Law Enforcement and Mental Health: Crisis Response and Officer Wellness

Law enforcement and mental health collide in two places at once: officers are the default responders when someone in the community has a psychiatric emergency, and officers themselves experience depression, PTSD, and suicide at roughly double the rates of the general public. The response on both fronts has been a patchwork of specialized training, co-responder teams, civilian crisis units, the new 988 lifeline, federal confidentiality laws, and state reforms, with results that are promising in parts and uneven overall.

Why Police Became the Default Crisis Responders

911 dispatch systems route behavioral health calls the same way they route crime calls, so for decades officers have been the people who show up when someone is in psychiatric distress. A 2020 national survey found just 14.4% of U.S. law enforcement agencies had a specialized unit for mental health response. Another 27.7% had designated personnel but no formal unit, roughly half had no dedicated resources at all, and about 7% had no formal approach.¹

The consequences fall hardest on people with serious mental illness. The National Alliance on Mental Illness reports they are over ten times as likely to experience police use of force as people without mental illness.² The Treatment Advocacy Center has estimated that at least one in four fatal law enforcement encounters involves someone with a severe psychiatric condition, with some analyses closer to half, and that people with untreated serious mental illness face 16 times the risk of being killed during a police encounter compared to other civilians.³ Washington Post data shows that roughly 25% of all fatal police shootings between 2015 and 2020 involved a person with a mental illness. Research also indicates that individuals with mental illness are 4.5 times more likely to be arrested than the general public.⁴

Those numbers have driven a rethink of who responds. The alternatives in use today fall into three broad categories: train officers better, pair them with clinicians, or send clinicians instead.

Crisis Intervention Team Training

The most widely adopted reform is the Crisis Intervention Team model, developed in Memphis in 1988 after police fatally shot Joseph Dewayne Robinson, a man in mental health crisis. The Memphis Model combines 40 hours of specialized training for volunteer officers with dispatcher protocols that route mental health calls to CIT-trained personnel, plus a centralized “no-refusal” psychiatric receiving facility so officers can hand off patients quickly.⁵ CIT International, which oversees program standards, describes it as a community partnership that includes mental health providers, people with lived experience, and advocacy organizations.⁶

By 2019, about 2,700 CIT programs were operating nationally, covering roughly 15% to 17% of police agencies, up from an estimated 400 in 2008. Adoption remains concentrated in larger urban departments.⁵

The evidence on CIT is mixed. Trained officers report greater confidence in de-escalation, and studies show more diversion from jails to psychiatric facilities. But peer-reviewed research has found little measurable effect on arrest rates, officer injuries, citizen injuries, or actual use of force.⁵ Departments categorize mental health calls inconsistently, and factors like neighborhood demographics and firearm prevalence may overshadow what training alone can do.

Co-Responder Teams

Co-responder programs send a licensed clinician out with an officer, either riding together, arriving separately, or supporting remotely. Denver’s program, launched in 2016, has been widely studied. In its first year clinician-officer teams responded to 1,725 calls, and only 4% ended in arrest or citation; the rest ended with connections to mental health care. The program grew from four clinicians to 45, with Medicaid reimbursements keeping costs below budget. The Bureau of Justice Assistance supports 92 similar programs nationally through its Connect and Protect initiative.⁷

A Stanford evaluation of San Mateo County’s pilot, which ran from December 2021 through December 2023 in four cities, found a 16% reduction in involuntary psychiatric holds and a 17% drop in calls classified as mental health incidents. The study detected no community-level change in arrests or use of force, but qualitative findings showed better connections to mental health resources and shifts in how officers handled calls even without a clinician present.⁸

Civilian-Led Alternative Responses

More than 100 programs now dispatch unarmed teams of clinicians, paramedics, or peer specialists instead of police for certain calls.⁹

CAHOOTS

CAHOOTS (Crisis Assistance Helping Out On The Streets), founded in Eugene, Oregon, in 1989, is the pioneer. Two-person teams of a crisis worker and a medic respond to low-risk calls involving mental health, substance use, and homelessness. At its peak the program resolved nearly 20% of all calls routed through Eugene’s public safety communications center at a cost of about $2 million per year, roughly 2% of the police department’s budget. In 2019 CAHOOTS responded to an estimated 24,000 calls and needed police backup for only 311.¹⁰

In 2025, Eugene eliminated the program’s funding, resulting in approximately 80% of staff being laid off.¹¹ The city later contracted with Ideal Option to deploy peer navigators for non-emergency calls, and Lane County launched its own mobile crisis team in 2024.¹²

STAR and Similar Programs

Denver’s Support Team Assisted Response (STAR) program, modeled on CAHOOTS, launched as a pilot in 2020. Teams of mental health clinicians and paramedics handle low-risk 911 calls involving behavioral health, homelessness, or substance use.¹³ As of mid-2022, the program had never required police backup, and one study linked it to a 34% reduction in low-level crime in neighborhoods where it operated.⁹

Comparable programs have launched in Portland, Rochester, New York City, Albuquerque, Atlanta, Chicago, Los Angeles, Durham, Dayton, and Anchorage.¹⁴ Backup rates for unarmed teams run around 1% in Eugene and Albuquerque. Many of these programs rely on temporary pandemic-era federal funding, face recruitment and retention challenges tied to pay disparities, and, experts caution, cannot substitute for broader investments in housing and ongoing care.⁹

988 and Medicaid-Funded Mobile Crisis

The 988 Suicide and Crisis Lifeline launched on July 16, 2022. In its first two years counselors handled over 10 million contacts, and about 98% of those interactions were resolved over the phone without dispatching emergency services. The line is designed to complement 911, not replace it. When a caller is at imminent risk and the crisis cannot be resolved by phone, 988 staff can transfer the call to 911 or share the caller’s location.¹⁵

States are building technology to divert behavioral health calls from 911 to 988, slowed by logistical issues like the existence of multiple 911 call centers inside a single area code.¹⁶ A public concern that calling 988 might still trigger a police response or involuntary hospitalization is one of the barriers jurisdictions are trying to work through.¹⁵ Available data does not yet show whether 988 has reduced overall police involvement in mental health calls.

The American Rescue Plan authorized an enhanced 85% federal Medicaid match for mobile crisis services, and 20 states have received planning grants to build community-based mobile crisis intervention teams. To qualify for reimbursement, teams must include at least one licensed professional and be trained in trauma-informed care, de-escalation, and harm reduction.¹⁷¹⁸¹⁹

Federal Guidance and the Legal Standard for Force

In 2023 the Department of Justice and the Department of Health and Human Services issued joint guidance on emergency responses to people with behavioral health or other disabilities, acting on a 2022 executive order. The guidance makes clear that under Title II of the Americans with Disabilities Act and the Supreme Court’s decision in Olmstead v. L.C., public entities must provide services in the most integrated setting appropriate to a person’s needs, and a failure to offer sufficient community-based crisis services may constitute illegal discrimination by causing “needless institutionalization.” The guidance recommends diverting non-imminent behavioral health calls from 911 to 988, backs mobile crisis and co-responder models, urges 24/7 access to crisis stabilization facilities, and warns against the use of sedatives like ketamine administered by non-medical personnel to subdue people in crisis outside hospital settings.²⁰

When officers use force on someone in a mental health crisis, courts still apply the “objective reasonableness” test from Graham v. Connor (1989), which weighs the severity of the offense, the immediate threat to officers, and the level of resistance. Federal courts have generally declined to create a separate legal track for encounters involving mental illness. In Hart v. City of Redwood City (2024), the Ninth Circuit granted qualified immunity to an officer who used deadly force against a suicidal person holding a knife, ruling the individual posed an immediate threat.²¹

There are exceptions. In Chamberlain v. City of White Plains, the Second Circuit denied qualified immunity in the 2011 fatal shooting of a man with a mental health condition, and the city settled with the family for $5 million in 2023. Federal circuits also remain split on whether the ADA’s reasonable accommodation requirements apply to on-the-street police encounters before a scene is secured.²² Colorado and New York City have eliminated qualified immunity for officers as part of post-2020 reforms.²³

State Training Mandates

Requirements for officer mental health training vary widely, set by individual legislatures or state Peace Officer Standards and Training (POST) agencies. A few examples give the shape of the patchwork:

California recruits must complete 15 hours of training on persons with disabilities, including mental illness. Continuing professional training cycles of 24 hours every two years can include POST-certified mental health courses.²⁴²⁵
Utah requires certified CIT officers in all jurisdictions, with CIT consisting of the standard 40-hour curriculum over five consecutive days.²⁴
Washington requires every new full-time officer hired after July 1, 2017, to complete eight hours of CIT training.²⁴
Indiana recruits must complete six hours of mental health training.²⁴

The Commission on Accreditation for Law Enforcement Agencies requires accredited departments to provide entry-level and refresher training at least every three years, but prescribes no specific hour count or curriculum for mental health.²⁴

Officers’ Own Mental Health

Police personnel experience PTSD and depression at roughly twice the rate of the general population, around 20% compared with 7% to 9%. One global review found that one in seven officers worldwide suffers from PTSD or depression.²⁶

Suicide

Between 2017 and 2021, the nonprofit First H.E.L.P. recorded 756 officer suicides, nearly three times the 270 officers killed feloniously in the same period.²⁷²⁸²⁹

Recent clusters have brought the issue into sharper focus. In November 2023, four current and former Los Angeles Sheriff’s Department employees died by suicide within 24 hours. In early 2024, Denver lost three officers, and on Long Island two police officers, a probation officer, and a deputy sheriff died by suicide within four weeks. In early 2025, four current and former Texas deputies died in a six-week span, and three more officer suicides occurred on Long Island in the same window.³⁰

Stigma

Research on why officers do not seek help points to workplace culture. A survey reported by Mental Health First Aid for Public Safety found that 90% of police officers view stigma as a barrier to mental health assistance.³¹ A 2025 study of the Fargo Police Department by criminal justice professor Carol Archbold found 60% of officers said most of their peers would not disclose a mental health condition to a colleague, and nearly 75% said they would not tell a supervisor. More than half agreed peers view treatment as a sign of personal weakness, and 40% believed a mental illness history would hurt an officer’s chances for promotion. Although 93% of officers knew their department had a peer support program, only 42 had actually used it.³² Officers commonly fear that admitting to struggles will trigger a fitness-for-duty evaluation, lead to being placed on leave, or cost them their weapon.

Federal Laws and Programs for Officer Wellness

LEMHWA Grants

The Law Enforcement Mental Health and Wellness Act, signed in January 2018, created a grant program run by the DOJ’s COPS Office to fund peer support, mental health training, suicide prevention, family resources, and stigma reduction.³³ The fiscal year 2025 cycle offered approximately $8.85 million, with individual awards capped at $200,000 over 24 months and about 55 awards anticipated. Agencies that received LEMHWA funding in fiscal years 2023 or 2024 were ineligible for the 2025 cycle to spread the money more widely.³⁴

The COPS Counseling Act

Fear that counseling disclosures could leak has been one of the largest legal barriers to officers seeking help. The Confidentiality Opportunities for Peer Support Counseling Act, signed by President Biden on November 18, 2021, addresses this for federal law enforcement by prohibiting peer support specialists and participants from disclosing the contents of peer support communications to anyone outside the conversation.³⁵ The law was drafted partly in response to the 2019 suicide of Montgomery County Police Officer Thomas Bomba.³⁶

Confidentiality has limits. Disclosure is permitted when someone shares both an intent to die by suicide and a specific plan, when there is an explicit threat of serious bodily harm to another person, when abuse or neglect of a child or vulnerable person is involved, or when criminal conduct is admitted.³⁵ A Fraternal Order of Police survey found 73% of officers identified peer support as the most helpful mental health resource, which is why the privacy rules matter.³⁶

Suicide Data Collection

The Law Enforcement Suicide Data Collection Act, passed in 2020, directed the FBI to collect voluntarily submitted suicide data from law enforcement agencies nationwide. Data collection began on January 1, 2022, and results are published on a rolling basis through the FBI’s Crime Data Explorer. Participation is voluntary, so reported numbers run far below what organizations like First H.E.L.P. document. As of November 2024, the FBI reported data from just seven agencies covering nine suicides and three attempted suicides that year.³⁷

Pending Legislation

Bills introduced in 2025 include the Homeland Security Department Suicide Prevention and Resiliency for Law Enforcement Act, which would create a mental health and wellness program for DHS law enforcement personnel, and the Corrections Officer Blake Schwarz Suicide Prevention Act, which targets mental health screenings for Bureau of Prisons employees. Neither had been voted on as of early 2026.³⁸ The Law Enforcement Training for Mental Health Crisis Response Act of 2025, introduced in the 119th Congress, would address officer training on community mental health calls.³⁹

Best Practices for Officer Wellness

A 2023 DOJ report on officer wellness laid out a framework built on eliminating stigma, making leadership prioritize wellness, and embedding mental health support throughout an officer’s career from recruitment through retirement. Its recommendations include routine, confidential, non-diagnostic mental wellness visits conducted on agency time, rigorous peer support teams with private interactions, tele-mental health platforms that protect confidentiality, and hiring mental health professionals trained in law enforcement culture.⁴⁰

The report stresses a sharp line between routine wellness visits and fitness-for-duty evaluations. Participants should provide only a signed attendance form, with no diagnostic or screening component, and officers should choose their own provider.⁴¹ That separation addresses the central deterrent: the fear of being evaluated rather than supported.

The International Association of Chiefs of Police, with the University of Pennsylvania’s Positive Psychology Center and the Bureau of Justice Assistance, developed a separate Officer Resilience Training Program focused on cognitive and emotional skills for managing stress. The one-day, in-person curriculum covers learned optimism, avoiding “thinking traps,” and managing difficult conversations; at least one department has trained over 600 personnel through it.⁴²

Race, Policing, and Mental Health

The NAACP has noted that police killings of unarmed Black Americans contribute more than 50 million additional days of poor mental health per year among Black Americans, a burden comparable to that of diabetes in the same population.⁴³ Research on New York City adults found police encounters associated with poor mental health outcomes, with the strongest associations among Black residents. Studies of adolescents have found that Black, Hispanic, and multiracial youth report higher rates of feeling angry and unsafe during police stops than white youth.⁴⁴

Researchers acknowledge the existing literature lacks sufficient analyses stratified by race to quantify how police respond differently to mental health crises among people of color.⁴⁴ The data gap is part of the problem. The FBI’s National Use of Force Data Collection has not reached a sufficient response rate to release information about mental illness, and local collection remains inconsistent.⁴⁵

Post-2020 Reforms and What Has Followed

The murder of George Floyd in May 2020 accelerated many of these trends. Governors in 45 states signed police reform laws, and at least 30 states and the District of Columbia enacted statewide reforms addressing use of force, duties to intervene, or misconduct reporting.²³ Virginia passed legislation requiring mental health clinicians to play a greater role in crisis response through co-response teams, though the legislature later allowed localities with populations under 40,000 to opt out, and many rural counties withdrew citing budget constraints.⁴⁶

At the federal level, the George Floyd Justice in Policing Act, which would address use of force and mandate misconduct reporting, has not passed Congress.²³ State implementation has been uneven, held back by funding shortfalls and limited enforcement mechanisms. Nevada’s 2021 reforms, for example, mandated a statewide use-of-force database that still did not exist as of late 2022.⁴⁶ Across roughly 18,000 law enforcement agencies, the distance between reform on paper and reform in practice is the recurring theme of how law enforcement and mental health intersect in the United States.

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