them were either severely injured or killed by police. All of them suffered from mental illness. They represent but a fraction of people in crisis who are harmed by the police. One out of four fatal police encounters involve people suffering from mental illness, and that’s not counting a broad spectrum of harmful, non-fatal encounters that rarely, if ever, make national headlines.

The importance of reducing police interactions with people experiencing such crises cannot be overstated. In this time of increasing attention to police violence and the need for change, alternative crisis response initiatives that authorize civilians to respond to 911 calls involving people in crisis are receiving significant attention and acclaim. Regardless of where one stands on the role or existence of police in our society, many people support the idea of having civilians address non-criminal situations that involve mental health crises.

There is much to commend in these initiatives. Alternative crisis response frameworks address a very real problem — namely, over-reliance on police. They reflect and help realize a more holistic understanding of what public safety entails and what it requires. And they are clearly superior to many of the inhumane and utterly pointless tactics —  including arrests, sweeps, and banishment — that have been used in the past. New ways of responding to vulnerable people who are experiencing mental health crises are clearly needed.

At the same time, some current models have a number of limitations that are worth considering. We explore these limits here not because we are opposed to the current popular approach — we are not — but rather because we believe we should, and can, do more to respond to people in crisis (some of whom commit crimes or inflict harm, and some of whom do not) over longer periods of time.

One of our main concerns with some current models is that many alternative crisis response programs are limited to calls for service that do not involve any allegation of crime or danger. Most alternative crisis response initiatives focus on calls that are coded as “mental health crises” and “mental health disturbances” that do not involve weapons; some also prioritize other non-criminal issues such as public intoxication and syringe disposal. This separation of crisis and crime — and the treatment of the latter as largely off-limits for civilian first responders — creates a limiting framework for those who are truly seeking lasting change outside of the criminal legal system.

In our work, we aim to bridge this gap — while proposing a new course forward that merges the best of what current models have to offer while also being careful to avoid reproducing old patterns. Here, we’ll identify some of the current limitations and argue that alternative first response initiatives should be accompanied by new ways of responding to people and situations that do involve allegations of crime, while providing ongoing support to people who are experiencing chronic crises. In short, we need to not only imagine and develop alternative first responses to acute crises, but also “second responses” designed to address the deep social marginalization at the root of those crises.

Many alternative crisis response initiatives in the United States and Canada are based on the CAHOOTS, or Crisis Assistance Helping Out on the Streets, model that was pioneered in Eugene, Oregon. CAHOOTS is not new, but the deepening of the national conversation around police violence has drawn attention to it. Originally developed in 1968 as a volunteer-run mobile crisis unit aimed at reducing police interactions with vulnerable people, the erstwhile  “bummer squad” that later became known as CAHOOTS responded to certain calls alongside the police, evolving in the 1980s to become a civilian mobile crisis unit dispatched through the 911 system.

Fast-forward to the summer of 2020, and CAHOOTS had 310 outstanding requests for information from communities across the country. A seemingly endless list of cities — among them Oakland, Rochester, Portland, San Francisco, Denver, Dallas, New York, and Toronto — have recently announced the development of new initiatives based on CAHOOTS. And the recent expansion of federal Medicaid funding for such initiatives means that this model is likely to continue to spread.

We need to not only imagine and develop alternative first responses to acute crises, but also “second responses” designed to address the deep social marginalization at the root of those crises.

As sociologists, we have studied policing, homelessness, and related issues for decades, observing and interviewing officers, organizations, and community members in places as diverse as Washington, Ohio, and California. We have been struck by the rapid growth and rising popularity of CAHOOTS, and yet are concerned that some of the models’ structural limitations are being overlooked.

Although the original CAHOOTS units in Eugene and Springfield, Oregon, are housed in and are partially funded by their respective police departments, they’re commonly described as an alternative to police. In one sense, this is accurate. Many CAHOOTS-inspired initiatives are aimed at reducing police involvement in non-emergency and non-criminal situations involving mental health issues. The Rapid Integrated Group Health Care Team (RIGHT CARE) in Dallas, for example, seeks to “shift the focus of mental health crisis response to paramedics and health systems in order to create a health-based response to mental health crises.” Similarly, San Francisco’s Street Crisis Response Teams (SCRT) “provide rapid, trauma-informed response to calls for service to people experiencing crisis in public spaces in order to reduce law enforcement encounters.” CAHOOTS itself reports mainly dealing with calls involving mental health, suicide threats, welfare checks, and family disputes. Roughly three-fourths of the calls they respond to involve people who live unsheltered.

This focus on the intersection of mental health, substance use, and poverty makes good sense. People experiencing homelessness, mental health disabilities, or unmanaged substance use disorders are the subject of many 911 calls and often cycle repeatedly in and out of jail. In San Francisco, the police receive roughly 100,000 911 calls about homelessness each year. Portlanders call the police about people they deem unwanted — homeless individuals and others combating behavioral health issues — once every 15 minutes. And a growing number of studies document the myriad harms caused by police to vulnerable populations. On the one hand is the likelihood of death: One-third to a half of all people killed by police are disabled, while one in four people killed by police suffers from a mental illness. Moreover, half of all police killings of unarmed civilians originated in a 911 call. On the other hand are less-than-lethal forms of police violence, to say nothing of harassment, stops, stress, and the dignitary costs of needless police interactions.

But there are important implications of this model that must not be overlooked. First, if situations involving perceived criminal law violations — including minor offenses such as trespass, drug possession, theft, and illegal camping — are out-of-bounds for these non-police interventions, the capacity of these initiatives to facilitate decriminalization or decarceration will be dramatically reduced. These situations, thus, will continue to be handled by the criminal legal system, where racial inequities persist: Research on implicit bias suggests that reliance on 911 callers and dispatchers to identify situations that involve crises but not crime or weapons raises the very real possibility that calls involving white people in crisis are more likely to be deemed eligible for an alternative response than those involving people of color. Beyond creating disparities in alternative responses, this dynamic perpetuates the so-called “Karen phenomenon” — the longstanding practice of white residents who weaponize 911 against minorities they personally deem too loud, suspicious, or out of place in parks and other public venues.     

Second, approaches based on CAHOOTS do not invite widespread reconsideration of our collective reliance on 911 to address issues and behaviors that are currently defined as crimes. In addition to important systemic changes that must happen, any real transformation regarding the role of police in our society will be impossible without a broader cultural shift toward valuing the expertise of people who are not police officers. This kind of cultural transformation begins by reassessing our reliance on 911 and working together to develop non-punitive, community-based responses to non-emergency situations. The fact that some residents, especially people of color, are reluctant to call 911 further underscores the need for non-police response models that do not rely on 911. Fortunately, such initiatives have been developed in some cities. Alternative crisis response initiatives in Rochester and Atlanta, for example, encourage people to call a non-emergency number rather than 911. These shifts are a move in the right direction, but the primary referral mechanism for most alternative crisis programs remains 911.

Any real transformation regarding the role of police in our society will be impossible without a broader cultural shift toward valuing the expertise of people who are not police officers.

There’s the added complication that CAHOOTS initiatives are often housed in, and funded by, police departments. For example, CAHOOTS itself and Olympia’s Crisis Response Units are housed within their city police departments. Other initiatives are jointly housed in municipal police and fire departments. (Some CAHOOTS-type initiatives are administratively housed in non-profit organizations, but this appears to be less common.) To the extent that these initiatives are housed in, and funded by, police departments, they do not truly shift resources and control away from the police. Moreover, many initiatives are touted as a way to save police departments money. But what this often means in practice is that the programs simply pay civilian first responders significantly less than police officers. This wage disparity, of course, makes staffing challenging and creates significant turnover, leaving CAHOOTS-like initiatives worse off than their parent police departments.

Finally, as people directly involved with CAHOOTS point out, the program does not entail ongoing support for the people they assist or any significant reallocation of resources. As a result, outreach responders who work for CAHOOTS-type programs often end up interacting with the same people over and over again. As one CAHOOTS case manager put it, “All these other cities are really looking to CAHOOTS right now as this Band Aid, right, because they want to have that thing that looks good and says, look, police aren’t responding to these situations. But we’re still going to end up being part of that same machine of oppression … if there aren’t other resources to get folks connected to.” Some alternative response initiatives are hiring staff who provide follow-up support to people who are the subject of repeated 911 calls. Still, the modal encounter generated by most alternative response models is short-term by design.

From Short-term Crises to Long-term Care

Although it has clearly captured the imagination of policymakers, funders, and advocates, the CAHOOTs model is not the only non-police option for responding to situations that involve untreated mental health issues, substance use, and extreme poverty. JustCARE, a holistic and collaborative initiative that involves numerous programs and organizations, emerged in Seattle, Washington, in 2020 and provides a useful contrast. If CAHOOTS offers an alternative first response to acute crises, JustCARE can be understood as a second response aimed at offering a longer-term response to chronic crises — and low-level criminal behavior. Together, they form a more holistic strategy for cementing deeper transformations and reducing the reach and impact of the criminal legal system. 

JustCARE enables people living in unauthorized encampments to move into non-congregate, supportive interim housing, where they receive trauma-informed care guided by harm reduction principles, with the goal of securing permanent housing and meeting other goals participants identify as important to them. To begin, JustCARE partners conduct outreach in encampments that generate significant concern — and many 911 calls — in order to better understand residents’ situations and needs. JustCARE staff also work closely with people who live and work in affected neighborhoods and address their concerns as well. Most camp residents are then offered, and they accept, the opportunity to move into safe, private, and supportive housing and to work closely with case managers, many of whom have relevant lived experience that enables them to build trust with participants. Once safely housed, people receive on-site medical services and intensive case management support. Dedicated staff and dedicated safety teams use de-escalation and other harm reduction techniques to ensure that participants and staff are safe and to avoid reliance on 911.

The findings from a recent developmental evaluation of JustCARE’s first six months of operations (which one of us co-authored) are encouraging. In interviews, JustCARE participants reported significant improvements in their emotional well-being after securing housing that offers safety and privacy and establishing positive relationships with case managers. The availability of on-site medical providers means that many are also able to address longstanding health challenges. Nearly all of the participants who acknowledged having previously relied on illicit survival strategies such as theft and drug sales reported ceasing or dramatically curtailing those activities once housed and supported. Some are able to secure permanent housing with the support of case managers — though increased investments in affordable permanent housing, expanding access to housing vouchers, and improvements in mental health care and substance abuse treatment remain vital.

The JustCARE model addresses many of the limitations of the CAHOOTS framework. First, JustCARE providers intentionally focus on situations (i.e. unauthorized encampments) that involve residents who sometimes rely on illicit survival strategies and commit other low-level crimes. In fact, 84 percent of the campers screened by JustCARE outreach responders in its first month of operation reported regularly using drugs, mainly methamphetamine and heroin. Many also relied extensively on illicit survival strategies. By responding to people and situations that involve criminalized behaviors, JustCARE has the potential to reduce not only potentially harmful police encounters, but also criminal legal system involvement more generally. And by specifically engaging residents of encampments that mainly include campers of color, JustCARE may also reduce racial inequities in the criminal legal system.

Second, rather than responding to redirected 911 calls, JustCARE works with community members to address their concerns and identify areas of need. In the process, JustCARE staff are engaging in deep cultural and relational work in affected neighborhoods, taking neighbors’ concerns seriously while also inviting community members to reevaluate their tendency to rely on 911 to address non-emergency situations. In this sense, JustCARE is doing the cultural work that reducing the “policeability” of mental health issues, poverty, drug use will require in the medium and long term. JustCARE’s focus on heavily impacted neighborhoods means that it can provide tangible improvements that are then deeply felt by people who live and work in those neighborhoods — people who have generated many 911 calls in the past.

Finally, as noted previously, JustCARE provides interim supportive housing with the goal of supporting participants in, among other things, securing affordable permanent housing. Alternative first response models are simply not designed to do this. Of course, this intensive case management (and the provision of interim housing) means that JustCARE is comparatively expensive. In Seattle and King County, newly available federal funds are being used to expand JustCARE, though additional monies will be needed to achieve regional coverage. Over the long term, bringing JustCARE to scale may necessitate progressive tax reform and/or reallocation of funds currently allocated to law enforcement, which adds an element of unpredictability to the enterprise. And of course, continued federal funding for local housing initiatives and expanding access to permanent affordable housing is essential. The available evidence suggests that such investments would likely pay handsome dividends.

Although quite different, these two types of interventions are, in theory, compatible. And CAHOOTS-based initiatives can do some things that JustCARE cannot. For example, because of its focus on targeted encampments, JustCARE is not in a position to respond to calls for service pertaining to particular individuals who live outside of targeted areas but generate many 911 calls. In this way, frameworks such as JustCARE might benefit from the existence of alternative crisis responders who can refer people with long-term needs to ensure that they receive the housing and support they need.

While it remains unclear how the co-existence and collaboration of these two approaches might play out, it is evident that a meaningful and transformative response to homelessness, mental health, and substance use will require responding to both acute and chronic crises. Alternative first response models have an important role to play, but they alone cannot bear the weight of the policing and housing crises that are unfolding in cities across the United States. Together, the CAHOOTS and JustCARE models provide a glimpse of how cities might begin to reimagine our collective response to homelessness, substance use disorders, and mental health issues without relying on either the police or the criminal legal system. Doing so will require significant financial and social investment in housing and in our most vulnerable residents, increasing community well-being in the long term. Indeed, the alternatives — abandonment, sweeps, crackdowns, and mass incarceration — are far costlier in every way.

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