The Landscape of Mental Health Crisis Response in the United States
By Jordyn Jensen
In the United States, what happens in a moment of mental distress is shaped not by need, but by place, power, and infrastructure. A crisis unfolds differently depending on who you are, where you are, and which institutions dominate the landscape around you.
For many people, a mental health crisis is not met with voluntary, community-based care. It is met with police lights, emergency rooms, locked doors, clinical authority, and the real possibility of confinement in the name of “safety.” Carceral and psychiatric systems have long operated together as default responders to mental distress, and police remain the primary institutional actors. What is shifting now is not the underlying logic of control, but the political investment in deepening it, even as non-police alternatives remain fragile and underfunded.
Recent federal and state policy shifts are expanding involuntary commitment, court-ordered treatment, and institutional confinement, often framed as public safety or improved access to care. These shifts are unfolding alongside continued disinvestment in housing, disability supports, and community-based care. As a result, distress is increasingly governed through systems of control, rather than supported through voluntary care.
These systems do not operate evenly across space. Laws and policy regimes shape where harm and protection concentrate, producing distinct crisis response landscapes across cities and neighborhoods. These patterns reveal that crisis response in the U.S. is not a single system of care, but a governing infrastructure that organizes distress through uneven combinations of support, surveillance, and force. This infrastructure is structured around who holds the power to detain, confine, and compel treatment, and how that power is exercised.
How Crisis Response Is Structured
Today’s crisis response system is frequently framed as offering “alternatives” to traditional police responses. In reality, it consists of three structurally distinct models, separated by where coercive authority sits. Which model someone encounters is not determined by need, but shaped by where they live and how their neighborhood is policed.
1. Police-Led Crisis Response (Status Quo)
Police remain the primary responders and legal authorities in most crisis encounters. This includes traditional police responses, Crisis Intervention Team (CIT) training, and police-initiated transport and involuntary psychiatric holds. Even when framed as “reformed,” these responses remain police-centered. The authority to detain, use force, and initiate confinement rests entirely with law enforcement.
2. Co-Responder Models (Still Police-Based)
Co-responder programs pair police with clinicians, social workers, and sometimes peers. These programs are often described as multidisciplinary or health-led. But police remain embedded as first responders and retain legal control over whether and how force is used. Although mental health clinicians may be present, officers continue to control the scene and can initiate detention and involuntary hospitalization. Power does not shift — only its presentation does.
3. Non-Police Crisis Response (True Alternatives)
True non-police crisis response means the absence of coercion, punishment, and criminal legal authority in the response itself. These models rely on voluntary, consent-based support and intentionally exclude law enforcement. They include civilian mobile crisis teams, peer-led response teams, peer-run warm lines, crisis stabilization and respite programs, and civilian 911 diversion.
Prime examples include Mental Health First in Oakland and Sacramento, a community-led mobile crisis response program that dispatches peer-centered teams without police, and Cambridge’s HEART program, a peer-led alternative that currently operates a crisis support line and is building toward full mobile response.
Our forthcoming collaborative report with Human Rights Watch and the New York Lawyers for the Public Interest examines these and other non-police crisis response models nationwide. Taken together, the uneven presence and fragility of these programs illustrate how geography, funding, and legal authority determine whether true alternatives can exist at all.
To qualify as genuine alternatives, these approaches must fully break from carceral control and align with disability justice principles centered on autonomy, consent, and collective care, meaning the response itself is non-coercive rather than merely non-police.
Expansion Did Not Equal Transformation
After 2020, the crisis response landscape shifted visibly. In the wake of nationwide uprisings against police violence following the murder of George Floyd, cities and states rapidly expanded all three types of crisis response programs. Many jurisdictions launched mobile crisis teams, civilian diversion programs, and peer-involved services for the first time. For some communities, this marked a real departure from police-only response as the sole default for mental distress.
Yet programs described as alternatives were largely layered onto the existing carceral system rather than replacing it.
Chicago’s Crisis Assistance Response and Engagement (CARE) pilot illustrates this tension. Initially framed as a replacement for police-led crisis response, CARE quickly shifted into a co-response model. Over time, implementation challenges and funding instability have narrowed CARE’s reach, reinforcing police as the primary responders for a growing share of calls.
This pattern reflects a broader national trend. Non-police programs are often tested in limited service areas, while police remain the default across most geographic space, especially in disinvested neighborhoods.
At the same time, programs widely described as non-police are facing contraction or elimination, such as the CAHOOTS program in Eugene, Oregon, even as involuntary systems expand across the political spectrum. This result is not a linear shift away from coercion, but a volatile coexistence between expanding alternatives and hardened systems of control.
What these patterns reveal is that crisis response is not simply a collection of individual programs, but a system of governance. The question is not only who responds, but how the entire structure of response is built, funded, and legally authorized.
Crisis Response as Infrastructure, Not Just a Service
Understanding crisis response as infrastructure helps explain why reforms that add services without redistributing authority fail to transform how crises are governed.
Although often described as a mental health service, crisis response functions more like an infrastructure that organizes how distress is managed across institutions, systems, and space. Infrastructure determines what is accessible, what is structurally foreclosed, and what becomes visible to the state. In this way, crisis response infrastructure actively determines:
- Who can access voluntary, community-based support
- Who is met with police instead of care
- Who is routed through emergency medical systems
- Who is confined through involuntary psychiatric confinement
- And who remains subject to surveillance and coercive control based on how crisis infrastructure is layered across place
How care is organized and unevenly distributed across communities and institutions reflects broader housing and care infrastructures. Even where mobile crisis teams exist, they often operate under narrow conditions — limited hours, limited geography, or only in coordination with law enforcement. In many places, people can only reach “care” by first passing through police or hospitals.
As a result, the system that responds in a moment of need is shaped less by what people actually need and more by what institutions are funded and legally empowered to use force. Because this infrastructure is built unevenly, the experience of crisis and the meaning of “help” vary dramatically by geography.
Where You Are Shapes What “Help” Looks Like
Crisis response is deeply uneven across the U.S. This becomes visible at the precise moment when someone seeks help and instead encounters the arm of the state trained in force and control. The Sonya Massey case makes this landscape painfully clear.
Massey’s call for assistance did not unfold in a vacuum. It unfolded within a crisis response terrain shaped by policing, disinvestment, and the absence of accessible, voluntary care. What happened to Sonya Massey was not a tragic anomaly. It was the predictable outcome of a system designed to route distress through law enforcement.
This case is just one example that showcases how race, gender, and disability intersect when police respond to mental health crises leading to lethal outcomes. Whether non-carceral support exists depends on local investment, state law, neighborhood infrastructure, and the intensity of policing and surveillance.
Patterns of segregation, disinvestment, and racialized enforcement shape not only who experiences distress, but how such distress becomes visible and what kind of response it triggers.
In Chicago, the 2012 closure of half the city’s public mental health clinics disproportionately impacted the crisis care landscape in Black and Latinx neighborhoods on the South and West Sides, cutting off access to community-based care. In the years that followed, mental health crises in these areas were increasingly routed through police-initiated emergency transport and hospital-based psychiatric systems rather than voluntary support.
The result is a fragmented geography of care and control. In some places, people are met by peers, clinicians, and voluntary support. In others, distress reliably triggers police dispatch, detention, involuntary hospitalization, or even death. Geography does not just determine who suffers. It powerfully shapes which version of “help” arrives when suffering becomes visible.
What This Moment Reveals
Today’s crisis response system is defined by a central contradiction: “alternatives” expanded after 2020, but police, hospitals, and involuntary systems have remained structurally dominant.
Programs described as non-police have largely been underinvested from the start, and many continue to operate alongside police or coercive authority rather than fully breaking from it. The system continues to route distress through institutions of control, concentrate coercion where community infrastructure has been stripped away, and treat need as a governance problem rather than a collective obligation of care. What results is not a single crisis response system, but a fragmented geography of care and coercion, where space and place determine whether mental distress is met with peers or police.
This is not a failure of rights on paper, but a political choice to manage distress through surveillance, confinement, and force rather than through material investment in voluntary, community-based care.
And yet, as non-carceral, community-led care faces increasing threats, communities continue to build and practice their own forms of safety. As Shira Hassan and Mariame Kaba remind us in Loving and Protecting Us, people have always made safety through relationships, mutual aid, accountability, and collective responsibility — not through punishment or the state. Even as coercive systems expand, community care is not disappearing. It is adapting, organizing, and refusing to be erased.
The real question of this moment is not whether care exists — but whether we will choose to fund, protect, and grow the life-saving work communities are already doing instead of continuing to pour resources into systems of confinement and control.
The Northwestern Pritzker Law Center for Racial and Disability Justice (CRDJ) is a first-of-its-kind center dedicated to promoting justice for people of color, people with disabilities, and individuals at the intersection of race and disability.
Learn more about CRDJ by visiting the Center for Racial and Disability Justice webpage.
