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Reimagining Response to Vulnerable Populations in Crisis


  • Over-reliance on first responders in non-criminal or medical matters
  • Development of a framework for reimagining crisis response
  • Generation of materials for reimagining crisis response
The Challenge

Homelessness and untreated serious mental illness (SMI) and/or substance use disorders (SUD) are at the root of many crisis-related calls for emergency services. However, first responders often lack the necessary information, skills, resources, or coordinated support to engage safely, justly, and effectively with individuals experiencing such crises. As a result, these interactions often increase involvement in the justice system and rely too much on the emergency response system, neither of which was designed to deal with behavioral health issues.

The Approach

We conducted a broad Internet scan to collect information on U.S.-based, first responder-led programs that were designed to maximize diversion from the justice and emergency systems to treatment and community-based services. We organized the range of programs into program types and overarching program models. We also reviewed the research evidence for these programs to assess the effectiveness of the various approaches.

The Results

We provide a framework for considering the different types of programs for preventing crises or improving emergency responses for individuals experiencing SMI, SUD, and/or homelessness and are in crisis. The types of programs included in our framework support efforts to minimize involvement of first responders by engaging behavioral health or other specialists in the response and, when first responders are involved, ensuring they have the training and support to de-escalate, screen, and connect individuals to needed services and care. We also introduce factors, including the extent to which programs have been evaluated, for communities to consider when deciding on the type of program to implement or expand to improve responses to vulnerable populations in crisis.

For more of our work in this area, please visit

Reimagining Response Materials:

A Guidebook to Reimagining America’s Crisis Response Systems: A Decision-Making Framework for Responding to Vulnerable Populations in Crisis.  For policymakers and emergency response agencies considering implementing or expanding crisis response programs in their communities. (pdf)

A Comprehensive Framework of Emergency Response Approaches to Vulnerable Populations in Crisis. For communities that want to understand the range of programs that first responder agencies in the U.S. have implemented to improve response to behavioral health- and/or homelessness-related crises. (Article)

Perspectives on Reimagining America’s Emergency Response System (Webinar). Communities face increasing pressure to minimize unnecessary engagement of first responders in non-criminal or medical matters, and, if engaged, to improve their responses to individuals in crisis. However, policymakers lack the consolidated information on various approaches needed to inform their decision-making. In this webinar, we present our decision-making framework for reimagining emergency response, followed by a panel discussion with diversionary emergency response experts who discuss approaches used and relevant factors for decision-making at state, county, and local levels. (Webinar)

Reimagining Crisis Response Systems. Communities want to reimagine models of emergency responses to individuals experiencing a crisis. But the paucity of research in this area means policymakers have little access to data to inform their decision-making. In this white paper, we summarize the types of first responder-led, emergency-response models and present the evidence that exists for them. Then we suggest investment to fill the evidence gaps, support reform efforts, and ensure that reimagining the emergency response system both contributes to and relies on evidence. (pdf)

Shifting from Crisis Response to Crisis Prevention. Individuals and communities typically rely on the conventional—but often inappropriate--emergency response system for behavioral health crises (e.g., mental health, substance use, homelessness). Ideally, community infrastructure would be designed to prevent and treat behavioral health concerns to minimize crises. In this white paper, we set out a framework for communities seeking to shift from crisis response to crisis prevention by identifying incremental changes across multiple system components that can help build healthier communities. (pdf)