Responses to People with Mental Health Conditions

Traditionally, law enforcement has been the default first responder to people in crisis. This approach has presented several challenges, including the potential for increased involvement with the criminal justice system and the potential for these interactions to escalate to the point of police use of force. Approximately 25% of people living with a mental health condition have been arrested by police at some point in their life⁴ and about 41% of people incarcerated in prisons report having a history of a mental health problem.⁵ According to the Washington Post, since 2015, approximately 1 in 5 people shot and killed by police had a history of mental health conditions or were exhibiting mental distress at the time of the shooting. ⁶

To enhance responses to people in crisis, many communities have been exploring alternatives to the traditional law enforcement response. Substantial innovation has occurred related to crisis response with the implementation of police-mental health collaboration programs and community responder programs. Several crisis response models have been implemented across communities and significant variation exists in how communities adapt a model to fit their community.

Community responder programs include health professionals and other staff who receive training in crisis response and serve as first responders to calls for service and social disturbances. These teams conduct wellness checks, provide support to people experiencing a mental health crisis and people with housing needs, and other assistance.⁷

Across police-mental health collaboration programs and crisis response models, there are several common overarching goals, including:⁸

Improved safety for all

Programs emphasize the use of de-escalation strategies to enhance the safety of officers and the people they encounter.

Increased access to mental healthcare

Programs aim to increase individuals’ connection to services to support crisis response and facilitate short- and long-term care.

Diversion from the criminal justice system

Programs are designed to divert people away from the criminal justice system and into services, leading to fewer arrests and repeat encounters with the system.

Reduced costs

Programs seek to reduce costs for the criminal justice system and emergency services, through reduced patrol officers’ time spent on calls for service, fewer repeat calls for service, and diversion from emergency services.

Law enforcement agencies and communities may operate multiple crisis response models within their jurisdiction to provide a multi-layered response to people with mental health conditions. Various models for crisis response and police-mental health collaboration are described in greater detail below.

Crisis Intervention Team (CIT)

What is a Crisis Intervention Team (CIT)?

The Crisis Intervention Team (CIT) model is a collaborative police-based crisis response model that includes partnerships among law enforcement; mental health professionals; mental health advocates, including people living with mental health conditions; and other partners to improve police and community responses to mental health crises.⁹ Key components of this model include (1) training for volunteer CIT officers on signs of a crisis and mental health conditions, crisis de-escalation, and diversion from the criminal justice system into mental health services; (2) training 911 call-takers and dispatchers on the identification of crisis incidents to be able to appropriately assign these calls to CIT officers; (3) partnerships among law enforcement, mental health advocates, and mental health providers; and (4) collaboration with psychiatric emergency receiving facilities (e.g., crisis stabilization centers) and other mental health service providers so officers have somewhere to transport people experiencing a crisis for services.¹⁰ Goals of the CIT model include improving safety for all during police encounters with people experiencing a crisis, increasing connections to mental health services, and diversion from the criminal justice system, when possible.¹¹

How are CIT programs implemented in different communities?

The CIT model is characterized by several core elements, including partnerships among law enforcement, advocacy, and mental health service providers; CIT training for volunteer officers and 911 call-takers and dispatchers; and crisis services to which officers can refer and transport people experiencing a crisis.¹⁴ How CIT programs are implemented in different communities varies across several dimensions.¹⁵ Some agencies’ CIT programs are part of multi-layered responses to people experiencing a crisis, which may include other programs (e.g., co-responder teams, case management services), while other agencies’ use CIT as a standalone response. CIT programs can operate through a single law enforcement agency or at the county, regional, or state level. CIT officers may be directly dispatched to calls for service as the primary first responder and/or serve as a secondary response after other officers, or other first responders, respond and request CIT officers on scene. CIT training also varies across communities, with some agencies requesting police officers to volunteer and attend the training and others mandating all officers attend and/or incorporating CIT training into the academy. The CIT model recommends enough officers are CIT-trained to provide enough coverage to have CIT officers on all shifts. The percentage needed to achieve this goal varies across agencies, with a recommended 20–25% of officers in large agencies and a higher percentage in smaller agencies.¹⁶ Additionally, the length and content of the training may vary. ¹⁷

The CIT model includes a recommendation for training 911 call-takers and dispatchers to be able to effectively identify calls for service involving mental health crises; though, communities vary in the implementation of this recommendation. The availability of crisis services varies across communities, with some jurisdictions having access to 24-hour crisis stabilization centers with a “no refusal” policy and others having limited services to transport people experiencing a crisis to receive services.

What does the research say?

Much of the research on CIT has focused on the impact of CIT training on officers’ reported knowledge, attitudes, and behaviors.²¹ For an overview of the research on CIT training and programs, see the Best Practice Guide chapter produced by the Academic Training Initiative to Inform Police Responses – Assessing the Impact of Crisis Intervention Teams: A Review of Research.

Impact of Crisis Intervention Team (CIT) Training

Knowledge of mental health conditions: CIT training has been found to significantly improve officer knowledge of mental health conditions, increase officers’ confidence in interacting with people experiencing a mental health crisis, and reduce stigma related to mental health conditions.²²
Knowledge of available mental health services: Officers who receive CIT training have reported increased knowledge of available mental health services and more positive perceptions of these services as compared to non-CIT trained officers, which is a key aspect of the training. There is some evidence that officers with more positive views toward mental health services may be more likely to make referrals to services than officers with more negative perceptions.²³
Familiarity with de-escalation techniques: Some studies suggest that CIT training may increase officers’ support for the use of de-escalation strategies when responding to people experiencing a mental health crisis.²⁴ The beneficial effects of CIT training on support for and self-reported use of de-escalation strategies may diminish over time, suggesting the utility of refresher training.

Impact of Crisis Intervention Team (CIT) Programs

Connections to services: There is some evidence that CIT programs increase transport to and referrals to services for people experiencing a crisis, which is a primary goal of the program.²⁵ Though, the availability of mental health services in the community will affect the capacity of CIT programs to increase connections to services.
Crisis de-escalation: A main goal of CIT programs is to enhance crisis de-escalation and decrease the use of force and injuries in crisis incidents. Research examining the impact of CIT programs on use of force is limited and has mixed findings, with some studies showing reduced use of force by CIT officers as compared to non-CIT officers and reduced injuries and other studies finding no effects.
Pressure on the criminal justice system: CIT programs seek to reduce officers’ use of arrests when responding to people with mental health conditions, diverting them from the criminal justice system when appropriate. Some studies found CIT programs were associated with reduced arrests and others finding no effects.
Cost-effectiveness: A few studies found financial benefits of CIT programs for the criminal justice and health care systems through avoided jail time and reduced hospitalizations despite the expenses associated with CIT program implementation.

Resources

Co-Responder Team

What is a co-responder team?

A co-responder team is a police-based crisis response model that pairs a police officer with a mental health professional to respond to mental health calls and crisis incidents.¹² These teams seek to use the expertise of law enforcement and mental health professionals to enhance responses to people experiencing a crisis, divert individuals from the criminal justice system and into mental health services, and reduce the need for emergency services and hospitalization.¹³

Harris County (TX) Sheriff’s Office C.I.R.T. & C.O.R.E. Program

How are co-responder team programs implemented in different communities?

Co-responder team programs vary significantly across communities due to the need to tailor the program to the needs and resources of the community.¹⁸ Co-responder teams may be the primary first responders to crisis incidents and/or be secondary responders responding to a scene after receiving requests from other first responders. Requests for response may come directly from 911 dispatch, requests from other responders, and/or crisis lines. These teams can respond to crisis incidents, engage in proactive outreach, and/or provide follow-up services to people who were in a crisis to enhance connections to services and prevent future crisis incidents. The mental health professionals on the co-responder teams may be employed by the law enforcement agency or the mental health provider.¹⁹

The mental health professional may ride with an officer and jointly respond to the scene (ride-along support), respond separately to the incident (ride-separate support), and/or provide support through video, phone, radio, or the use of other technology (remote support).²⁰ Programs also vary in geographic focus, days/hours of operation, staffing, training, equipment, and role of team members, which are often outlined in policies and procedures.

What does the research say?

For an overview of the research on co-responder team programs, see the Best Practice Guide chapter produced by the Academic Training Initiative to Inform Police Responses – Assessing the Impact of Co-Responder Team Programs: A Review of Research.

Resources

Mobile Crisis Team

What is a mobile crisis team?

Mobile crisis teams are a mental health-based response composed of a team of mental health professionals who respond to mental health incidents in the community.²⁹ These teams provide a rapid response to people experiencing a mental health crisis in the community, complete assessments to determine the most appropriate level of care, de-escalate crisis incidents, and facilitate connections to services to prevent future crises. Goals of mobile crisis teams include providing the least restrictive care for people with mental health conditions and allowing people to remain in the community, if appropriate; providing services and avoiding unnecessary law enforcement contact; and reducing unnecessary emergency department visits and hospitalizations. Although mobile crisis teams mainly operate out of the mental health system, involvement and collaboration with police is not uncommon. Police may provide referrals to mobile crisis teams after responding to an incident and determining mobile crisis team response is appropriate or request mobile crisis teams co-respond to crisis incidents with police.

Denver STAR Program

How are mobile crisis team programs implemented in different communities?

Mobile crisis teams vary in their implementation across communities on several dimensions, including staffing, days/hours of operation, the operating agency (e.g., community-based mental health organization, hospital, county), co-location with other services or a stand-alone entity, and the level of follow-up care provided (e.g., in-person visits, case management services).³² Mobile crisis teams also vary in the types of professionals who operate these teams and may include social workers, Master’s level clinicians, peer support specialists, and EMTs. How mobile crisis teams are notified of crisis incidents varies and can include police referral, crisis hotline, 911 dispatch, emergency medical services, self-referrals, and/or referrals from family members, mental health providers, or schools. Some mobile crisis teams have specific target populations including children and adolescents and individuals experiencing homelessness.

What does the research say?

For an overview of the research on mobile crisis teams, see the Best Practice Guide chapter produced by the Academic Training Initiative to Inform Police Responses – Assessing the Impact of Mobile Crisis Teams: A Review of Research.

Connection to services: Research suggests mobile crisis teams can be effective in connecting people experiencing a crisis to services.³⁴
Pressure on the health care system: Available research suggests mobile crisis teams can be effective in reducing unnecessary emergency department visits and hospitalizations, while still facilitating connections to higher level of care as desired; though, this finding is not universal.
Cost-effectiveness: Only a few studies have examined the cost-effectiveness of mobile crisis teams and found these programs may produce cost savings. It is suggested these teams can prevent the need for law enforcement contact and transportation to the emergency department and hospitalization.

Resources

Law Enforcement-Based Case Management Services

What are law enforcement-based case management services?

Law enforcement-based case management services, also known as case management teams, involve a partnership between police and mental health professionals to identify, engage, and provide case management services to people living with serious mental illness (SMI), chronic behavioral health conditions, or other conditions who repeatedly come into contact with law enforcement and/or other emergency services.³⁰ These programs developed out of the observation that a relatively small number of people living with SMI have frequent contact with law enforcement and/or other emergency services due to unmet needs.³¹ Case management teams take a proactive approach in using data and referrals to identify people who frequently use emergency services, conduct a comprehensive assessment, and provide initial outreach and follow-up to ensure they are connected to services and their needs are being met. Individuals voluntarily engage in case management services and are not required to participate.

How are law enforcement-based case management services implemented in different communities?

Law enforcement-based case management services are traditionally embedded in police departments as part of a multi-layered approach to responding to people with mental health conditions.³³ These programs employ a data-driven approach to identify people who have had a mental health crisis in the past and/or multiple contacts with law enforcement and emergency services related to their mental health condition. Individuals voluntarily participate and receive individualized response plans to promote their connections to services and can include short-term follow-up and long-term case management.

What does the research say?

For an overview of law enforcement-based case management services, see the Best Practice Guide chapter produced by the Academic Training Initiative to Inform Police Responses – Law Enforcement-Based Case Management Services: A Review of Research.

Limited research has examined the outcomes of law enforcement-based case management services; though, these programs may be a promising practice based on the data-driven, proactive nature of the approach which can help connect people living with mental health conditions to services.³⁵

Resources

Law Enforcement Assisted Diversion (LEAD)

What is Law Enforcement Assisted Diversion (LEAD)?

LEAD is a community-based diversion program that is designed to reduce criminal justice system involvement for program participants and improve public safety and public order.³⁶ With a LEAD program, officers use their discretion to refer people who are routinely arrested for minor offenses that are associated with their mental health conditions to divert them from the criminal justice system and into community-based services.³⁷ In lieu of arrest and prosecution, officers refer people to case managers who create an individualized plan to address their needs. A primary goal of LEAD is to reduce harm for the people referred to the program, their loved ones, and the community.³⁸ Key components of the LEAD program include stakeholder collaboration, diversion from the criminal justice system based on officer discretion, and intensive case management to address program participants’ need using a harm reduction approach.³⁹

'She Literally Saved My Life': How the LEAD Program in Seattle is People Those in Crisis

How is LEAD implemented in different communities?

LEAD implementation can vary based on the community context and can include differences in participant eligibility criteria, method of referral, days/hours of operation, nature of response, amount/type of training, and level of follow-up care.⁴¹ The offense types that are eligible for LEAD participation can vary and can include drug offenses, prostitution, and/or other nonviolent offenses. People can be referred to LEAD in lieu of arrest and/or through social contact referrals, in which an officer identifies people with an offense history who could benefit from the program. In some communities, officers can make direct referrals to eligible participants to a LEAD case manager and in others, officers need to refer potential participants to another entity to conduct an initial assessment and assign the person to a case manager. Some LEAD programs involve training all officers about LEAD and the referral process and others involve training officers specifically chosen to participate in LEAD. The level of follow-up care and case management depends on the different resources available in the community and the needs of the target populations.

What does the research say?

For an overview of the research on LEAD, see the Best Practice Guide chapter produced by the Academic Training Initiative to Inform Police Responses –Assessing the Impact of Law Enforcement Assisted Diversion (LEAD) – A Review of Research.

Connection to services: Many LEAD participants do not have access to stable housing.⁴⁷ Several studies found that LEAD programs can increase access to housing for program participants and may help reduce recidivism. Research on programs’ effects on employment and income is mixed, with some studies finding improved employment outcomes and income for program participants and others finding no effects. Studies generally have found LEAD participation is associated with reduced substance use; though, abstinence is not a goal of LEAD. Program participation can also increase connections to mental health and physical health services.
Pressure on the criminal justice system: Research suggests LEAD programs can reduce future arrests among program participants and there is some evidence that participation can reduce the number of cases an individual is charged with. There have been fewer evaluations that studies LEAD programs’ impact on booking and incarceration; though, the preliminary research suggests LEAD may reduce jail booking and incarceration rates.
Cost-effectiveness: Although few studies have assessed the cost-effectiveness of LEAD, they generally have found lower health care and criminal justice-related costs for LEAD participants than non-participants.

Resources

EMS and Ambulance-Based Responses

What are EMS and ambulance-based responses?

Emergency medical services (EMS) and ambulance-based response programs are community-based responses that use paramedics to provide services to people with mental health conditions.⁴⁰ These programs include partnerships among emergency departments, community-based mental health facilities, law enforcement agencies, substance use treatment services, and case management services to provide a more efficient response to crisis situations and provide referrals to treatment options. Program goals include providing people with mental health conditions with faster access to specialized mental health services that may not be available in an emergency department, reduce the unnecessary use of ambulance transport and allow EMS providers to respond to medical emergencies, and reduce emergency department overcrowding.

How are EMS and ambulance-based responses implemented in different communities?

EMS and ambulance-based response programs vary in how they are implemented across communities to reflect local needs and resources.⁴² Target populations can include people living with mental health conditions, substance use disorders, and other social needs or can primarily focus on people experiencing a mental-health related crisis. People can be identified for these programs through 911 dispatchers who conduct an initial screening and then deploy specialized response teams for further assessment, through trained paramedics who assess individuals for diversion, and through other first responders. Some programs provide on-scene assessment and services, while others transport people to other service providers for treatment.

There are generally three types of EMS and ambulance-based response programs:

Frequent EMS user programs: These programs provide services to people who frequently call 911 for assistance related to their mental health conditions.⁴³ Paramedics provide assessment of patients’ needs and offer voluntary case management services. A goal is to connect participants to mental health, substance use, and other community resources to reduce the need for emergency services.
Alternative destination programs: These program focuses on diversion from emergency departments to other treatment facilities (e.g., mental health crisis centers, sobering units) and require paramedics and other healthcare providers to ensure patients are medically stable prior to transport.⁴⁴
Mobile response teams: These teams, also known as mobile integrated healthcare models, use paramedics and nurses to provide patient care outside of emergency departments.⁴⁵ These services can include phone consultation to people who call 911, providing preventative care, home visits and other on-scene treatment, diversion from the emergency department to other treatment services, and providing referrals to needed services.⁴⁶

What does the research say?

For an overview of the research on EMS and ambulance-based responses, see the Best Practice Guide chapter produced by the Academic Training Initiative to Inform Police Responses – Assessing the Impact of EMS and Ambulance-Based Responses: A Review of Research.

Connections to services: Several studies found that EMS and ambulance-based response programs provide referrals to services (e.g., mental health services, substance use treatment, housing, transportation).
Pressure on EMS providers and hospitals: Some research has found that these programs can reduce EMS transports, hospitalizations, and future 911 calls for service and that most people who received services do not require additional emergency medical treatment.
Cost-effectiveness: Several studies found cost savings associated with EMS and ambulance-based response programs through reduced ambulance transports and emergency department visits.

Agencies can utilize the Police-Mental Health Collaboration (PMHC) Self-Assessment tool to assess the status of their current response efforts. The tool helps law enforcement agencies and their behavioral health partners assess their progress toward implementing high quality partnership-based interventions. The PMHC Self-Assessment tool can be accessed here.

Additional Resources on Responses to People with Mental Health Conditions

Law Enforcement-Mental Health Learning Sites

The Law Enforcement-Mental Health Learning Site Program, led by the Council of State Governments (CSG) Justice Center with support from the U.S. Department of Justice Bureau of Justice Assistance, provides examples of crisis response in practice. This peer-to-peer learning program offers assistance to law enforcement and mental health practitioners to support the implementation of evidence-informed and best practices.

CSG Justice Center Police-Mental Health Collaboration Self-Assessment Tool

The Police-Mental Health Collaboration (PMHC) Self-Assessment tool helps law enforcement agencies and their behavioral health partners assess their progress toward implementing high quality partnership-based interventions. This tool is designed to provide resources to help improve responses to calls for service for people with mental illnesses and/or co-occurring substance use conditions.

SAMHSA (2020) National Guidelines for Behavioral Health Crisis Care Best Practice Toolkit

The National Guidelines for Crisis Care – A Best Practice Toolkit advances national guidelines in crisis care within a toolkit that supports program design, development, implementation and continuous quality improvement efforts. It is intended to help mental health authorities, agency administrators, service providers, state and local leaders think through and develop the structure of crisis systems that meet community needs.

The Council of State Governments (CSG) Justice Center (2019) Police-Mental Health Collaborations: A Framework for Implementing Effective Law Enforcement Responses for People Who Have Mental Health Needs

Increasingly, law enforcement officers are called on to be the first, and often the only, responders to calls involving people who have mental health needs. To begin tackling that challenge, The Council of State Governments (CSG) Justice Center released a framework to help law enforcement agencies across the country better respond to the growing number of calls for service they receive involving this population.

National Alliance on Mental Illness (NAMI) Divert to What? Community Services That Enhance Diversion

Many communities are committed to diverting people with mental illness away from the criminal justice system. However, in order to do so, communities need effective mental health services, such as outpatient, inpatient and crisis care. This publication is meant to help communities identify the gaps and opportunities in the existing system that will enhance their efforts to divert people from justice system involvement.

Stepping Up Initiative: Discover Local Strategies

This webpage features an interactive library of policies, practices, and programs implemented by jurisdictions across the country to reduce the prevalence of people living with mental health conditions in jails. The database includes dozens of different programs, policies, and practices (e.g., crisis intervention team, co-responder team), including definitions and local examples.

References

⁴ James D. Livingston, 2016, “Contact Between Police and People with Mental Disorders: A Review of Rates,” Psychiatric Services 67(8): 850–857.

⁵ Laura M. Maruschak, Jennifer Bronson, and Mariel Alper, June 2021, Survey of Prison Inmates, 2016. Indicators of Mental Health Problems Reported by Prisoners, Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, NCJ 252643, retrieved from https://bjs.ojp.gov/sites/g/files/xyckuh236/files/media/document/imhprpspi16st.pdf.

⁶ Washington Post, accessed May 21, 2023 from https://www.washingtonpost.com/graphics/investigations/police-shootings-database/.

⁷ The Council of State Governments (CSG) Justice Center, n.d., “Overview of Community Responder Programs.” Accessed May 22, 2023 from https://csgjusticecenter.org/publications/expanding-first-response/the-toolkit/.

⁸ Bureau of Justice Assistance, n.d., Learning: Police-Mental Health Collaboration Toolkit, accessed May 22, 2023 from https://bja.ojp.gov/program/pmhc/learning.

⁹ Center for Police Research and Policy, March 2021, Assessing the Impact of Crisis Intervention Teams: A Review of Research, Cincinnati, OH: University of Cincinnati, retrieved from https://www.informedpoliceresponses.com/_files/ugd/313296_14ca1e6710bb4d6daa88bacb127da069.pdf; Laura Usher, Amy Watson, Ron Bruno, Suzanne Adriukaitis, Don Kamin, Carol Speed, and Sabrina Taylor, 2019, Crisis Intervention Team (CIT) Programs: A Best Practice Guide for Transforming Community Responses to Mental Health Crises, Memphis, TN: CIT International, retrieved from https://www.citinternational.org/resources/Best%20Practice%20Guide/CIT%20guide%20desktop%20printing%202019_08_16%20(1).pdf.

¹⁰ Amy C. Watson, Michael T. Compton, and Jeffrey N. Draine, 2017, “The Crisis Intervention Team (CIT) Model: An Evidence-Based Policing Practice?” Behavioral Sciences & The Law, 35: 431–441; Center for Police Research and Policy, Assessing the Impact of Crisis Intervention Teams; Usher et al., Crisis Intervention Team (CIT) Programs: A Best Practice Guide.

¹¹ Center for Police Research and Policy, Assessing the Impact of Crisis Intervention Teams.

¹² Center for Police Research and Policy, March 2021, Assessing the Impact of Co-Responder Teams Programs: A Review of Research, Cincinnati, OH: University of Cincinnati, retrieved from https://www.informedpoliceresponses.com/_files/ugd/313296_4a364b2093ed4fb9be28dd6dd977816b.pdf.

¹³ Melissa S. Morabito, Jenna Savage, Lauren Sneider, and Kellie Wallace, 2018, “Police Response to People with Mental Illnesses in a Major U.S. City: The Boston Experience with the Co-responder Model, Victims & Offenders, 13(8): 1093–1105.

¹⁴ Center for Police Research and Policy, Assessing the Impact of Crisis Intervention Teams; Randolph Dupont, Sam Cochran, and Sarah Pillsbury, September 2007, Crisis Intervention Team Core Elements, Memphis, TN: The University of Memphis CIT Center, retrieved from https://www.citinternational.org/resources/Pictures/CoreElements.pdf.

¹⁵ Center for Police Research and Policy, Assessing the Impact of Crisis Intervention Teams.

¹⁶ Usher et al., Crisis Intervention Team (CIT) Programs: A Best Practice Guide.

¹⁷ Center for Police Research and Policy, Assessing the Impact of Crisis Intervention Teams.

¹⁸ Center for Police Research and Policy, Assessing the Impact of Co-Responder Teams Programs.

¹⁹ Ashley Krider, Regina Huerter, Kirby Gaherty, and Andrew Moore, January 2020, Responding to Individuals in Behavioral Health Crisis Via Co-Responder Models: The Roles of Cities, Counties, Law Enforcement, and Providers, Policy Research, Inc., National League of Cities, retrieved from https://www.prainc.com/wp-content/uploads/2020/03/RespondingtoBHCrisisviaCRModels.pdf.

²⁰ Center for Police Research and Policy, Assessing the Impact of Co-Responder Teams Programs.

²¹ Center for Police Research and Policy, Assessing the Impact of Crisis Intervention Teams.

²² Center for Police Research and Policy, Assessing the Impact of Crisis Intervention Teams.

²³ Amy C. Watson, Victor C. Ottati, Melissa Morabito, Jeffrey Draine, Amy N. Kerr, and Beth Angell, 2010, "Outcomes of Police Contacts with Persons with Mental Illness: The Impact of CIT," Administration and Policy in Mental Health and Mental Health Services Research 37(4): 302–317.

²⁴ Center for Police Research and Policy, Assessing the Impact of Crisis Intervention Teams.

²⁵ Center for Police Research and Policy, Assessing the Impact of Crisis Intervention Teams.

²⁶ G. K. Shaprio, A. Cusi, M. Kirst, P. O’Campo, A. Nakhost, V. Stergiopoulos, “Co-Responding Police-Mental Health Programs: A Review,” Administration and Policy in Mental Health and Mental Health Services Research, 42(5): 606–620.

²⁷ Center for Police Research and Policy, Assessing the Impact of Co-Responder Teams Programs.

²⁸ Center for Police Research and Policy, Assessing the Impact of Co-Responder Teams Programs; Shapiro et al., “Co-Responding Police-Mental Health Programs: A Review.”

²⁹ Center for Police Research and Policy, March 2021, Assessing the Impact of Mobile Crisis Teams: A Review of Research, Cincinnati, OH: University of Cincinnati, retrieved from https://www.informedpoliceresponses.com/_files/ugd/313296_8d01cdc7187a489893197f2d07300ee6.pdf.

³⁰Center for Police Research and Policy, March 2021, Law Enforcement-Based Case Management Services: A Review of Research, Cincinnati, OH: University of Cincinnati, retrieved from https://www.informedpoliceresponses.com/_files/ugd/313296_1f6fa5d6933b4feea1bd8ce378e999b1.pdf.

³¹ The Council of State Governments Justice Center, December 2019, How to Reduce Repeat Encounters: A Brief for Law Enforcement Executives, Council of State Governments Justice Center, retrieved from https://csgjusticecenter.org/wp-content/uploads/2020/01/JC_How-to-Reduce-Repeat-Encounters_TwoPager8JAN20508compliant.pdf.

³² Center for Police Research and Policy, Assessing the Impact of Mobile Crisis Teams.

³³ Center for Police Research and Policy, Law Enforcement-Based Case Management Services.

³⁴ Center for Police Research and Policy, Assessing the Impact of Mobile Crisis Teams.

³⁵ Center for Police Research and Policy, Law Enforcement-Based Case Management Services.

³⁶ LEAD National Support Bureau, n.d., “What is LEAD?” accessed May 21, 2023 from https://www.leadbureau.org//.

³⁷ Center for Police Research and Policy, March 2021, Assessing the Impact of Law Enforcement Assisted Diversion (LEAD): A Review of Research, Cincinnati, OH: University of Cincinnati, retrieved from https://www.informedpoliceresponses.com/_files/ugd/313296_3fe253651ac5403bb85d85550a9149fc.pdf.

³⁸ Robin S. Engel, Robert E. Worden, Nicholas Corsaro, Hannah D. McManus, Danielle Reynolds, Hannah Cochran, Gabrielle T. Isaza, and Jennifer Calnon Cherkauskas, 2019, The Power to Arrest: Lessons from Research, SpringBriefs in Translational Criminology.

³⁹ Center for Police Research and Policy, Assessing the Impact of Law Enforcement Assisted Diversion (LEAD).

⁴⁰ Center for Police Research and Policy, June 2021, Assessing the Impact of EMS and Ambulance-Based Responses: A Review of Research, Cincinnati, OH: University of Cincinnati, retrieved from https://www.informedpoliceresponses.com/_files/ugd/313296_6b9bf4a2e40846d8ac5cf7335527f7f0.pdf.

⁴¹ Center for Police Research and Policy, Assessing the Impact of Law Enforcement Assisted Diversion (LEAD).

⁴² Center for Police Research and Policy, Assessing the Impact of EMS and Ambulance-Based Responses.

⁴³ Janet M. Coffman, Lisel Blash, and Ginachukwu Amah, January 27, 2020, Update of Evaluation of California’s Community Paramedicine Pilot Program, Healthforce Center and Philip R. Lee Institute for Health Policy Studies at UC San Francisco.

⁴⁴ Center for Police Research and Policy, Assessing the Impact of EMS and Ambulance-Based Responses; Coffman et al., Update of Evaluation of California’s Community Paramedicine Pilot Program.

⁴⁵ Kevin E. Mackey and Chichen Qiu, 2019, "Can Mobile Integrated Health Care Paramedics Safely Conduct Medical Clearance of Behavioral Health Patients in a Pilot Project? A Report of the First 1000 Consecutive Encounters," Prehospital Emergency Care 23(1): 22–31.

⁴⁶ Center for Police Research and Policy, Assessing the Impact of EMS and Ambulance-Based Responses.

⁴⁷ Center for Police Research and Policy, Assessing the Impact of Law Enforcement Assisted Diversion (LEAD).

Knowledge Lab Responses to People with Mental Health Conditions

Improved safety for all

Increased access to mental healthcare

Diversion from the criminal justice system

Reduced costs

Crisis Intervention Team (CIT)

Co-Responder Team

Mobile Crisis Team

Law Enforcement-Based Case Management Services

Law Enforcement Assisted Diversion (LEAD)

EMS and Ambulance-Based Responses

Additional Resources on Responses to People with Mental Health Conditions

Law Enforcement-Mental Health Learning Sites

CSG Justice Center Police-Mental Health Collaboration Self-Assessment Tool

SAMHSA (2020) National Guidelines for Behavioral Health Crisis Care Best Practice Toolkit

The Council of State Governments (CSG) Justice Center (2019) Police-Mental Health Collaborations: A Framework for Implementing Effective Law Enforcement Responses for People Who Have Mental Health Needs

National Alliance on Mental Illness (NAMI) Divert to What? Community Services That Enhance Diversion

Stepping Up Initiative: Discover Local Strategies

Partners

Questions?