This article was originally published by Bloomberg News on October 19, 2022.
A Chicago pilot program that dispatches mental health clinicians and emergency medical responders to some 911 calls has connected 385 people to care without a single use-of-force incident or arrest in its first year — a promising start for a program designed to reduce potentially dangerous interactions with police.
It’s also been a slow start: Crisis Assistance Response and Engagement (CARE) teams operate just six hours a day, five days a week — and only in four of Chicago’s 22 police districts. Those districts have together logged almost 3,400 mental health disturbance calls since their respective pilots started through Sept. 25 of this year, the most recent date for which CARE data is available. Not all mental health disturbance calls are eligible for a CARE response, and the program’s teams are sometimes looped into situations with a mental health component that aren’t tagged as such in the 911 system — but based on the main pool of calls to which CARE teams might be dispatched, they’ve captured about 11% of Chicagoans’ expressly labeled need in the pilot districts.
The pilot has scaled up over the past year, with more calls answered in August than the first four months combined. And in year two, the city says it plans to expand the program’s hours of operation and reevaluate limits on the types of calls CARE teams can answer. But local legislators and community organizers say the city isn’t moving fast enough, and some argue that the program is still too reliant on police. They’re calling for Chicago to take a more holistic approach to mental health.
“We knew one of our greatest challenges at the beginning of this was going to be managing people’s expectations,” said Matt Richards, Chicago’s deputy commissioner of behavioral health. “Our approach has been very deliberate precisely because we want this program to stick around, but we understand the sense of urgency.”
Models With and Without the Police
Chicago is piloting two models of its mental health 911 response, which is separate from the city’s 211 service for non-emergency crises: one that includes a crisis intervention-trained police officer alongside a paramedic and mental health clinician, and one that doesn’t involve police at all. The first program launched across two police districts in September 2021; the second was launched in June on the city’s southwest side after repeated criticism from advocates of the law enforcement presence in the original model. (The city’s department of public health also plans to ask for state approval of a third model, focused on substance use, that includes a peer mentor.)
The dual design, Richards said, removes police from situations where they aren’t necessary but ensures that CARE teams are able to respond to calls that involve some measure of danger. CARE teams don’t respond to crimes in progress, situations involving weapons, or “demonstrated safety risks,” Richards said — a recommendation from the Texas-based Meadows Mental Health Policy Institute, which has advised Chicago on its police-involved model.
Having police involved means CARE teams can respond to some acute crises, said B.J. Wagner, senior president of health and public safety at the Meadows Institute. Wagner, who has worked with Chicago on its program and calls it “the most advanced multidisciplinary response in the country,” said those situations can include a person displaying behavior that is “unusual” or “volatile” to the 911 caller. She acknowledged potential bias in that system and that police may be dispatched to calls where they aren’t needed, but underscored that without the police-involved team, the city’s mental health response would be inequitable — essentially telling residents, as she put it, that “if you create a public safety risk with your mental health care needs, we’re just going to send the cops” with no additional support.
“I really want our officers to be focused on what is their comparative advantage, which is taking on violent crime.”
But advocates pushing for the end of the police-involved pilot say the presence of law enforcement on CARE teams doesn’t make anyone safer. Around 1 in 5 people fatally shot by police have a mental illness, according to a Washington Post database — and in Chicago, Alderman Rossana Rodriguez-Sanchez highlighted the lack of arrests or use of force in CARE’s first year as evidence that police involvement is “overkill.”
She also pointed to the apparent death by suicide of Army veteran Irene Chavez while in police custody late last year as an example of the Chicago Police Department’s inadequate response to mental health crises, which is one of the main subjects of a court-mandated federal consent decree implemented in 2019. After an alleged confrontation outside a South Shore bar, Chavez repeatedly said she needed a therapist and tried to get the attention of the arresting officers while handcuffed in a holding cell, according to a lawsuit filed on her behalf. She was found dead 45 minutes later.
“We have many social work professionals who respond and do home visits and tend to crisis calls,” said Arturo Carrillo, the leader of a coalition of mental health professionals and advocates called the Collaborative for Community Wellness. “No one considers having them accompanied to every house visit with a police officer independent of the crisis that they’re dealing with.”
Small Scale
Carrillo added that police can always be called for backup — as is the practice in Eugene, Oregon, which started responding to mental health-related calls with medics and crisis workers three decades ago. That program, CAHOOTS, handles nearly 20% of the city’s total 911 call volume — and response teams need police backup just 1% of the time.
Many other US cities began exploring similar programs after Black Lives Matter protests swept the country in summer 2020 following the police killings of George Floyd and Breonna Taylor. Those pilots are in varying stages: Chicago, for its part, has three CARE teams on standby from 10:30 a.m. to 4 p.m., five days a week — capturing about half of the 10 a.m. — 10 p.m. time frame with the highest volume of mental-health-related 911 calls, Richards said. (CARE teams make contact with the person in crisis around two-thirds of the time, with the person having left or another team having already responded in the remaining third of calls.)
Richards said the city wants to add a second shift in year two. And the ultimate goal, Deputy Mayor for Public Safety Elena Gottreich told aldermen in August, is 24/7 citywide service. But Gottreich declined to specify the timeline, saying that other cities took years to scale their programs.
New York City started its B-HEARD program in Upper Manhattan last June, piloting response teams with one mental health professional and two EMTs — and no police — 16 hours a day, seven days a week. It responded to 20% of eligible calls in the first month, according to data published by the city, but that rate has since dropped to 16% for January through March of this year — roughly on par with Chicago’s numbers during that time period.
Response rates are much higher in San Francisco, where Street Crisis Response Teams scaled from just eight hours a day in the Tenderloin neighborhood to a round-the-clock citywide response in one year, with an overall response rate of 38% of all 911 calls for “mentally disturbed persons.” In July, teams answered 78% of eligible calls.
Limited Funding
New York Mayor Eric Adams has poured $55 million into the city’s program; San Francisco’s SCRT has a $13 million annual budget funded by a city business tax. Chicago allocated $3.5 million to CARE in its 2022 budget — enough to fund one year of operations at the current scale — and set aside $15 million in the Chicago Recovery Plan, which leverages federal stimulus dollars and anticipated money from an upcoming bond sale. Lightfoot did not include a separate line item for CARE in her 2023 budget proposal.
Advocates say that $15 million is needed for 2023 alone to fund a citywide expansion of the alternative response model and turn at least three of Chicago’s five city-run mental health clinics into round-the-clock treatment centers. The money, Rodriguez-Sanchez said, could come from moving 200 vacancies off the police department’s payroll, which budgeted almost $130 million for unfilled positions as of February as the department has struggled to recruit and retain officers.
An expanded CARE pilot would also benefit the police department — and its budget — by lightening law enforcement’s workload, advocates and aldermen say. (The Chicago Police Department did not respond to a request for comment.)
“I really want our officers to be focused on what is their comparative advantage, which is taking on violent crime,” said Alderman Daniel La Spata at an August budget committee meeting. “So anything else that can be competently and relevantly and compassionately addressed by other city professionals feels like something to be working on.”
Wraparound Vision
Mental health funding has been a priority for Mayor Lori Lightfoot, who allocated $89 million in her 2022 budget — up from $12 million when she entered office in 2019 — and expects to have a community mental health clinic in all 77 Chicago community areas by the end of this year. Those investments increased the number of Chicagoans served from 3,651 to around 60,000 over the course of her tenure.
But a sticking point for advocates is the mayor’s unfulfilled campaign promise to reopen shuttered city-run mental health clinics, which have fallen victim to budget shortfalls and dwindled in number from 19 to just five. And when the five that do remain close their doors for the night, advocates say, law enforcement typically takes people in crisis to emergency rooms that aren’t equipped for their care.
“We definitely agree that there’s a need for crisis stabilization alternatives other than emergency departments,” Richards said — ones that won’t turn anyone away because of their immigration status or ability to pay. The Department of Public Health doesn’t immediately plan to reopen closed clinics or expand any of the remaining ones to 24/7 service, he said, but has money set aside for other settings like low-barrier shelters. The CARE program already relies heavily on one of Chicago’s four state-run psychiatric living rooms, which are safe places to deescalate and rest with support from peer counselors, as a destination for people requiring transport from a scene.
CARE counselors also follow up with people one, seven and 30 days after the initial crisis — a good starting point, advocates say, but one that falls flat without wraparound services that view mental illness as a public health crisis rather than a public safety one.
“CARE’s response is only as good as the follow-up supports and care people receive,” Carrillo said.
