Joe Prude’s brother Daniel was visiting him in Rochester, NY, when Joe noticed Daniel’s continued erratic behavior and suspected he may be having a mental health episode. He called 911 after Daniel fled, naked and bleeding, from his house. Police officers arrived on the scene in the middle of the night. Daniel was unarmed and agitated, and officers forcibly restrained him—using their body weight to pin his head to the ground, place their knee on his back, and immobilize his legs. As they put him into this hold, Daniel said: “you’re trying to kill me.” The officers persisted, and ultimately killed Daniel.
Too few communities have emergency response systems that respond with care first. Instead, people like Joe and his brother are left to risk the potential consequences of our existing emergency response systems that lead with tasers, guns, force, and threats of arrest.
Daniel Prude had a mental health episode, and he did so while being Black. Due to systemic racism, ableism, and the failures of traditional crisis response systems rooted in policing and punishment, mental health crises — and police response to them — disproportionately harm marginalized communities. Police response to crises like Daniel’s can result in immense harm to health: the racism and ableism entrenched in the policies and practices of policing means that Black people are over three times more likely to be killed by police than White people, Indigenous people are around two times more likely to be killed by police than White people, and people with untreated mental health needs are 16 times more likely to be killed by police than those without. Since 2015, more than 400,000 people have been treated in emergency rooms because of a violent interaction with police or security guards. And beyond physical violence, being stopped by police is associated with psychiatric hospitalization and symptoms of anxiety, depression, and posttraumatic stress disorder.
In 2018, the American Public Health Association identified police violence as a public health crisis, calling for public health solutions that “allocate funding from law enforcement agencies to community-based programs that address violence and harm without criminalizing communities, including mental health intervention… particularly in the communities currently most affected by law enforcement violence.”
Many communities are starting to fill that gap with alternative response programs and responding to emergencies with care and connection to resources rather than with guns and handcuffs. These are public health programs because they help to strengthen the social safety net and connect people to care. Models like CAHOOTS in Springfield, OR, or STAR in Denver, CO divert 911 calls to trained crisis responders; co-response models like that of Los Angeles County’s Mental Health Evaluation Team pair police with mental health professionals; and models like Mental Health First in Oakland and Sacramento, CA, or HEART in Cambridge, MA operate completely separately from police or 911 through community-run dispatch systems. And, while many of these programs have been more formally built up in the last decade, particularly following the police murders of George Floyd and Breonna Taylor and the subsequent uprisings for Black liberation in 2020, marginalized communities have facilitated informal structures of mutual aid and support for generations, like the Fireweed Collective in the Bay Area.
While early research suggests that alternative response programs are promising approaches to reducing arrests, reducing violence, and connecting communities to needed services, these alternative structures are often under-evaluated and under-funded, especially in comparison to the billions of dollars state and local government budgets pour into police departments. Contributing to the research on the public health benefits of non-police crisis response programs is a clear lane that public health researchers and practitioners can occupy to support alternative responses.
With this understanding in mind, our team of public health academics, practitioners, and alternative response program staff members recently co-authored an article entitled “A logic model for alternative response programs to guide public health research and practice” in Social Science and Medicine. Through semi-structured interviews with eleven staff members across six independent alternative response programs and a focus group with seven expert practitioners and scholars, we identified pathways by which these programs can influence health outcomes: connecting residents to services, providing direct care, de-escalating conflict, and reducing involvement in the criminal legal system.
The final logic model highlights program inputs (e.g., trained staff, funding, partnerships), outputs (e.g., care-based responses, community outreach), and outcomes that range from short-term (reduced arrests, increased service access) to long-term (improved individual and community health). We intend that this logic model could be utilized by planning teams developing a new alternative response program or by evaluation teams to ensure the program was implemented as designed and assess whether the intended impacts occurred.
Non-police crisis response programs can ultimately improve public health and advance health equity, but need to involve people who are most directly impacted by police violence in their development, need to be separate from the police, and need to be adequately and sustainably funded. Ideally, investment in such programs should come from reallocated police budgets, in order to jointly decrease the power and resources of policing and increase the power and resource of community-led responses. Public health has a role to play in building up the evidence base for such reinvestments to occur, and we hope this work will continue to grow and develop within the field. With increased investments in these systems, Joe, Daniel, and others like them could have had a life-saving and life-affirming community resource available, instead of the systems that killed them.