As a situation spirals out of control, bystanders grow nervous and call police while a person yells, makes demands and appears ready to turn violent. That moment can determine whether someone receives treatment or enters the criminal justice system.
This scene presents a familiar crossroads: “the clinical track” toward support and healing, or “the carceral track” toward a jail cell, or, for some, death.
Eleanor Bumpurs, Deborah Danner, Daniel Prude, and Tanisha Anderson are names tied to a bleak history: individuals failed by the mental health and justice systems. Although the clinical track is a road to healing, the financial burden is too great for many. This leaves the carceral track, a road marked by the criminalization of people who struggle to care for themselves.
Experts argue that the current crisis response lacks a unified structure. Shannon Scully, director, justice policy & initiatives at the National Alliance on Mental Illness (NAMI), said a robust crisis response system requires three elements.
The Substance Abuse and Mental Health Services Administration (SAMHSA) refers to the three elements of crisis care, “which is someone to call, a safe place for help, and then someone to respond,” said Scully. These pillars create a personal and compassionate handoff between law enforcement and mental health care providers.
The risk for an individual to fall into the carceral track can happen at any point on their journey. “The answer is it [falling into the carceral track] can happen anywhere in that process or within those systems. It can happen from first contact with law enforcement. It can come from a call to 9-1-1 or even a call over to 988,” said Emily Ribnik, director of the Criminal Justice Coordinating Center of Excellence.
This highlights the need for off-ramps to the clinical track throughout the process to divert individuals from the criminal justice system. States across the country have been working to establish solutions that make the mental health treatment track more accessible to people in need.
Two paths to care
States are implementing two broad models: police-based and non-police-based. Police-based initiatives provide training to help officers better identify and respond to people in crisis. Crisis Intervention Team, or CIT, used in Ohio, includes about 40 hours of training focused on mental health response.
Non-police-based programming like the Support Team Assisted Response Program, or STAR, in Denver, dispatches mental health practitioners and paramedics or EMTs to calls, prioritizing de-escalation and the connection to mental health services.
Similar approaches are already taking shape in Cleveland. The city has tested a CARE response pilot program designed to send trained responders, rather than police, to certain nonviolent mental health calls. The goal mirrors programs like Denver’s initiative: de-escalate situations and connect individuals to care without involving the criminal justice system.
Cleveland Division of Police (CDP) officers continue to receive annual CIT training, which focuses on recognizing signs of mental illness and safely responding to individuals in crisis. Advocates say these efforts represent progress, but gaps remain in funding, staffing and access to treatment.
Ribnik said that though methods vary, the intent is the same. “The reality is that no matter what system you’re in, behavioral health, mental health, developmental disabilities, criminal justice, emergency medicine, law enforcement, we all want safer communities,” she said.
“We all want our community members to feel safe and able to live the best version of their lives. So that’s ultimately the same goal. Now, all of those systems approach that goal very differently,” Ribnik added.
Integrating these divergent approaches into a cohesive “off-ramp” is where the work of systemic change begins.
A path forward
While more people struggling with mental health may be reaching the clinical track, experts argue that more is required to maintain it. Despite established programs and research suggesting positive outcomes, policy change remains incomplete.
While the path to rectification is clear, a large rift between knowledge and action remains. “We know what the problems are. We know what the solutions are,” said Luke Russell, executive director of NAMI’s Ohio CIT program.
“[The programs] cost money, appropriately so. Everyone involved should be appropriately compensated. And those also need to be funded and supported because the more robust those resources are, the more available those resources are, the hope is that the fewer people we’re going to see then move on to the justice piece,” said Ribnik. Her comment suggests the challenge isn’t a lack of ideas, but a lack of funding.
The goal is to shift funding from jails to preventative care. The challenge now is sustained monetary investment and a system that outlasts the initial crisis, creating long-term stability.
This article is the first in a three-part series exploring how crisis response models work, what the data shows about their effectiveness and what a more sustainable system could look like.
Jennifer Bailey is a licensed clinical social worker and registered drama therapist
