Considering Alternate Response Programs by Jamie Bradway

We cover a lot of mental health topics on the WELLness blog; enough that you might get the impression that emotional health is a pretty big deal that has a significant impact on a lot of people. It is. The stats on mental illness justify our focus on the subject: More than 20% of Americans experience mental illness and more than 5% of those are serious or debilitating. Over half of those do not receive any treatment for a variety of reasons. Missing from these numbers, by its very nature, is the percentage of the population that is completely undiagnosed and untreated. Especially concerning is the significantly lower percentage of men ages 18-44 that will seek support for mental health. I’m thinking of that gap of support today because young men also experience the highest level of interaction with law enforcement throughout the country. Many communities are grappling with that gap, trying to ensure their populations receive appropriate support and aren’t subject to emergency responses that too often end in violence. 

Members of the Raleigh Police Department were part of the inaugural Crisis Intervention Team (CIT) training in 2005. This effort encourages officers to connect individuals to treatment centers instead of jails when they can do so safely and to foster stronger connections with social work and mental health services. As of 2023, RPD had more than 400 officers trained in CIT methods. In 2020, Raleigh implemented the Addressing Crises through Outreach, Referrals, Networking, and Service (or ACORNS) unit that embeds social workers and counselors within the police department, assisting officers when there’s an indication of a need for mental health intervention. ACORNS was designed to forge stronger community partnerships for referrals for substance use or unhoused families.

Other communities around North America have developed models that establish this network of care outside the framework of law enforcement. An early program developed in Eugene, Oregon, (Crisis Assistance Helping Out On The Streets or CAHOOTS) pairs two-person teams composed of a medic (someone with a variety of medical training) and a crisis worker (trained in a mental health field) to respond directly to 911 calls. In over 24,000 CAHOOTS responses, police backup was only used 250 times. Locally, instead of a proposed increase of 72 police officers, community organizers in Durham advocated for a model similar to CAHOOTS and launched the Holistic Empathetic Assistance Response Teams (HEART) pilot program in 2022. The success of that program in its first year led to funding to expand from 20 employees to 50 last summer. They’re now staffing Community Response Teams (CRTs) from 9:15 am to 11:45 pm seven days a week and building connections with the community to support unhoused populations, those struggling with quality of life issues, and anyone experiencing a mental health crisis.

All of this to say, The City of Raleigh is now exploring the implementation of a similar program. The data from the early years of the ACORNS program reveal significant underutilization. Police officers remain the sole responders to suicide-related calls in nearly all cases, indicating enforcement is a higher priority than support. The City is conducting drop-in sessions around the city to educate and gather ideas from the community. You can view their presentation here [PDF] before you go to be prepared to ask questions. I’ll include resources below that provide a variety of viewpoints, as well. The link for this survey allows you to register for additional events and to provide your comments, questions, and opinions. The city’s deadline for gathering community comments is March 10, 2024. I hope you’ll be able to find some time to increase your awareness of the issue and help guide our community in better serving the public, especially those needing additional support and care.

Resources:

“Policing the Mentally Ill,” NeoGov, 2020. https://www.powerdms.com/policy-learning-center/policing-the-mentally-ill

Balfour, Stephenson, et al, “Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies,” Psychiatric Services, Vol. 73, Issue 6, June 2022. https://doi.org/10.1176/appi.ps.202000721

“Addressing Law Enforcement Violence as a Public Health Issue: Policy Number 201811,” American Public Health Association, 2018. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/29/law-enforcement-violence

Spolem, Watkins, et al, “Not Reform, But Alternatives: The Benefit of Alternative Response Programs,” Public Health Post, 2023. https://www.publichealthpost.org/viewpoints/not-reforms-but-alternatives-the-public-health-benefit-of-alternative-response-programs/

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_¹ “Mental Health by the Numbers,” National Alliance for Mental Health. https://www.nami.org/mhstats

_² “The State of Mental Health in America,” Mental Health America, 2021. https://mhanational.org/issues/state-mental-health-america

_³ “Statistics: Mental Illness,” National Institute of Mental Health, 2021.
https://www.nimh.nih.gov/health/statistics/mental-illness

_⁴ “What is CAHOOTS?” CAHOOTS Consulting, 2020. https://whitebirdclinic.org/what-is-cahoots/

_⁵ “HEART, Durham’s Non-Police Crisis Response Program, is No Longer Two Sizes Too Small,” IndyWeek, 2023
https://indyweek.com/news/durham/heart-durhams-non-police-crisis-response-program-is-no-longer-two-sizes-too-small/