Sending Health Care Workers instead of Cops Can Reduce Crime

In September 2020 Golda Barton’s 13-year-old autistic son became frantic with anxiety the first day she had to return to work after several months at home. His mother called 911 and asked for a crisis intervention team. When Salt Lake City police showed up, the boy ran. One of the officers chasing him shot him 11 times, leaving him in critical condition. According to the family’s GoFundMe page set up to cover the boy’s medical bills, in spring 2021 he had to undergo a complex nerve transplant surgery, one of a line of medical procedures and has endured intractable pain.

This is a “particularly shocking” example of what can happen when police officers are the first responders in a mental health crisis, write Stanford University researchers Thomas Dee and Jaymes Pyne in a study describing success with a different approach: sending out trained health care responders on these calls instead of cops.

Their findings, published on Wednesday in Science Advances, show that the “community response” tactic in a six-month pilot program in Denver led to a 34 percent decline in reports of less serious crimes targeted by the program and prevented almost 1,400 criminal offenses. For the budget-conscious, the results also suggest that the conventional approach of police-first response in these incidents costs four times as much as a community response approach.

“There may be a propitious opportunity because of the larger political context, and these types of reforms should be appealing across the spectrum,” says Dee, a senior fellow at the Stanford Institute for Economic Policy Research. “If your politics are ‘back the blue,’ you should be excited because many police say they don’t want to deal with the service calls being handled by community response.” Allowing police to focus on their training and competencies “might improve retention of the best police,” he adds.

“For those advocating defunding the police,” Dee says, “they should find a lot to like because it reduces the operational footprints of police in the community and creates a case for reducing police budgets.”

This type of program is a step toward actual solutions to the so-called revolving door associated with low-level offenses, says Alex Vitale, a professor of sociology at Brooklyn College and the Graduate Center, City University of New York, who was not involved in the research. “If we can actually stabilize people with a mental health condition, that’s going to reduce their involvement in other kinds of harmful behavior, and that’s good for everybody,” he says.

The Support Team Assistance Response (STAR) program in the Denver pilot is one of three types of reform-oriented programs intended for response to low-level offenses that may involve a mental health crisis. Two of the programs still involve police: one trains them in crisis intervention, and the other is a co-response model that partners cops with mental health professionals. The STAR program, which is modeled on an older program known as CAHOOTS (Crisis Assistance Helping Out on the Streets) that began in Eugene, Ore., sidesteps a police response altogether. STAR relies on a mobile crisis response van staffed by a mental health clinician and a paramedic, both trained specifically for the program.

During the six-month pilot, in eight Denver precincts, the STAR team responded to low-level calls related to incidents such as intoxication, well-being checks, or trespassing, as long as there was no evidence of weapons, threats or violence.

The team members responded to 748 incidents during that time. In about a third, police at the scene had requested their assistance. In the other two thirds, the STAR team participants were the first responders, and they did not have to call for police support in any of these cases.

Compared with rates of criminal offenses in the same precincts before the program was piloted and with those in precincts that did not use it during the same six-month period, the researchers estimate that there were 1,376 fewer low-level offenses during the pilot.

What didn’t change was the number of higher-level offenses. Some criminal justice experts have predicted a link between reductions in low-level crimes and lower rates of more serious offenses, known as the “broken windows” theory. During the pilot, using STAR in place of a conventional police response to low-level incidents was not associated with increases or reductions in more serious crimes.

“These types of community-response models that bring mental health professionals rather than the police to low-severity calls seem to work,” says Pyne, a research associate and sociologist at Stanford’s John W. Gardner Center for Youth and Their Communities. The results offer one of the first pieces of “credible, plausible evidence that gives us some confidence” that these programs are effective.

Expenditures for providing help may also drop when health workers show up instead of police. Dee and Pyne estimated that the $208,141 program cost Denver about $151 for each incident. In contrast, if the people involved were funneled through the criminal justice system, the estimated cost would be $646 per person, more than four times higher.

“It turns out that the non-police-centered strategies not only are better at reducing crime; they are less expensive, and they don’t come with the negative lateral consequences associated with policing,” Vitale says. Potential lateral consequences of police at a scene include expensive hospital visits and incarceration. “Typically, police don’t have as much ability to resolve these problems in the field,” Vitale adds, “so their options are limited to emergency rooms and arrests, both of which are extremely expensive and not associated with good outcomes for the people subjected to them.”

As Dee points out, though, “It’s not just cost-effective. It’s humane to provide people in health care distress with health care.”

Denver officials are taken enough with the outcomes to ramp up funding for STAR, Vitale says. The co-response model, Pyne adds, is undergoing more formal piloting and testing in San Mateo County, California, where cities with and without the program are being compared.

“It’s going to be important to see whether this model works at scale in Denver and if other cities will be able to replicate this success,” Dee says. “But the message today is that there is extraordinary promise in these sorts of innovations.”