Expand First Response and Crisis Intervention Teams

Introductory Paragraph

Law enforcement officers and 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 (SUD) treatment providers, peers, and recovery personnel, these multidisciplinary programs are helping to reduce overdoses by connecting individuals to community-based treatment. Law enforcement and first-responder diversion program models 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.” Deflection and pre-arrest diversion are complementary practices of a systems approach at the intersection of first responders, SUD and MHD treatment, recovery support, and community. These two practices, always taken together as a single coin, are simply referred to as the “field of deflection.”

Deflection is the practice by which law enforcement or other first responders (i.e., fire and EMS) connect individuals to community-based treatment and/or services when arrest would not have been necessary or permitted, or in lieu of taking no action when issues of addiction, mental health, and/or other need are present. Deflection is performed without fear by the individual that if they do not “accept the deflection” they will subsequently be arrested.

Pre-arrest diversion is the practice by which law enforcement officers connect individuals who otherwise would have been eligible for criminal charges to community- based treatment and/or services in lieu of arrest, thereby diverting them from the justice system into the community. Some pre-arrest diversion programs have policies that mandate holding charges in abeyance until treatment or other requirements, such as restitution or community service, are completed, at which time the charges are dropped. Although pre-arrest diversion is facilitated by justice system stakeholders (usually police and sheriffs but sometimes prosecutors or a local government agency), clients are diverted to community-based services.

Pre-arrest diversion programs should not be confused with prosecutorial diversion, which occurs after individuals have already been arrested and become involved in the justice system; in contrast, pre-arrest diversion occurs before the filing of charges.

There are five pathways in the field of diversion for first responders highlighted below. Each of which has the goal of providing a structured response that diverts a person exhibiting behaviors due to substance use, mental health disorder, or other treatable condition to an appropriate medical or treatment agency. For each of the pathways, the targeted population or circumstance appropriate for the pathway is elaborated.

In 2014, Treatment Alternatives for Safe Communities (TASC), Center for Health and Justice (CHJ) developed the first iteration of the Five Pathways to Treatment, which offered different pathways for deflection that first responders could use to move someone from the justice system at the point of contact with law enforcement to community-based treatment. Each pathway has unique characteristics that make it appropriate to address particular problems such as SUD, OUD, MHD, homelessness, and other issues. Identifying and naming these pathways created a common language for practitioners to use in the new, emerging field of deflection.

These programs are collaborative interventions connecting public safety (e.g., law enforcement, fire, and emergency medical services [EMS]) with public health systems to create community- based pathways to treatment and services for people who have SUD, mental health disorders (MHD), 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 through connection to community-based treatment and services. For law enforcement, deflection programs can enable individuals to receive referrals to services without fear of arrest if the individual does not accept deflection (in cases when law enforcement would have otherwise taken no action) or can serve in lieu of arrest when charges are present and an arrest would have otherwise occurred.

• Self-Referral: An individual voluntarily initiates contact with a first-responder agency (law enforcement, fire department, or EMS) for a treatment referral. If contact is initiated with a law enforcement agency, the individual makes that contact without fear of arrest. Individuals with SUDs are targeted population.
• Active Outreach: A first responder intentionally identifies or seeks out individuals with SUDs to refer them to, or engage them in, treatment; outreach is often done by a team consisting of a clinician and/or peer with lived experience. Individuals with SUDs are targeted population.
• Naloxone Plus: A first responder and program partner (often a clinician or peer with lived experience) conducts outreach specifically to individuals who have experienced an overdose recently to engage them in and provide linkages to treatment. Individuals with opioid use disorder are the targeted population.
• First-Responder/Officer Prevention: During routine activities such as patrol or response to a service call, a first responder conducts engagement and provides treatment referrals. If a law enforcement officer is the first responder, no charges are filed or arrests made. The targeted population are persons in crisis, or with non-crisis mental health disorders and SUDs, or in situations involving homelessness or sex work.
• Officer Intervention: (applicable only for law enforcement) During routine activities such as patrol or response to a service call, a law enforcement officer engages an individual and provides treatment referrals or issues noncriminal citations for that individual to report to a program. Charges are held until treatment and/or a social service plan is successfully completed. The targeted population are persons in crisis, or with non-crisis mental health disorders and SUDs, or in situations involving homelessness or sex work.

Relevant Research

PTACC Key Findings

 

Impactful Federal, State, and Local Policies

Strategies are often locally designed and implemented, they do not operate in a legal or political vacuum. Communities are subject to state laws and regulations that directly impact their ability to institute pre-arrest diversion and other crisis response strategies.

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 Statewide Policies report reviews all fifty states relating to Pre-arrest diversion and crisis response including legal status and legislative actions. STATEWIDE POLICIES RELATING TO PRE-ARREST DIVERSION AND CRISIS RESPONSE:

Emergency Mental Health Hold- 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 -Protective custody procedures operate as the substance abuse analog to emergency mental health holds by authorizing first responders to place an individual experiencing an acute substance abuse episode in temporary civil custody.

Citation Authority- Citation authority statutes permit or require law enforcement officers to issue a citation to individuals alleged to have committed certain specified offenses, instead of placing them under arrest, booking or detaining them.

Substance use Good Samaritan- Substance abuse 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.

AZ Good Samaritan Law

IL Good Samaritan Law

PPD Naloxone Directive

Ambulance Transport Destination- 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.

Available Tools and Resources

Crisis Intervention Team (CIT) Programs: A Best Practice Guide for Transforming Community Responses to Mental Health Crises

Crisis Intervention Team (CIT) Methods for Using Data to Inform Practice: A Step-by-Step Guide

Working Across Systems for Better Results: City Efforts to address Mental Health, Substance Use and Homelessness Through Emergency Response and Crisis Stabilization

Jail Diversion Programs in America

Advanced Recovery Systems University An online library of webinars specific to mental health and substance use within the First Responder Community.

Promising Practices

• Alabama -- The Mercy Project. Walker County had the fifth-highest per capita rate of overdoses in the United States and the highest overdose rate of any county in the state. As a result, Sheriff Nick Smith wanted to create a program to help people struggling with SUD and reduce the recidivism rate resulting from substance misuse. Interested participants fill out an application and then receive consultation. People are ineligible for program entry if they are facing drug charges or have outstanding warrants. However, the consultation allows a potential participant to turn in any drugs or drug paraphernalia without the threat of arrest, and although the individual must still enter the justice system, drug court is an option. If the person is accepted into the program, consultation determines individual treatment needs.

• Illinois -- Safe Passage. People who realize they need help can go to one of the participating law enforcement agencies in Lee and Whiteside Counties without fear of being arrested. If they ask for help with their drug addiction and turn in their drugs, they will be placed in a treatment facility, usually within 24 hours. Once initial paperwork is completed, persons will be paired with a volunteer who will guide them through the process. Safe Passage partners with treatment centers throughout Illinois and the Midwest.

• Maryland. Safe Stations is an innovative new program in Anne Arundel County. It shifts barriers to treatment for those members of our community who are eager 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.

• New York. Hope Not Handcuffs is an initiative started by Families Against Narcotics (FAN). It aims to bring law enforcement and community organizations together in an effort to find viable treatment options for individuals seeking help to reduce dependency with heroin, prescription drugs, and alcohol. A person struggling with any drug addiction can come to any of the participating police agencies and ask for help. They will be greeted with support, compassion, and respect. If accepted into the program, the individual will be guided through a brief intake process to ensure proper treatment placement.