Sometimes a mental health crisis team doesn’t need to respond to a crisis. Sometimes the crisis walks right up to them.
That’s what happened to Gabrielle Mitchell and her Crisis Assistance Response and Engagement (CARE) team in an encounter that turned into one of their most rewarding interactions of the year.
During a shift this summer, the clinical social worker and her crew were driving through Chicago’s South Side when they decided they wanted some coffee. As they pulled the bright blue van with the CARE logo into a McDonald’s near an expressway off-ramp they were approached by a young, visibly pregnant woman, who asked if they had any resources.
“She didn’t have a place to stay. She was trying to figure out if we could get her some housing, some food, anything,” Mitchell said.
The woman suffered from bipolar disorder and had recently lost the place she was living.
“We were able to get her a bunch of different resources. Most importantly, we were able to find her parents,” Mitchell said.
While far from typical, Mitchell considers the encounter with the unhoused woman a success. She worked with them voluntarily. They spent hours with her, chatting and winning her trust. They surprised her with gifts for the baby. Instead of the final destination being a hospital, it was her family’s home.
As part of standard CARE team follow-up, the team visited her two more times over the next month and even got to meet the newborn baby, Mitchell said. “Miraculously, this all happened within 30 days,” she said.
Mitchell and her team are part of a pilot program testing alternative ways to respond to mental health-related 911 calls, which would otherwise be handled by officers from the Chicago Police Department. She’s the mental health clinician on a three-member team that also includes a paramedic and a police officer trained in crisis intervention techniques.
Data suggest that the program, launched in September 2021, is having success assisting people in crisis – without resorting to force or making arrests. But the teams are handling only a tiny fraction of the mental health crisis calls that come through 911.
Two of these three-member teams operate in neighborhoods on the north and south sides of Chicago, which have some of the city’s highest rates of mental health-related calls to 911, according to data obtained by MindSite News.
A historic change
This past summer, the U.S. began an historic change in the way mental health crises are responded to. While lots of attention has been paid to the rollout of a new three-digit number – 988 – as the contact point for the National Suicide Prevention Lifeline, advocates see the line as just one piece of a multi-pronged effort to create a comprehensive crisis response system.
The second part of that effort is to create a way for people experiencing a significant mental health crisis – one that can’t be resolved by a trained phone counselor – to get on-the-ground help from trained mental health responders instead of police.
Chicago is trying out two different models and will evaluate how each performs. One model – the one Mitchell works with – uses a police officer, paramedic and mental health clinician. The other deploys a paramedic and clinician – without the police officer.
The three-member CARE teams that include a police officer began operating in September 2021, working 10 a.m. to 4 p.m. on weekdays and not at all on weekends . In that time, the CARE teams that include a police officer have responded to calls about 440 times – less than one call per shift, according to city data. The single no-police team that began operating in June 2022 on the city’s Southwest Side has responded to 59 calls in those six months.
Since the city’s 911 system receives nearly 193 mental health-related calls per day, according to data obtained by MindSite News, that means the CARE teams are handling less than 1% of mental health calls. All the rest are handled by police officers.
And what about use of force? From January 2020 through June 2022, officers responding to mental-health-related calls filed 147 tactical response reports, indicating some kind of force was used, according to data from the Office of Emergency Management and Communications (OEMC) and the Chicago Police Department. None of the crisis calls that CARE teams have gone out on have led to an arrest or use of force.
While the data CARE has collected to date show many positive outcomes, local community organizers question whether police should be involved at all in mental health-related crisis response. Although many states are deploying mental health crisis teams that don’t include police officers – including Oregon’s CAHOOTS, New York’s B-HEARD program, and San Francisco’s Street Crisis Response team – two of the three pilot teams in Chicago include a police officer trained in crisis intervention techniques and known as a CIT officer.
There’s a long history of Chicago police using force when responding to mental health calls. At least four times in the past eight years, such incidents resulted in fatal shootings by police officers, according to the Washington Post. Non-fatal force is used far more frequently, as the 147 use-of-force incidents documented by MindSite News shows. For this reason, many advocates are opposed to including law enforcement in mental health crisis teams – and worried that their inclusion will make Black residents, especially, hesitant to call for help when they need it.
“The CARE program is just furthering this narrative that police have to be a part of crisis response, otherwise it’s not viable,” said Cosette Ayele, a South Side resident and organizing director of Raheem, an Oakland, Calif.-based group of organizers and technologists pushing for non-police alternatives to crisis response. “I think the city hasn’t even given what the people have been asking for a chance, which is a non-police crisis team.”
Raheem has created an app called People and Technology for Community Health (PATCH), a tool for dispatching non-police community crisis response teams and coordinating response on the ground. They’ve also created a coalition of almost 60 different organizations across the country, and have helped some to set up their own local crisis response networks.
The group works closely with the Treatment Not Trauma Coalition, which is fighting to reopen mental health centers on the South and West Side of Chicago that were closed by then-mayor Rahm Emanuel in 2012. The group also wants to establish a citywide crisis response program using EMTs and mental health professionals but not police officers.
The coalition got these twin goals onto the November midterm ballot in three, mostly Black and Latinx Chicago wards. More than 90% of voters in those wards voted in support, according to the Triibe, a local news outlet.
“Obviously, there’s a lot of politics in this, but I think [the city is] failing to listen to the people and what they want,” said Any Huamani, an organizer with the Collaborative of Community Wellness, a citywide coalition of community groups which has been pushing the Treatment Not Trauma initiative since 2019. “Chicago wants a non-police crisis response. They don’t want this CARE program that involves police.”
The Issues with CIT
Matt Richards is the deputy commissioner of behavioral health at the Chicago Department of Public Health. He’s worked in the department since 2018 and oversees its mental health, substance use and recovery, and violence reduction programs.
He admits the use of Crisis Intervention Officers is controversial, but believes it is necessary from a safety perspective.
“There are a large volume of 911 calls with a mental health component where there is not a safety risk,” he said, adding that for those, there’s no need to send police. “There are also a large volume of calls with a mental health component that do include a safety risk. What I mean by safety risk is that there is a crime in progress.”
These include situations where a weapon is present, someone has been assaulted, or someone has made a verbal threat. While police response is not “optimal,” he says, those calls aren’t eligible for a healthcare-only response in Chicago or most other cities that are using alternative crisis-response teams.
Mitchell, the CARE team social worker, believes that Involving police in this work makes it easier to get people to engage, though she wasn’t sure if it was out of fear or trust.
“People tell us I’m scared to go [with the crisis team] because last time X, Y, and Z happened. We can show them it doesn’t always have to be traumatic,” she said. “Once they see that this is a positive interaction – that we’re not here to detain them, that we’re not here to harm them – then we’re able to start taking the steps on helping them get treatment.”
While they aren’t allowed to hospitalize people simply because they have a mental disorder, the teams sent people to local hospitals for psychiatric evaluations about 70 times and on 17 occasions, have initiated emergency hospitalizations. In most cases, Richards said, patients agree to go, but in a small number of cases, they don’t and may be brought to the hospital against their will.
“We try to communicate to the patient why it is really important for their safety that they go to the hospital,” he said. “If you can’t achieve alignment with the patient you have a legal obligation to get the patient to the hospital.”
About 14% of CARE team encounters end with police officers or firefighters taking people to hospitals. In 11% of encounters, the person is brought to a crisis stabilization facility or shelter for homeless people, according to the CDPH’s publicly available data. Another 30% receive care on the scene by the team.
The push for a non-police response
Cosette Ayele’s work as an advocate stems from personal experience. She was a schoolmate of Quintonio LeGrier at Gwendolyn Brooks College Preparatory Academy, a selective enrollment high school on the South Side of Chicago. She remembers the shock in the community when he was fatally shot by police while brandishing a bat during a mental health episode the day after Christmas in 2015. Bettie Jones, a 55-year-old neighbor who opened the door for the officers, was also shot and killed by police.
After the incident, Ayele helped organize a vigil across the street from the school with their classmates and friends. That moment kick-started her work as an organizer with the Black Youth Project 100.
“That was one of the first times that I realized that people cannot call the police for a mental health crisis and get the care that they’re expecting,” she said. “From there is where I really developed an abolitionist politic, that I can get trained and learn how to create my own safety pod or my own network of people that can help me if I’m ever in crisis.”
Ayele’s work is part of a national push to create alternative crisis response systems that leave police out of the equation. Ideally, she said, 988 – not 911 – would be the system people use to connect to mobile crisis response, mental health clinics and community care.
Ayele is a regular at meetings of government advisory bodies tasked with getting public input on mental health crisis services. When the committees hold hearings, they often ask for input from community members who have lived experience with the mental health and criminal justice systems.
At one recent hearing on the state law that is funding new forms of crisis response, Ayele asked a lot of questions. None of them were answered. “That’s infuriating,” she said. “They do this to create a hostile environment for people with lived experience and people that want the option for police not to be involved.”
A day in the life
For Gabrielle Mitchell and her partners on the CARE team, the work day begins around 10:30 am, when they head to their district and start receiving calls from 911 dispatchers. Before accepting the job on the CARE team, Mitchell worked with children in the foster care system, doing home visits and providing trauma therapy. She was attracted to the CARE program because she prefers working with adults and views the program as the future of mental health care.
When calls come in, the team sometimes serves as the primary responder and is first on the scene of a reported crisis. Other times, they follow up after other police units have arrived, she said.
The first step if they arrive first is for the team’s police officer to “secure the scene” and for team members to check in with other police or firefighters who may have arrived separately. Then, Mitchell said, she will connect with the person in crisis, family members, and whoever called 911.
Typically, Mitchell explained, the team is on hand because a 911 call has been categorized as a mental health crisis. Sometimes, they’re responding to calls about a person thought to be suicidal. Other times, they hear calls over a police scanner that have been overlooked by dispatchers and they suspect the person may be experiencing a mental health crisis. They may call officers at the scene to check it out.
In some cases, business owners have called 911 to report someone trespassing at their business, and team members arrive to find a person in crisis.
“They’re rambling. They are exhibiting signs of mental health symptoms, but they are also trespassing,” Mitchell said. “They are in the place and they need to leave, but the bigger issue is that they have a mental health issue that’s preventing them from just leaving.”
The South Side resource problem
Mitchell’s team works in the 6th police district, which covers the South Side neighborhoods of Chatham and Auburn Gresham. She is also a resident of the South Side, a predominantly Black neighborhood with pockets of poverty. Between January 2020 and June 2022, more than four in ten of the city’s mental health-related calls originated from the South Side.
The high volume of need and lack of nearby resources presents a unique problem for the South Side team. “It’s a lot harder in the 6th district because we just don’t have as many resources as some of the other areas have,” Mitchell said. Her team is working to build relationships with community organizations that are already working with residents who have mental health needs.
People with more common mental health issues like depression or anxiety are easier for local agencies to assist than those with more severe mental illness such as schizophrenia. The Human Resource Development Institute, which covers a huge swath of the South Side, can address medical and behavioral needs and has a methadone clinic. But it doesn’t have enough beds, clinicians or rooms to accommodate people with severe mental illness, said Tiffany Patton-Burnside, senior director of crisis at the Chicago Department of Public Health.
“They have all of the services; they don’t have the capacity,” she said.
While some agencies have satellite offices in the area, they rarely have mental health programs their clients qualify for. Worse, she said, their central intake is miles away on the North Side.
CARE vs the normal police response
In the 15 months since it launched, Chicago’s CARE program has achieved something that the Chicago Police Department’s regular responders have not: There have been no use-of-force incidents involving a CARE team during a response to a mental health crisis call.
During CARE program calls, no mentally ill resident or bystander has been struck by a baton or bullet, or shocked by a taser. But despite its accomplishments, the program is responding to only a fraction of the crisis calls that continue to be handled by police.
Community advocates contend the program would reach more residents if police were not involved at all. Despite some inroads, fear and distrust of police is widespread in Chicago’s Black and brown communities, and recent incidents like the shooting of an unarmed 13-year-old Black boy in the back are just the latest in a history of violent encounters.
Abolitionists like Ayele view the co-response model that so far has been the biggest part of the CARE program as little better than traditional police response. “The city of Chicago has a history of prescribing solutions that residents didn’t ask for,” she said.
But Patton-Burnside believes the two models within the CARE program can continue to coexist. She compares the crisis response landscape to a fruit basket with multiple options to choose from.
The continuing influx of cash coming from both the state and Washington DC is allowing the program to dream big. Patton-Burnside hopes to see a version of the CARE team expand to all of the city’s 77 community areas with the option to consider teams that include and don’t include police.
The department had hoped that by the end of the year it would launch a fourth team, composed of a paramedic and a peer specialist experienced with substance use disorder, but is still awaiting sign-off from the Illinois Department of Public Health, Richards says.
Ayele hopes to push the state to ease some restrictions and allow small community groups to receive funding for crisis teams that don’t use police.
“At least give people the autonomy to choose whether or not they want police there in the midst of their crisis,” she said.
To succeed on the South Side and earn the trust of skeptical residents, the program needs to scale up, Patton-Burnside said.
Being present in the community and making connections is also critical, she said. Last year, team members went to community meetings, gave out turkeys and hosted baby showers, she said.
“Because of the work they did on the front end, they were able to get people flagging them down to say: ‘Hey, you were at our block party. We know you help with this. Can you help with this now?’”