9.3: Crisis Intervention

Crisis intervention within the criminal justice context represents a fundamental shift in how law enforcement, courts, corrections, and communities respond to individuals experiencing mental health crises, substance use emergencies, homelessness-related incidents, and other acute situations that have traditionally resulted in arrest and incarceration. Rather than treating these crises purely as criminal matters, crisis intervention approaches them as opportunities for connection to treatment, services, and support—recognizing that jail is often the worst place for someone in crisis and rarely addresses underlying problems.

The Foundation of Crisis Intervention in Criminal Justice

California's criminal justice system has long served as a de facto mental health and social services system. Following deinstitutionalization in the 1960s-70s, when psychiatric hospitals closed without adequate community treatment infrastructure, jails and prisons became the largest mental health facilities in the state. Studies consistently show that 25-40% of jail inmates have serious mental illnesses, and even higher percentages struggle with substance use disorders.

Traditional law enforcement responses—arrest, booking, brief detention, release—created a revolving door. The same individuals cycling through repeatedly, their underlying crises never addressed, at enormous cost to taxpayers and human dignity. Crisis intervention emerged as both a humanitarian imperative and a practical necessity.

Core Principles

Diversion Over Incarceration: Connecting people to treatment and services rather than jail whenever possible and safe.

Specialized Training: Equipping first responders with skills to de-escalate mental health crises and recognize symptoms.

Coordinated Systems: Building partnerships between law enforcement, mental health providers, hospitals, social services, courts, and community organizations.

Person-Centered Approaches: Treating individuals in crisis with dignity, recognizing their humanity beyond their immediate behavior.

Continuity of Care: Ensuring connections made during crisis moments lead to sustained support, not just one-time interventions.

Crisis Interventional Models in California

Crisis Intervention Teams (CIT): The Crisis Intervention Team model, originally developed in Memphis, has been widely adopted across California. CIT provides 40 hours of specialized training for patrol officers who volunteer for this role, teaching them to:

• Recognize signs and symptoms of mental illness, developmental disabilities, and substance use disorders.
• Use de-escalation techniques rather than force.
• Understand local mental health systems and available resources.
• Connect individuals to appropriate services rather than defaulting to arrest.

San Jose's CIT Program is among California's most established, training hundreds of officers since the early 2000s. Officers learn through scenarios with actors portraying mental health crises, visit psychiatric facilities to understand treatment environments, and hear directly from people living with mental illness and their families. San Jose CIT officers carry resource cards with local mental health services and are trained to exercise discretion in using crisis holds (5150s) versus other interventions.

Los Angeles Police Department's Mental Evaluation Unit represents a large-scale CIT implementation. LAPD has trained thousands of officers in mental health crisis response and created specialized Mental Evaluation Units that pair specially trained officers with dedicated psychiatric nurses or mental health clinicians. These teams respond to mental health calls citywide, providing on-scene assessment and facilitating connections to treatment.

Sacramento Police Department's CIT has trained significant portions of its force and tracks outcomes, finding that CIT-trained officers are more likely to resolve mental health calls without arrests or use of force. Sacramento has also developed strong partnerships with county mental health to ensure individuals contacted during crises can access follow-up care.

Co-Responder Models

Co-responder programs pair law enforcement officers with mental health clinicians who respond together to crisis calls. The clinician provides clinical assessment, therapeutic intervention, and connection to services while the officer ensures safety.

Eugene's CAHOOTS Model Influence: While CAHOOTS (Crisis Assistance Helping Out On The Streets) originated in Eugene, Oregon, it has profoundly influenced California programs. CAHOOTS sends unarmed mental health crisis workers to many calls that would traditionally go to police, reserving law enforcement for situations involving weapons or violence.

Oakland's Mobile Assistance Community Responders of Oakland (MACRO) launched in 2020 as California's first CAHOOTS-inspired program. MACRO teams—consisting of a paramedic/EMT and a mental health crisis interventionist—respond to non-violent, non-criminal mental health and behavioral health crisis calls. They operate in fire department vehicles and can transport individuals to crisis stabilization centers rather than emergency rooms or jail.

MACRO handles calls involving mental health crises, welfare checks, substance intoxication, homelessness-related concerns, and other situations where a clinical response is more appropriate than law enforcement. Early data showed MACRO successfully resolved many calls without police involvement, and zero MACRO calls resulted in use of force or arrest.

Los Angeles's Community Crisis Response (CCR) initiative has deployed mental health teams in several neighborhoods to respond to 911 calls involving mental health crises. The teams include licensed clinicians and peer support specialists (individuals with lived experience of mental illness) who can relate to people in crisis in unique ways.

San Francisco's Street Crisis Response Team (SCRT) operates in the Tenderloin and other neighborhoods, sending teams of paramedics and behavioral health specialists to respond to behavioral health emergencies. SCRT can connect individuals to the city's extensive network of crisis stabilization beds, sobering centers, and treatment programs—critical alternatives to jail.

Psychiatric Emergency Response Teams (PERT)

San Diego's PERT Program pioneered the embedded clinician model in California. Since 1993, PERT has paired licensed mental health clinicians with specially trained law enforcement officers to respond to mental health crisis calls. San Diego County now operates multiple PERT teams covering different regions.

PERT clinicians ride in patrol vehicles with officers, responding to calls in real-time. The clinician conducts on-scene assessments, provides crisis counseling, determines appropriate level of care, and facilitates connections to psychiatric emergency services, crisis residential programs, or outpatient treatment. The officer handles safety concerns and, when necessary, initiates 5150 psychiatric holds.

San Diego PERT has diverted thousands of individuals from jail to treatment annually. Follow-up studies found participants had reduced arrests and emergency service utilization after PERT contact, demonstrating that connecting people to appropriate care during crises creates lasting benefits.

Orange County's PERT has expanded the model significantly, operating teams throughout the county with funding from voter-approved mental health taxes. Orange County PERT responds to schools, homes, and public spaces, with specialized teams for different populations including youth, homeless individuals, and veterans.

Riverside County Sheriff's PERT serves the vast Riverside County area with multiple teams. They have developed specialized protocols for different crisis situations and maintain relationships with all county mental health facilities to expedite placements.

Crisis Stabilization Centers

Rather than bringing people in crisis to jail or emergency rooms, California has invested in dedicated crisis stabilization facilities designed specifically for mental health and substance use emergencies.

San Francisco's Dore Urgent Care Clinic operates 24/7 as a walk-in psychiatric crisis center. People experiencing mental health crisis, whether brought by police, family, or arriving independently—receive immediate clinical assessment, crisis intervention, medication services, and short-term stabilization. The facility can hold individuals for up to 23 hours, often preventing psychiatric hospitalizations or criminal justice involvement.

Los Angeles County's Urgent Care Centers operate across the county, providing 24/7 walk-in crisis services. These centers assess individuals, provide immediate intervention, dispense medications, and connect people to ongoing care without requiring appointments or insurance verification, removing barriers that often lead people in crisis to police contact instead.

Sacramento's Crisis Stabilization Unit offers short-term residential crisis services where individuals can stay for several days while receiving intensive support, medication management, and care coordination. Law enforcement can bring individuals directly here rather than booking them into jail.

Crisis Receiving Centers

Alameda County's John George Psychiatric Pavilion serves as a crisis receiving center where law enforcement can bring individuals on psychiatric holds (5150s) for evaluation and stabilization rather than keeping them in jail cells awaiting psychiatric beds. This medical approach to psychiatric emergencies recognizes that jail environments often worsen mental health crises.

Contra Costa County's Crisis Stabilization Unit provides similar services, accepting law enforcement drop-offs 24/7 and conducting comprehensive assessments to determine appropriate disposition—hospital admission, crisis residential placement, or connection to outpatient services with safety planning.

Specialized Courts

Mental Health Courts operate in counties throughout California, providing intensive judicial supervision and mandatory treatment as an alternative to traditional prosecution. Participants typically have serious mental illnesses and criminal charges; they agree to treatment compliance in exchange for reduced charges or dismissed cases upon successful completion.

Los Angeles County's Mental Health Court is one of the nation's largest, operating in multiple courthouses. Participants receive case management, housing support, benefits enrollment, treatment services, and regular court appearances where judges monitor progress. The collaborative approach—with prosecutors, defense attorneys, and treatment providers all focused on recovery rather than purely punishment—creates accountability while addressing underlying needs.

San Francisco's Behavioral Health Court serves individuals with mental illness, substance use disorders, or both who are facing criminal charges. The program provides intensive community-based treatment, peer support, housing assistance, and judicial monitoring. Participants meet regularly with a dedicated judge who celebrates successes and problem-solves around challenges, creating therapeutic jurisprudence.

San Diego's Mental Health Court has operated since 2001, serving hundreds of participants annually. Research on the program found participants had significantly fewer arrests and jail days compared to similar individuals in traditional prosecution, and most successfully complete treatment programs they had previously been unable to access.

Veterans Treatment Courts

Recognizing that veterans often face unique challenges including PTSD, traumatic brain injury, and military sexual trauma that can lead to criminal justice involvement, California has established Veterans Treatment Courts in over thirty counties.

Orange County's Veterans Treatment Court connects justice-involved veterans with VA services, veteran peer mentors, and intensive case management. Participants receive treatment for mental health and substance use disorders, assistance accessing VA benefits, housing support, and employment services. The court's mentor program pairs participants with veterans who have successfully navigated recovery.

Sacramento's Veterans Court similarly provides a structured program where veterans appear regularly before a judge, engage in required treatment, submit to drug testing, and receive support from veteran mentors and VA staff. Successful completion can result in dismissed charges and sealed records, giving veterans a genuine second chance.

Law Enforcement Assisted Diversion (LEAD)

LEAD programs allow officers to divert individuals arrested for low-level offenses—typically drug possession, prostitution, or crimes driven by addiction—directly to intensive case management and services rather than booking them into jail.

Santa Rosa's LEAD Program was among California's first implementations. When officers encounter someone meeting program criteria, they can offer LEAD instead of arrest. Participants work with intensive case managers (maintaining exceedingly small caseloads of 10-15 clients) who provide whatever support the person needs—housing, treatment, ID recovery, benefits enrollment, legal advocacy—using a harm reduction, housing-first philosophy.

Santa Rosa LEAD found significant reductions in recidivism among participants compared to similar individuals who went through traditional prosecution, along with increases in housing stability and treatment engagement.

Huntington Beach's LEAD focuses heavily on connecting participants to substance use treatment and mental health services while also addressing collateral consequences of criminal records that create barriers to employment and housing.

Mobile Crisis Teams

Beyond co-responder models, some California jurisdictions operate dedicated mobile crisis teams that can respond independently or alongside law enforcement.

Contra Costa County's Mobile Crisis Team operates county-wide, responding to calls from law enforcement, family members, service providers, or community members concerned about someone in crisis. The team conducts field-based assessments, provides crisis intervention, and connects individuals to appropriate services. They maintain relationships with all county crisis facilities to facilitate immediate placements.

San Mateo County's Mobile Crisis Response Team operates 24/7, responding to mental health emergencies throughout the county. The team includes licensed clinicians and peer support specialists who can conduct 5150 assessments in the field, coordinate voluntary admissions to psychiatric facilities, or arrange crisis residential placements—all alternatives to criminal justice involvement.

Jail-Based Crisis Intervention

Recognizing that some individuals inevitably enter custody despite diversion efforts, California jails have developed specialized crisis intervention programming.

Los Angeles County Jail's Mental Health Services represent the largest jail-based mental health program in the nation. The jail system houses thousands of individuals with serious mental illness at any given time and operates dedicated mental health housing units, 24/7 psychiatric services, crisis intervention teams, and discharge planning to connect individuals to community treatment upon release.

San Francisco County Jail's Behavioral Health Services provides comprehensive mental health care within the jail, including psychiatric evaluation, medication management, individual and group therapy, substance use treatment, and intensive discharge planning. The program works closely with community providers to ensure continuity of care upon release.

Santa Clara County's Jail Mental Health Services operates specialized units for individuals with acute psychiatric needs, provides cognitive behavioral therapy programming, and employs peer support specialists who are formerly incarcerated individuals with mental health lived experience to support inmates preparing for release.

Pretrial Diversion Programs

Los Angeles County's Office of Diversion and Reentry (ODR) operates one of the most comprehensive diversion systems nationally. ODR intercepts individuals with mental health and substance use disorders at multiple points:

• Pre-arrest: Working with law enforcement to divert from arrest.
• Pre-booking: Diverting at jail before formal booking.
• Post-booking: Connecting booked individuals to treatment in lieu of prosecution.
• Pre-trial: Providing services to those awaiting trial.
• Sentenced: Operating alternatives to incarceration.
• Re-entry: Supporting individuals leaving jail with intensive services.

ODR maintains housing, provides intensive case management, coordinates treatment, and has dramatically reduced recidivism among participants while saving taxpayers millions in incarceration costs.

San Francisco's Behavioral Health Diversion offers similar multi-point intervention, identifying individuals with behavioral health needs early in the justice process and connecting them to community-based treatment rather than continuing prosecution.

Innovative California Programs

San Francisco's Street Crisis Response System Expansion: San Francisco is working toward a comprehensive crisis response system where mental health and medical professionals respond to most behavioral health crises without police involvement. The system includes:

• Street Crisis Response Teams for field response.
• Crisis hotlines are staffed by peers and clinicians.
• Crisis stabilization centers for immediate, voluntary walk-in care.
• Crisis residential programs for short-term stays.
• Mobile evaluation teams for psychiatric assessments.
• Coordination with hospitals and outpatient providers.

This ecosystem approach ensures multiple entry points and pathways for people in crisis, reducing reliance on law enforcement and emergency rooms.

Los Angeles's Crisis and Incident Response through Community-Led Engagement (CIRCLE): Los Angeles piloted CIRCLE to send unarmed community crisis responders to non-violent calls including mental health crises, substance use issues, and homelessness concerns. The program employs individuals from the communities being served, many with lived experience of homelessness, mental illness, or incarceration.

CIRCLE responders receive extensive training in de-escalation, trauma-informed care, harm reduction, and resource navigation. They carry backpacks with basic supplies—water, snacks, hygiene items, harm reduction materials—and can spend as much time as needed building rapport and connecting people to services, unconstrained by the productivity demands facing law enforcement.

California's Mental Health Services Act (MHSA) Crisis Programming: Proposition 63, passed in 2004, imposed a tax on millionaires to fund expanded mental health services. MHSA funding has supported crisis intervention infrastructure statewide including:

• Mobile crisis teams in every county
• Crisis stabilization units
• Crisis residential programs
• Psychiatric emergency services expansion
• Crisis hotlines
• Peer-run crisis services

Sacramento County's MHSA-funded Crisis Stabilization Unit provides sixteen beds for adults experiencing psychiatric crises, offering 24/7 admission and short-term residential treatment. This facility accepts law enforcement drop-offs, providing a medical alternative to jail.

Kern County's Crisis Stabilization Unit similarly uses MHSA funding to operate crisis beds, mobile crisis response, and crisis intervention training for law enforcement and community members.

Whole Person Care Programs

Several California counties have implemented Whole Person Care initiatives that provide intensive care coordination for individuals frequently utilizing crisis services and criminal justice.

San Diego's Whole Person Wellness identifies individuals who cycle through jails, emergency rooms, psychiatric hospitals, and homeless services, then provides intensive case management addressing all their needs simultaneously—housing, treatment, physical health, benefits, legal issues. By coordinating across systems that normally operate in silos, the program reduces crisis episodes and criminal justice involvement.

Contra Costa County's Whole Person Care similarly targets high utilizers, providing field-based services, housing support, and coordination across health, mental health, substance use, and criminal justice systems.

Training Initiatives

POST Crisis Intervention Training: The California Commission on Peace Officer Standards and Training (POST) has developed Crisis Intervention Training curricula that many departments use to train officers statewide. The training covers:

• Mental illness recognition and response
• De-escalation techniques
• Autism and developmental disability awareness
• Substance use and withdrawal
• Trauma-informed approaches
• Community resources and referral pathways
• Legal issues including conservatorships and psychiatric holds

UC Davis LEAD Crisis Intervention Training: UC Davis developed a comprehensive crisis intervention training program used by law enforcement agencies throughout Northern California, providing practical skills for responding to individuals in mental health crisis.

Technology Solutions

Los Angeles's Data-Driven Jail Diversion: Los Angeles developed a data-matching system that identifies individuals cycling through jails, emergency rooms, psychiatric hospitals, and homeless services. When someone is arrested, the system alerts diversion staff who can intervene immediately, accessing comprehensive histories and coordinating appropriate placements rather than allowing another incarceration episode.

Crisis Hotlines and Text Lines

California's Statewide Crisis Line provides 24/7 access to trained counselors who can provide crisis support, conduct suicide risk assessments, and dispatch mobile crisis teams when needed. The line accepts calls from individuals in crisis, family members, law enforcement, or anyone concerned about someone's safety.

The implementation of 988 (the national mental health crisis line) in California has expanded crisis phone support capacity, with links to local mobile crisis teams that can provide in-person response when callers need more than phone support.

Challenges and Limitations

Despite expansion, California's crisis services remain inadequate to meet demand. Crisis stabilization beds fill quickly, mobile crisis teams have limited capacity and wait times for outpatient treatment can be weeks or months. This means even well-trained officers sometimes lack anywhere to take people in crisis except jail or emergency rooms.

Rural California counties often lack the infrastructure that urban areas have developed. Counties with smaller populations struggle to maintain 24/7 crisis teams or dedicated facilities, meaning rural residents in crisis still face primarily law enforcement responses.

Many California crisis intervention programs rely on temporary grants, MHSA funds that face periodic challenges, or county general funds vulnerable to budget cuts. Programs can lose funding just as they demonstrate effectiveness, disrupting relationships and infrastructure that took years to build.

Effective crisis intervention requires seamless coordination across law enforcement, mental health, hospitals, housing, and social services—systems that often have incompatible data systems, conflicting priorities, and territorial dynamics. Building and maintaining these partnerships demands sustained leadership and resources.

As crisis response shifts from traditional law enforcement to alternative models, questions arise about quality control, training standards, response times, and accountability when interventions fail. California continues developing regulatory frameworks for these newer models.

Not everyone in mental health crisis can be safely diverted from criminal justice. When individuals are violent, when crimes are serious, or when public safety risks are high, crisis intervention approaches must balance therapeutic goals with safety imperatives. Determining which situations require law enforcement versus clinical response remains challenging.

The Future of Crisis Intervention in California

California continues to innovate and expand crisis intervention within criminal justice:

Expansion of Non-Law Enforcement Response: Following successful pilots, more cities are deploying unarmed crisis teams to handle behavioral health calls that do not require police.

Investment in Infrastructure: Counties are building more crisis stabilization beds, crisis residential programs, and psychiatric emergency capacity—creating destinations for people in crisis beyond jails and emergency rooms.

Enhanced Training: Law enforcement training increasingly emphasizes de-escalation, procedural justice, and trauma-informed response, with some departments requiring all officers (not just volunteers) to complete crisis intervention training.

Data Integration: Systems are slowly improving data sharing across criminal justice, healthcare, and social services, enabling coordinated responses to individuals who cycle across systems.

Peer Specialist Integration: Crisis programs increasingly employ people with lived experience of mental illness, incarceration, homelessness, or addiction—individuals whose personal journeys give them unique credibility and insight when supporting others in crisis.

Community-Based Solutions: Recognition is growing that communities most affected by over-policing should lead crisis response in their neighborhoods, with investment flowing to community organizations rather than exclusively through government agencies.

Crisis intervention within California's criminal justice system represents a profound reimagining of how society responds to behavioral health emergencies. Rather than treating mental health crises, substance use, and homelessness purely as criminal matters requiring arrest, California is building comprehensive systems that connect people to care, treatment, and support. This shift reflects both compassion and pragmatism, recognizing that human dignity demands better responses than jail cells, and that communities are safer when people's underlying needs are addressed rather than merely punished.

The work remains incomplete and uneven, with significant gaps between urban and rural capacity, persistent funding challenges, and ongoing questions about how to balance therapeutic interventions with public safety. Yet the trajectory is clear: California is moving toward crisis intervention approaches that treat behavioral health emergencies as health crises requiring health responses, reserving criminal justice for situations that genuinely require it. This transformation—driven by advocates, people with lived experience, progressive law enforcement leaders, mental health professionals, and elected officials—continues reshaping how California's criminal justice system encounters its most vulnerable residents.