Why a US city sends mental health professionals

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  • Dispatching mental health professionals instead of police to respond to some 911 calls can have significant benefits, new research shows.
  • The Denver study found a 34% drop in reported crimes during the six-month trial.
  • The deployment of mental health professionals can help prevent future criminal activity and direct people in crisis to appropriate mental health care.
  • But more pilot projects and studies are needed to ensure that any permanent reforms are implemented in a thoughtful and detailed manner, according to the researchers.

New research reveals the strongest evidence to date that dispatching mental health professionals instead of police officers to respond to some 911 calls can have significant benefits.

The findings come as U.S. cities rethink the role of law enforcement in nonviolent 911 emergencies.

Study of a 911 response pilot program in Denver, in which mental health specialists responded to calls involving trespassing and other non-violent events, finds a 34% drop in reported crimes during of the six-month trial. The study by Stanford University researchers Thomas Dee and Jaymes Pyne also shows that the direct costs of the alternative 911 approach were four times lower than those of police-only responses.

“We provide strong and credible evidence that providing mental health support in targeted, non-violent emergencies can significantly reduce less serious crime without increasing violent crime,” says Dee, a professor at the Stanford Graduate School of Education and Senior Fellow at the Stanford Institute for Economic Policy Research (SIEPR).

“In our age of political division,” says Dee, “this first-responder innovation offers a rare opportunity for consensus on meaningfully improving public safety and health.

The analysis, which appears in Scientists progress, comes at a pivotal moment in broader national discussions about the performance of police officers who often serve as first responders. Public attention to the challenges of providing humane and effective policing has grown significantly since Minneapolis police officer Derek Chauvin murdered George Floyd in 2020 after a 911 call about a suspected counterfeit ticket, as well as following concerns over police responses to school shootings. in Parkland, Florida, and more recently in Uvalde, Texas.

This public discourse has also included a growing awareness of the potentially counterproductive – and sometimes tragic – consequences of having the police as first responders in non-violent situations involving people in mental health or addiction crisis. Today, a small but growing number of cities across the country are piloting programs that integrate mental health care and other social services into their first responder procedures.

In general, police reform efforts have become highly politicized. For example, while supporters of Black Lives Matter call for defunding the police in response to police brutality, opponents argue that urban violent crime rates are rising and reducing police involvement, whether through cuts budgets or a reallocation of resources, will only increase crime rates.

Dee says the results of their study indicate that there are sensible ways to reinvent first aid services and in a way that should have unusually universal appeal.

Three options for cities

Several cities, including New York, Austin, Texas, San Francisco, San Mateo, California, and Washington, D.C., are experimenting with new ways to respond to certain types of mental health emergencies with little or no law enforcement involvement. order. According to Dee and Pyne, cities have been driven not only by high-profile cases of police brutality, but also by estimates that police spend more time responding to “non-priority” calls than any other type of emergency. These estimates, they write, suggest that up to two-thirds of these types of 911 calls could be directed to mental health experts.

Cities typically explore three alternative emergency responses: In one model, police are trained to direct people in crisis to appropriate services. A second approach pairs law enforcement with mental health professionals. A third, more sweeping and less common reform removes the police altogether for some 911 calls.

Descriptive evidence from other studies suggests that these models can be effective. But so far, none have linked the cause and effect of these alternative approaches with empirical evidence that they work.

STAR in Denver

Enter Denver. For six months in 2020, the city tested the third, more drastic approach, completely removing police for specific 911 calls. In emergencies involving low-risk offenses such as public intoxication, traffic checks welfare, trespassing and public disorder, dispatchers would dispatch a mobile team consisting of a mental health specialist and a paramedic.

The pilot program, called Support Team Assistance Response (STAR), caught Dee’s attention. Dee had previously worked with several Bay Area cities to evaluate similar 911 reforms as faculty director of the John W. Gardner Center for Youth and Their Communities at Stanford, and Pyne is a senior research associate at the center. . They were both intrigued by Denver’s most extreme experience and that the city had already tried the most common tactic of additional training for police officers to better handle mental health cases.

“The concern was that maybe just training police to handle behavioral health crises wasn’t working,” Dee says.

One in four people will suffer from mental illness in their lifetime, costing the global economy an estimated $6 trillion by 2030.

Poor mental health is the leading cause of disability and poor life outcomes among young people aged 10-24 years, contributing up to 45% of the overall burden of disease in this age group. Yet globally, young people have the worst access to youth mental health care across the lifespan and at all stages of illness (especially in the early stages).

In response, the Forum has launched a series of global dialogues to discuss ideas, tools and architecture in which public and private actors can build an ecosystem for health promotion and the management of health-related diseases. mental.


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Cheaper, less crime

The STAR initiative covered eight precincts in downtown Denver neighborhoods, where 911 calls involving low-income, at-risk people in nonviolent situations were expected to be high. The STAR team handled nearly 750 incidents involving mental health, homelessness and/or substance abuse issues during the June-December 2020 pilot period. Not all incidents started with a call to 911 : In some cases, STAR teams were contacted directly by police officers. , or they reacted to situations they encountered on their own. In each case, the STAR team referred individuals, as needed, to addiction treatment centers or other support services.

Because Denver publicly releases granular crime data, researchers were able to track all adult criminal offenses reported at Denver’s 36 police stations from the time before STAR operations began as well as how long the program was active. .

Dee and Pyne find that sending in mental health workers has made a huge difference. During the pilot program, reports of less serious crime in neighborhoods monitored by STAR dropped by 34% compared to crime levels seen in neighborhoods where STAR was not available. The researchers attribute the drop in crime – which they estimate at 1,400 fewer criminal offenses based on pre-pilot rates – to fewer citations for public intoxication and other low-level offences, as well as the likelihood that potential repeat offenders now get the help they need.

Dee says the study provides “credible causal” evidence that it’s possible to reimagine 911 responses in ways that are both radical and sensible.

“The community outreach program has two benefits,” says Dee. “First, it directs people in crisis to appropriate mental health care instead of directing them to the criminal justice system. Second, it prevents future criminal activity because people who are currently receiving mental health care no longer commit offences.

In one of many quality checks of their data, Dee and Pyne also look at reports of more serious crimes that police, not STAR teams, responded to in the precincts covered. They find no detectable increase in these crime rates, suggesting that the STAR program caused the decrease in low-level criminal activity.

The authors also show that the STAR program saved money. They calculate that the direct cost of responding to each offense was $151 on average, four times less than the estimated average direct cost of $646 per minor criminal offense. Dee points out that these estimates do not include the costs of ongoing drug treatment or other support services, or the costs of incarceration. Even so, he says, the benefits far outweigh the costs. “I would also say it’s just about doing the right thing. People in mental health crisis need proper health care and they are just less likely to get it when we refer them to the criminal justice system,” he says.

While the findings are consistent with other less conclusive evidence from cities experimenting with new emergency response models, Dee says the study is as close as any research to date to linking emergency response. non-policing emergency to lower crime and costs.

“These results are extraordinarily promising,” says Dee. He warns, however, that more pilot projects and studies are needed to ensure that any permanent reform is carried out.

“It’s not something every 911 system should implement tomorrow,” he says. “This reform requires thoughtful and detailed implementation – from training people who respond to 911 calls to hiring the right kind of mental health interventionists and careful coordination with law enforcement agencies. .”


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