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Calling the cops on someone with mental illness can go terribly wrong. Here’s a better idea.

What if we sent mental health experts instead of police?

A participant holding a “Defund the Police” sign at a protest in Brooklyn.
Erik McGregor/LightRocket via Getty Images
Sigal Samuel is a senior reporter for Vox’s Future Perfect and co-host of the Future Perfect podcast. She writes primarily about the future of consciousness, tracking advances in artificial intelligence and neuroscience and their staggering ethical implications. Before joining Vox, Sigal was the religion editor at the Atlantic.

We’ve seen it happen too many times. Someone calls 911 to report a disturbance next door or out in the street. The police show up. Things go awry, and the police shoot the person at the center of the disturbance — and it turns out that the person had a mental health issue.

In the US, at least one in four people killed by the police has a serious mental health problem. Stories of these police killings have been in the headlines for years, with anguished family members decrying officers’ violence toward their loved ones. Now, with protests over police brutality going strong across the country, and calls to defund the police becoming increasingly mainstream, many Americans feel there has to be a better way to handle 911 calls.

Some people say there is: Instead of sending police to deal with non-criminal emergencies, why not send mental health experts? And instead of pouring more money into police budgets, why not redirect funds to programs that would get those experts out on the streets?

Oakland, California, is the newest city to explore this approach, which has already been tried to good effect in Oregon and, farther afield, in Sweden.

Rebecca Kaplan, Oakland’s citywide council member, successfully advocated last year for $40,000 from the city budget to be spent on a study on how best to implement the Oregon model there. The study investigated questions like: What’s the best way to complement existing mental health services without competing against them? Where in Oakland do most 911 calls related to mental illness originate? In which neighborhoods does it make most sense to concentrate a pilot program?

This month, as the city council debated the budget for the coming year, that study was presented to a meeting of the Oakland Police Commission. Council members discussed the possibility of launching a pilot called MACRO (the Mobile Assistance Community Responders of Oakland). The goal is to launch the pilot next year with funding from the city budget, and although supporters are not yet sure what its size and duration will be, they’re hopeful it’ll make a big difference to Oakland’s overpoliced community of people without homes. They were among those who first called for a non-policing approach.

Other cities from Portland to New York are keeping a close eye on what happens in Oakland, because they’re also interested in potentially implementing this approach. If the model takes off nationwide, it could be an effective way to reduce needless suffering for millions of Americans who have mental illness.

The non-policing approach has been tried elsewhere — and it works

In 2015, Stockholm started test-driving an ambulance devoted entirely to mental health care. It looks like a regular ambulance on the outside, but instead of stretchers, it’s got cozy seats — perfect for a therapy session on wheels. Two mental health nurses and one paramedic travel on board. Most of the emergency cases they handle involve people at risk of suicide; sometimes, they involve people having a psychotic episode.

The idea is that making these experts available boosts the quality of care, avoids needless escalation by law enforcement, and minimizes the stigma attached to people with mental illness.

“It used to be the police who handled these kinds of calls,” Anki Björnsdotter, who works as a mental health nurse aboard the ambulance, told Vice. “But just the presence of the police can easily cause a patient to feel like they’ve done something wrong. Mental illness is nothing criminal so it doesn’t make sense to be picked up by the police.”

During its first year, the ambulance was requested 1,580 times and attended to 1,254 cases. That means the single vehicle was tasked with zipping all around Stockholm to handle 3.4 cases per day.

“It has been considered a huge success by police, nurses, healthcare officials, as well as by the patients,” said Fredrik Bengtsson, who’s in charge of mental health emergencies at Stockholm’s Sabbatsberg Hospital.

In Eugene, Oregon, the group handling such calls is called Cahoots (Crisis Assistance Helping Out on the Street). This nonprofit was founded by social activists way back in 1989, but it’s been garnering more attention in recent years as the police’s sometimes violent and even lethal treatment of people with mental illness has sparked a public outcry.

Cahoots handles non-criminal crises involving people who are homeless, disoriented, or intoxicated, have a mental illness, or are enmeshed in an escalating dispute. Here’s how the Wall Street Journal explained their work:

The program in Eugene is unique because Cahoots is wired into the 911 system and responds to most calls without police. The name Cahoots was intended to be a humorous nod to the fact that they are working closely with police. Cahoots now has 39 employees and costs the city around $800,000 a year plus its vehicles, a fraction of the police department’s $58 million annual budget. They are also paid to handle calls for neighboring Springfield.

“It allows police officers to … deal with crime, but it also allows us to offer a different service that is really needed,” said Lt. Ron Tinseth of the Eugene Police Department.

In contrast to police officers who typically seek to project authority at all times, Cahoots employees dress in black sweatshirts, listen to their police radios via earbuds, and speak in calm tones with inviting body language.

In 2017, Cahoots handled 17 percent of the police calls in Eugene, according to the Journal. “When I’m talking to a more liberal group of people, I’ll make the argument it’s the compassionate thing to do, it’s the humane thing to do,” said Manning Walker, a Cahoots medic. “When I’m talking to a conservative group, I’ll make the argument that it’s the fiscally conservative thing to do because it’s cheaper for us to do this than for the police and firefighters.”

Oakland plans to launch a pilot program inspired by Cahoots. It will see a mental health counselor and an EMT respond to some 911 calls instead of police.

Anne Janks from the Coalition for Police Accountability, an organization that advocates for constitutional and transparent policing in Oakland, told me she hasn’t encountered any critics of the plan to adopt the Cahoots model. “It’s actually been heartening for those of us who’ve been doing political organizing for a while — we’ve been joking that we’ve never worked on something before where everyone’s supporting it,” she said.

“The Cahoots program has proven successful in Eugene to treat those struggling with mental health issues with dignity and respect, and to direct them to services that are more appropriate than spending time in police custody,” said Kaplan, Oakland’s citywide council member. “I believe this is a good model to test in Oakland, and I look forward to sharing the results.”

Already, Cahoots is working with a number of cities — Olympia, Washington; Denver, Colorado; New York; Indianapolis, Indiana; Portland and Roseburg, Oregon — to see how they might be able to implement the non-policing model. With any luck, this approach, which is both more empathetic and more cost-effective, can help reduce suffering for millions of people.

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