Expand First Response and Crisis Intervention Teams

Introductory Paragraph

In addition to law enforcement officers, other first responders, such as emergency medical technicians, firefighters, and paramedics, are on the front lines of the illicit substance use epidemic. They frequently respond to drug overdoses and calls for services involving individuals with substance use and co-occurring disorders. As a result, a variety of law enforcement-led diversion and fire/emergency medical services (EMS)-led responses have emerged across the country. In partnership with substance use disorder treatment providers, peers, and recovery personnel, these multidisciplinary programs are helping to reduce overdoses by connecting individuals to community-based treatment. First-responder diversion programs represent a pivotal opportunity to redirect individuals with SUDs, mental health disorders, and co-occurring disorders away from jails or emergency departments and toward community-based treatment for substance use, mental health services, recovery support, housing, and social services.

Key Information

There are two approaches used by first responders -- “deflection” and “pre-arrest diversion.” These are detailed in the SAFE article titled, "Expand Law Enforcement Assisted Diversion and Deflection Programs." It is important to note, as two sides of the same coin, deflection and pre-arrest diversion are complementary practices of a systems approach at the intersection of first responders, behavioral health service providers, recovery support, and community. These collaborative interventions connect public safety with public health systems to create community-based pathways to treatment and services for people who have SUD, mental health disorders, or co-occurring disorders. In partnership with SUD treatment providers, other service providers, peers, deflection specialists, and recovery personnel, these multidisciplinary programs help reduce overdoses.

Relevant Research

PTACC published a research report on the benefits of diversion programs. Key findings indicate that despite the lack of large-scale and multi-site evaluation efforts, there are important trends emerging from early research on pre-arrest diversion initiatives across the US. Here are some key results drawn from empirical research on a variety of programs.

• Pre-Arrest Diversion represents the first intercept with the criminal justice system, making it a prime opportunity to redirect adults with mental health conditions and substance use disorders from jails and to connect them with community-based service providers.
• The majority of adults booked into local jails require mental health services and treatment for SUDs, which are typically not provided in local facilities.
• Behavioral health conditions are associated with repeat criminal justice contact, and SUDs are the strongest predictor of jail readmission.
• Pre-arrest diversion programs assess and address behavioral health needs associated with continual involvement in the criminal justice system.
• Preliminary results indicate participants who fully engage in pre-arrest diversion programs tend to have low rates of recidivism for extended periods of time.

Impactful Federal, State, and Local Policies

Communities are subject to state laws and regulations that directly impact their ability to institute pre-arrest diversion and other crisis response strategies. Often, strategies are locally designed and implemented and do not operate in a legal or political vacuum. Laws that grant local officials noncriminal responses to crises can propel diversion efforts or provide alternative, supplemental crisis responses. Laws that require criminal responses or otherwise circumscribe when and how non-law enforcement responders are able to intervene can impede them. Current statewide barriers exist in pre-arrest diversion and crisis response strategies.

R Street has a Statewide Policies report which reviews legal status and legislative actions in all fifty states relating to pre-arrest diversion and crisis response. Policies relating to pre-arrest diversion and crisis response include:

• Emergency Mental Health Hold laws authorize certain first responders to take an individual experiencing a mental health crisis into a form of civil custody in order for them to be evaluated by appropriate mental health or medical personnel.
• Protective Custody. These procedures operate as the substance use analog to emergency mental health holds by authorizing first responders to place an individual experiencing an acute substance use episode in temporary civil custody.
• Citation Authority statutes permit or require law enforcement officers to issue a citation to individuals alleged to have committed certain specified offenses, instead of detaining them or placing them under arrest.
• Good Samaritan laws offer immunity from arrest, criminal charges, prosecution or conviction for limited, drug-related offenses as an incentive for individuals to call for assistance for someone experiencing a suspected overdose.
• Ambulance Transport laws and regulations can influence where emergency medical services may take an individual experiencing a crisis, potentially by requiring transport to a hospital emergency department or otherwise discouraging the use of alternative destinations.

Illinois Senate Bill 3023 is one example of legislation on deflection. The 2018 Community-Law Enforcement Partnership for Deflection and Substance Use Disorder Treatment Act authorizes and encourages local law enforcement leaders to partner with treatment and community members on programs that deflect individuals who have overdosed or who have substance use problems away from the justice system and into addiction treatment services.

Available Tools and Resources

SAMHSA provides a guidebook titled, "Crisis Intervention Team (CIT) Methods for Using Data to Inform Practice: A Step-by-Step Guide.

SAFE Project:

• SAFE Connections. This SAFE Project subprogram of the SAFE Choices portfolio provides an opportunity to impact youth recidivism and redirect young lives toward reaching their full potential.
• Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change. This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.
• See the wiki titled "Improve Links to Treatment for People who Experience Non-Lethal overdoses or Naloxone Revivals" for more detailed information on ways to improve linkage to services for those who have experienced a non-lethal overdose or have survived a Naloxone revival.

Crisis Intervention Team International published "A Best Practice Guide for Transforming Community Responses to Mental Health Crises."

The National League of Cities offers "Working Across Systems for Better Results: City Efforts to address Mental Health, Substance Use and Homelessness Through Emergency Response and Crisis Stabilization" highlighting case studies in cities in Kansas, Texas, and West Virginia.

Advanced Recovery Systems University provides an online library of webinars specific to mental health and substance use within the first responder community.

Promising Practices

• Maryland. Safe Stations is an innovative new program in Anne Arundel County. It shifts barriers to treatment for those community members who are ready to recover from drug addiction. Persons seeking treatment for addiction can visit any police or fire station across the county, day or night, to dispose of any paraphernalia and find assistance gaining access to care.

• New Hampshire. The Safe Station Program offers help to anyone with substance use disorder at any Manchester Fire Department. The firefighters will arrange for or provide a medical assessment within their scope of training. If there is cause for concern that there is something else medically wrong with the patient, transportation to an appropriate level medical facility will be provided. Each individual seeking assistance will be required to drop any needles and/or paraphernalia into a collection bin located at each fire station prior to speaking with coaches or seeking treatment.

Ohio. The Hamilton County Heroin Task Force partnered with law enforcement, fire departments and social workers to create the Quick Response Team. It follows up with overdose victims and offers them addiction treatment. The goal is to have a first responder follow up with overdose victims within the “recovery window” (72 hours after an overdose reversal) and to provide a warm hand off to treatment options. Teams work to find overdose survivors using a database maintained by the Greater Cincinnati Fusion Center, a public safety data-collecting agency. Teams also use “predictive analysis” to track drug activity to target potential overdoses with the help of University of Cincinnati’s Institute of Crime Science. QRT has since been launched as a national model.

Tennessee. The Crisis Intervention Team (CIT) program is a community partnership working with mental health consumers and family members. Officers are part of a specialized team which can respond to a crisis at any time, and they will work with the community to resolve each situation in a manner that shows concern for the citizen’s well-being. The CIT is made up of volunteer officers from each Uniform Patrol Precinct. CIT officers are called upon to respond to crisis calls that present those officers, face-to-face, with complex issues relating to mental illness. CIT officers also perform their regular duty assignment as patrol officers. The Memphis Police Department has 268 CIT officers who participate in specialized training under the instructional supervision of mental health providers, family advocates, and mental health consumer groups. Due to the training, CIT officers can, with confidence, offer a more humane and calm approach. These officers maintain a 24/7 coverage.