Co-Response to Psychiatric Emergencies in an Urban Setting: A Law Enforcement-Driven Response to Mental Health

Background

In response to the incidence of police interaction with people navigating mental health symptoms and the increased risk for escalation during these encounters, many cities have adopted a co-response model (i.e., police officer and mental health clinician) to improve the management of behavioral health crises. Co-response teams are often housed in police departments and funded by foundation and/or government money. Co-response programs’ stated goals are to reduce injuries to police and citizens with psychiatric disorders and/or distress, divert these persons from the criminal justice system, and connect them with mental health services (Morabito et al., 2018). Co-response programs have demonstrated mixed effectiveness toward these ends (Marcus & Stergiopoulos, 2022). While cities across the country have ramped up these programs, little research has documented the array of individual and community events that elicit response from co-response teams. Using clinician notes from an urban program in the Northeastern US, we analyzed co-response encounters to understand who is involved in these encounters and under what circumstances.

Methods

Using a grounded theory approach (Strauss & Corbin, 1990), we analyzed clinical notes from 4,111 co-response encounters between July 2019 and March 2022. A two-step process, open coding followed by axial coding, allowed us to develop a codebook, categorize codes, and identify themes within the data. To validate our interpretation of our findings, we obtained feedback from an expert advisory team and utilized member checking with current co-response clinicians.

Results

The co-response clinicians documented the reason for the encounter, the encounter setting, the individuals involved in the encounter, and actions taken by the co-response team, clinically and, at times, legally. Co-response clinicians are invited only when an encounter is determined to have low potential for violence and may only interact with the individual after law enforcement determined the scene was safe, which included potential restraint. Co-response intervention happened in one of the following environments: a private home, in outside public space, in a place of commerce, or in a carceral/ police setting. We identified a series of archetypal characteristics of the recipients of co-response intervention: (1) vulnerable/marginalized identity; (2) psychiatric symptoms; and (3) perceived potential violence. In addition to vulnerabilities related to psychiatric distress, many individuals embodied one or more additional vulnerable and/or marginalized identities (e.g., youth, older adults, non-English speaking). The most common psychiatric symptoms included psychotic symptoms (e.g., paranoia, decompensation, disorganization), suicidality, and substance use (acute intoxication and substance use disorders). Lastly, encounters were described as either including perceived potential violence or not.

Conclusions/Implications

In this city in the northeast, co-response teams interact with individuals who are socially marginalized, often experiencing psychiatric distress in public, and who are perceived to be dangerous to the public. While co-response is intended as an alternative to police-only response to community members in psychiatric crises, in practice it remains a law-enforcement driven intervention that furthers interaction between law enforcement and some of the community’s most vulnerable individuals. The development of non-law enforcement models is critical to avoid the continuation of a carceral response to mental health crises.