29 Jun Shelterforce: Crisis Response Practices That Help Avert Police Calls
The May 2020 murder of George Floyd by Minneapolis police officers galvanized anti-police-violence protesters across the U.S. In the aftermath, many cities and grassroots groups have sought changes, with calls to defund the police and to create and support crisis response methods that cut the chances of unnecessary arrests and police-instigated injuries or fatalities.
Alternative crisis response efforts take varied forms: Some seek to avoid police altogether, others aim to improve police culture with mental health training, still others dispatch mental health experts in concert with police.
For agencies that serve vulnerable populations, practices to avoid unnecessary police action include instilling a de-escalation mindset and cultivating internal crisis teams to handle onsite incidents as unarmed first responders.
Shelterforce explored crisis response practices and checked in with affordable and supportive housing organizations around the U.S. on how they strive to handle incidents at their properties safely.
Avoiding Police Altogether
With growing urgency to bypass police altogether, advocates have created or publicized a variety of guides and resources to non-police response options, as in this 2021 round-up from Vox.
The volunteer-run, donation-funded dontcallthepolice.com, launched in June 2020, has assembled a growing set of community-based alternatives to calling police or 911 “when faced with a situation that requires de-escalation and/or intervention, not violence.” Its database now includes more than 80 cities in the U.S. and Canada.
In Oakland, community ambassadors walk the streets of the city’s Chinatown and serve as eyes, ears, and bodies in an era of increasing anti-Asian hate crimes and low trust in police.
CAHOOTS: A Longstanding Police-Clinic Partnership
An oft-cited national model for effective crisis response is Eugene, Oregon’s CAHOOTS (Crisis Assistance Helping Out On The Streets) program, formed more than 30 years ago as a partnership between a counter-culture clinic’s emergency response team and the Eugene Police Department. The program sends a medic and a crisis worker with mental health experience to handle a range of non-criminal situations, such as homelessness, intoxication, substance abuse, and mental illness problems, and even dispute resolution.
CAHOOTS is funded by the city through the police department and responders are dispatched through the police non-emergency number. Police will still respond, though, when there is violence or a crime in progress.
Awareness and Crisis-Intervention Training for Police
Another longstanding program is the Eleventh Judicial Circuit Criminal Mental Health Project (CMHP) launched in 2000 in Miami-Dade County as an effort to divert people with co-occurring substance use and mental illness away from incarceration and into treatment and support services.
A major piece of the initiative is crisis intervention team (CIT) training for local police. Following the nationally known Memphis Model, more than 7,000 police officers in the city of Miami and Miami-Dade police departments have been trained to recognize the signs and symptoms of mental illnesses and to respond appropriately to individuals in crisis.
Steve Leifman, associate administrative judge of the Miami-Dade County Court and mastermind of the CMHP initiative, says the program has been “successful beyond our wildest dreams.” He notes that between 2010 and 2019, the average daily jail population dropped by 39 percent. The Eleventh Judicial Circuit estimates that CMHP prevents nearly 4,000 jail bookings annually of people with serious mental illnesses.
“We’ve seen a huge culture shift. Now you’re a cool cop if you get hit by someone with mental illness and you don’t arrest,” Leifman says.
Judge Leifman’s team also came to understand the prevalence of PTSD among police officers—potentially playing a role in high rates of suicide, domestic violence, substance use, and divorce—and arranged for them to get treatment outside their own departments to avoid stigma.
CIT training also is delivered to 911 call-takers and staff at community provider agencies, and in Leifman’s court, staff from judges to bailiffs have been trained in Mental Health First Aid.
Still, CMHP is fundamentally a police-focused program. Plans are in the works to add non-police responders for mental health calls. Leifman says the models they’ve been studying for this evolution include crisis response and call-diversion programs in Denver, Houston, and Dallas, as well as CAHOOTS.
The National Alliance on Mental Illness (NAMI) provides a list of resources for implementing CIT and police mental health programs.
What Can Housing Agencies Do to Respond to Onsite Crises Safely?
For affordable or supportive housing providers, onsite emergencies require rapid judgments on whether to call police, decisions that can affect not only the safety of the individuals in crisis, but that of other residents and staff. Shelterforce spoke with housing organizations that have found ways to de-escalate situations with internal staff or community providers and in some cases obviating the need to call the police.
Supportive Housing with an In-House Crisis Response Team
Rita Chapdelaine is senior director of behavioral health at Boston’s Pine Street Inn, which operates some 900 units of permanent supportive housing at small and large sites across the city in addition to its longstanding emergency shelter. She describes a multifaceted approach to responding to behavioral health crises at Pine Street’s properties.
“We train all of our staff in de-escalation techniques—from direct care staff like case managers to people who serve meals in the shelter, all the way up to leadership level,” she says. “It’s teaching people how to manage a situation that’s escalating, how to give people a way out, a way to calm down, to separate themselves from the situation.”
Secondly, Chapdelaine says, the organization has a robust housing stabilization team. In addition to offering ongoing health and well-being support groups and recovery coaching, its mobile crisis unit of clinicians and a recovery coach can respond to crises 24/7. “That staff is working around the clock to make sure people are safe. We have a baseline on every resident. We can see if there’s a change.”
Residents in crisis sometimes opt out of receiving help, she notes. “They can say ‘I don’t want to talk to someone right now.’ And then we have to tell them that if this escalates, we’ll have to call 911 or BEST [Boston Emergency Services Team, led by Boston Medical Center], which we call if someone needs hospitalization but isn’t putting anyone immediately in danger. So we give them options. We try to leave it open, because we don’t want to scare the resident or have them feel that their housing might be at risk if they say no.”
She adds, “Sometimes we can’t avoid calling 911. But in those instances, we meet the police there to ensure we can update them, let them know we’re familiar with and working with this person, make sure the encounter is as positive as it can be.”
Public Housing that Hires External Providers
At Seattle Housing Authority (SHA), which serves 37,000 people through federal subsidy vouchers and brick-and-mortar public housing developments, a corps of external providers serves as a first level of response.
“Our effort has been to have contracted providers that show up onsite when a resident is in crisis, find out the trigger for the crisis, and then work to de-escalate the situation,” says Rachael Steward, deputy director of SHA’s department of housing operations.
The providers are behavioral health professionals—mental health providers, care coordinators, nurses, social workers, case managers—who can offer some onsite assistance and connect residents to other resources appropriate for their situation.
SHA staff are trained in de-escalation techniques and “motivational interviewing,” a conversation technique in which they encourage residents in need to reflect on action they can take to help themselves.
“For example, someone with substance use disorder might say, ‘I’m drinking myself to death. I don’t want that to happen anymore,’” Steward says, “and staff might respond, ‘Who do you think can help you with that? How can I show up for you?’ You have conversation that encourages but doesn’t strip responsibility from the person while offering support.”
Staff also can seek help from the Seattle Fire Department’s Health One unit, launched in 2019, which dispatches a case manager from the city’s department of human services along with two firefighters who can respond to medical emergencies.
SHA is one of the housing authorities participating in HUD’s “Moving to Work” program. The designation allows greater flexibility to use federal funds for innovative practices, and that has helped SHA fund its crisis response and case management.
There are some limitations. At this point, the contracted mental health providers are available only during business hours. And the pandemic has disrupted some momentum. “Up until 2020, we had 100 percent of our staff trained in trauma-informed practices,” Steward says, “but we’ve had a lot of turnover. We’re now working to build that back up, and to build internal capacity for train-the-trainer sessions, so we can have more institutional knowledge.”
A Mental Health Clinic Knows and Serves its Supportive Housing Residents
In Miami Beach, the Douglas Gardens Community Mental Health Center offers permanent supportive housing near the clinic to 42 residents who have been through the health center’s continuum of care. The residence building has 24/7 tenant support staff at the front desk who know the residents and can contact clinicians when needed. But in addition to that, the clinic has regular interactions that keep them constantly aware of residents and their needs.
“We have case managers, psychiatric providers, and employment, substance use, and domestic violence counseling,” says Eleanor Lanser, CEO of Douglas Gardens. “We have weekly tenant support meetings with the assigned case manager present to observe and provide intervention when indicated. A shift report is completed three times a day and sent to the clinical staff to assist in any areas that indicate a need for intervention. All staff at the residence are trained in verbal de-escalation, and peer support staff at the residence provides another set of eyes and ears to lend support.”
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If a resident has a crisis during the clinic’s work hours, they can be screened promptly by a case manager or physician. After hours, Lanser says, staff members call a 24-hour hotline to reach a mobile crisis team from an external community health center. “They come with a van, a mobile crisis team with peer support,” Lanser says. “That team could do a Baker Act—evaluate to determine if an individual needs a higher level of care and must be hospitalized, like if they’re placing themselves or others at risk of harm.”
And lastly, they do at times call police. Thanks to the CMHP program, they know to request a CIT officer. “We do have a long-standing relationship with the police. We request a CIT officer. They know how to de-escalate verbally. So if we call the police, if someone is acting erratically, if we’re not sure if it’s psychiatric or drug- or alcohol-related, we can call the police, and we do.”
A Homelessness Agency Assembles an In-House Safety Team
Metro Housing Boston works to address homelessness through a range of services, including administering housing vouchers and providing emergency housing assistance, case management, and mediation services. While the organization doesn’t operate its own housing, its 250-person office in Boston’s Mission Hill neighborhood serves people walking in with many and varied needs.
Whether arriving for a case manager meeting, seeking emergency assistance after fleeing a domestic violence situation, or coming in off the street desperate for housing, “they can be upset,” says Felisha Marshall, Metro Housing’s director of housing supports. Incidents have occurred, for example, with people who’ve gone off the medication that helps them deal with past trauma. Other times, they may be anxious, stressed, or disgruntled.
Metro Housing has assembled a large and broad in-house safety team comprising not only behavioral health professionals, but other types of staff members who have volunteered for the role and have been trained in trauma-informed care and de-escalation methods. The safety team serves as a first and gentle response to incidents or signs of distress that front desk staff can’t resolve. Marshall explains that a sort of “panic button” system instantly brings dozens of staff members to the lobby from upper floors.
“Everyone arrives, and then we can say how many people need to stay. If we see the person needs additional support and no one is in immediate danger, and we can’t get them to engage, we can contact their medical team—their care navigators,” she says. “The sheer presence of the number of people in the safety team has helped. The individual sees all those people and realizes, ‘I don’t need this much help, I don’t need this much attention, I don’t want to have to leave’—and they calm themselves.”
If the person has an untreated or undiagnosed mental health condition, the intervention might go on for some time, Marshall notes. “One of the safety team members takes the lead and engages the person in conversation. They start with something like ‘I understand you’re upset. How can I help?’” she says. “And if that’s going well, then some of the safety team begins to depart.”
If the person in crisis is not in one of Metro Housing’s programs, staff calls on local emergency systems like BEST [the Boston Emergency Services Team led by Boston Medical Center] and other community services. And finally, if someone needs further stabilization, there’s an 800 number they can call for resources for a psychiatric evaluation or short-term beds, she says.
Effective as the in-house safety team is, it can’t resolve all incidents. “When we can’t de-escalate, and our own safety is at risk, we call 911,” Marshall notes.
This unusual multi-specialty, non-uniformed safety team was designed both to appear non-threatening and to be a large enough presence to convey a capacity to control the situation.
“We wanted to not give the stigma that we’re afraid of the population we serve. We didn’t want a first impression of uniformed security guards,” says Marshall. “We wanted to have the skills needed to address problems without having someone end up going to jail. It was a conscious decision to see how we can provide safety for ourselves and serve our clients.”
Sometimes Police are the Desired Response
While housing operators clearly have good reasons to sharpen practices that cut down on unnecessary police action, it’s not a cut-and-dried issue or a simple one-way movement (in fact, there’s something of an opposing trend: “Crime-free housing” programs across the U.S. intensify the presence of police at rental units, encouraging landlords and police to share information about resident activity and often set the stage for increased evictions).
Even for those housing agencies genuinely focused on effective onsite de-escalation, appropriate police involvement is still desired and appreciated—and at times lacking.
“On a regular day, we rely heavily on the police and consider them to be a partner,” says Pine Street Inn’s Chapdelaine. “They accompany our outreach team that engages with homeless individuals across the city day and night. There are some areas we won’t go to at night without police presence. The relationship is strong. I wouldn’t want to be without them when there are situations that can’t be resolved by a social worker.”
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Chapdelaine notes that since the Boston police decided in 2021 to pull back on handling Section 12 requests—which under Massachusetts law allow for transporting an unwilling person to the hospital for mental health treatment—the burden on shelters and homeless outreach teams is heavier (though the police department’s protocol change was generally lauded by mental health advocates).
“Now the police won’t take people who won’t go voluntarily. It has hampered our efforts to hospitalize people who need it,” Chapdelaine says. “We hate calling for Section 12, but for the safety of our tenants and others, we do have to do it. We are working to manage the risk to our clients and our staff when we make these decisions.”
In Seattle, Steward laments the loss of a community policing team that previously operated within public housing sites.
“We formerly had a contract with SPD for onsite community police officers. In 2020, they terminated that contract, because they experienced a shift in call to action for their department, as well as attrition,” Steward says.
She adds, “I did surveys of resident, staff, and partners to learn their perceptions of the community police team. By and large, it was seen as the ideal policing group. They had relationships with residents; they knew them. Residents could talk with them, ask for help. Those officers could let us know what we needed to pay attention to. It was a different partnership than the general public experiences with police. Folks may have felt [negatively] about the precinct police in the neighborhood, but pulling back was not what our residents or staff were seeking.”
Housers’ Tips on Successful Crisis Intervention Practices
The leaders who spoke to Shelterforce shared some advice for others looking to create or improve onsite crisis response.
Having a designated response team is crucial, says Metro Housing’s Marshall. “Knowing who’s going to respond and that they’re trained to de-escalate [and] to understand trauma is important. Not everyone at Metro Housing has that training, but we’ve made sure this core set of individuals has it.”
In addition, says Marshall, instill a core belief that the first step is to try to de-escalate. “So it’s about establishing teams and establishing norms. And then, having a list of who [on the outside] is available to respond in each community you serve—and making sure everyone on the team has that information so it’s easy to make those calls.”
Chapdelaine says a key to her team’s success is having the clinical staff build relationships with people before crises occur. “It’s much easier to build those relationships when people are moving in, so when they’re in a jam, we can check in and say ‘Remember me? How are you doing? If you need something, I can help.’”
Pine Street Inn’s housing stabilization team offers training to staff on stigma, substance use, and what success looks like in a permanent supportive housing model. “It’s important to be clear with staff on how to set boundaries and how to support people, and to set expectations about housing first and what it looks like in practice,” Chapdelaine says. “One thing we see is, if someone is going through a crisis, a staff member thinks it’s maybe because of something they did or didn’t do. It’s really hard to work in a housing first program if you’re expecting everybody to be OK all the time.”
One of the notable features of Pine Street’s in-house crisis response capability is that the organization is doing it even though the costs are not reimbursed by insurance. “We are trying to get it paid for by insurance,” Chapdelaine says, “but in the meantime, I think our very high housing retention rate is due to the presence of this team.”
In public housing, where the landlord isn’t responsible for providing wraparound social supports and health services, one way to ward off potentially dangerous police calls is to cultivate a cohesive community.
“It’s very important that neighbors have relationships with one another,” Steward says. “Similarly, staff members need to be trained to foster good relationships among neighbors. Oftentimes 911 is called by a neighbor, and what they communicate sets the tone for what happens when responders show up.”
At Seattle Housing Authority, she says, “We have a position called community builder. They develop community norms and feel and culture. In our high-rise buildings we host coffee hours, facilitate community meetings, support residents having barbeques and gardening. In our mixed-income developments, we have back-to-school bashes and host events to help people understand each other’s cultures. These things all promote people getting to know each other and valuing each other as neighbors. And that can really change the energy of a 911 call.”