Beyond arrest: Behavioral health crisis co-response for counties

How mental health funding cuts impact crisis response in local government

Across America, crisis scenarios play out millions of times each year. A call is made to 911 regarding a person in psychiatric distress; a patrol officer arrives. Without anywhere else to turn, the officer makes an arrest. This is the reality of a human in the grip of a mental health or substance use crisis entering a criminal justice system wholly unprepared to treat them. This problem has health and human services agencies all over the country looking for better solutions.

This scenario is not a rare occurrence, but a predictable outcome of policy by default. The threat of mental health funding cuts is continuously looming on the horizon. The weight of providing mental health response and treatment falls almost entirely on local government. Public agencies are paying for it in dollars, in human suffering, and in public safety outcomes that fall short for everyone.

The financial toll of this pattern is significant, even though the field itself acknowledges no single audited figure captures it precisely. A 2017 review by the Treatment Advocacy Center concluded that no national or state level data exist that quantify the cost of serious mental illness on law enforcement, corrections, or related systems.¹ Advocacy groups have estimated that incarcerating people with mental illness costs the federal government $81 billion and states $71 billion annually, a combined $150 billion figure that is widely cited in the field, but not traceable to a single audited government source.²

More conservative, government-sourced accounting points in the same direction. The Bureau of Justice Statistics reports that combined federal, state, and local justice system expenditures reached $305 billion in 2017 (the most recent year available), which is up 62% in real terms from $188 billion in 1997. Of that total, state and local governments alone spent about $241 billion, roughly 8% of all state and local government spending.³

The cost of treating a behavioral health crisis in a correctional facility

One in five U.S. adults experiences a mental illness each year, yet over half go untreated. For children and youth, the numbers are equally stark. Counties fund and operate mental health services like crisis lines, mobile response teams, treatment programs, housing supports, and justice diversion. Government spending on mental health treatment and programs is significant. America's counties collectively invest more than $130 billion annually in community health systems.⁴ Yet despite this investment, jails and emergency departments remain the first, and often only, response for individuals in behavioral health crisis.

A 2014 Pew analysis found that correctional health care accounts for roughly a fifth of overall state prison budgets. One third of incarcerated people have a mental illness, and one quarter have a co-occurring mental illness and substance use disorder. This population’s care disproportionately drives health spending, even though the Pew data does not isolate the share of the health budget attributable to behavioral health conditions specifically.⁵

A federally funded simulation of the U.S. state prison population went a step further. It modeled the lifetime criminal justice cost savings of diverting substance-using prisoners into community-based treatment, rather than incarceration. The savings were substantial, even after accounting for the cost of treatment itself.⁶

The gap between the cost of jailing someone in crisis and the cost of treating them is not marginal. In Los Angeles, community-based housing and clinical care for people with serious mental health needs runs about $180 a day, compared with $445 to $650 a day to hold the same person in the county's jails.⁷ When considering mental health funding cuts as part of the equation, counties are, in effect, paying a premium to make the underlying problem worse.

The good news is that a growing body of evidence, forged at the county level, is demonstrating where government spending on mental health is most effective. The harder pill to swallow is that the policy and financing environment surrounding these programs has never been more uncertain. County leaders who care about diversion cannot afford to wait for Washington to stabilize. They must act now, strategically, collaboratively, and with a clear understanding of both the opportunity and the obstacles ahead.

Why diversion is a public safety, public health, and fiscal imperative

Incarceration is expensive, and it’s clinically counterproductive for individuals whose primary need is mental health or substance abuse treatment. In Fairfax County, Virginia, the director of diversion initiatives has noted that community-based treatment costs a fraction of what taxpayers spend on jail.⁸ Nationally, individuals with untreated serious mental illness cycle through emergency departments, jails, and crisis facilities at extraordinary cost. This pattern is sometimes called the “familiar faces phenomenon”, where a small number of high-need individuals drive a disproportionate share of emergency, criminal justice, and hospital expenditures.

The criminal justice system was not designed to treat mental illnesses or substance use disorders, and it does not do so effectively. Criminalization disrupts continuity of care, damages housing stability, and deepens the social determinants that worsen behavioral health outcomes. For communities of color (who are disproportionately arrested for behavioral health-related conduct), the consequences compound across generations. Mental health funding cuts serve to exacerbate these issues because of increasingly scarce resources and burgeoning at-risk populations.

Diversion, when designed well and resourced sustainably, interrupts this cycle. It connects people to treatment when they need it most, reduces recidivism, lowers long-term public costs, and returns law enforcement to what they are trained to do. The question is no longer whether diversion works, but whether counties have the policy frameworks and financial architecture needed to implement and maintain it.

Understanding the model: Behavioral health crisis co-response

Behavioral health crisis co-response teams pair law enforcement officers with master's level clinicians—typically Licensed Clinical Social Workers or Licensed Professional Counselors—to respond to 911 calls involving behavioral health.

Teams operate in one of two modes:

1. Primary response, in which an officer and clinician ride together and respond jointly to behavioral health calls.
2. Secondary response, in which a clinician deploys separately to provide clinical support after an officer's initial assessment.

Once on scene, co-response teams de-escalate the situation, conduct crisis screening and assessment, and connect individuals to appropriate services. This may mean a referral and resources in place, transport to a crisis stabilization facility, or connection to follow-up care. Many programs include peer support specialists and dedicated case management for follow-up after the encounter.

Co-response is most effective when understood not as a standalone intervention, but as one component of a crisis intervention continuum. The Sequential Intercept Model (SIM) is a widely used planning framework. It maps six points at which individuals with behavioral health needs interact with the criminal justice system, from initial community contact and 911 dispatch through arrest, courts, jails, and re-entry.⁹

Effective county systems create diversion pathways at multiple intercept points:

• Pre-arrest co-response teams
• Supervised pre-trial release
• Mental health dockets and specialty courts
• Jail-based treatment with robust re-entry planning

Successful diversion efforts from leading county programs

Working around mental health funding cuts, co-response emerges as a strategic and practical approach. The counties achieving the strongest outcomes are those treating diversion as a systems transformation project, not a single program add-on.

Fairfax County, Virginia: Diversion First

Launched in 2016 using the SIM as its foundational framework, Diversion First has grown into one of the most comprehensive county-level behavioral health diversion systems in the country. The behavioral health program now includes four co-responder teams, a post-response team, behavioral health liaisons embedded at the 911 call center, three specialty courts, supervised pre-trial release, and peer recovery support. It also includes the Merrifield Crisis Response Center, a 24/7 crisis assessment site where law enforcement can transport individuals instead of sending them to jail.

Since 2016, Diversion First has achieved more than 3,800 diversions from potential arrest through 2023, with the program continuing to grow.¹⁰ County leadership, including the sheriff and police chief, championed the initiative from the outset, demonstrating that law enforcement buy in is not a barrier to diversion, but a prerequisite for its success.

Lane County, Oregon: CAHOOTS

In Lane County, the Crisis Assistance Helping Out On The Streets (CAHOOTS) program has been operating for more than 30 years, making it the most mature community responder model in the country. CAHOOTS deploys teams of medics and crisis workers (without law enforcement) to respond to behavioral health calls, public disturbance, wellness checks, and housing crises. Certain call types (including suicidal subjects, welfare checks, and housing crises) are routed to CAHOOTS by default.

The model is community-governed, with a Stewardship Council that includes diverse representation from the community it serves. CAHOOTS has become a national reference model, with a consulting arm that actively assists other jurisdictions seeking to replicate it.¹¹ The program's longevity demonstrates that when communities keep investing, over time these systems become both trusted and durable.

Travis County, Texas: Crisis Care Diversion Pilot

Travis County's approach illustrates the power of multi-funder partnerships and intentional system design. The county, the City of Austin, Central Health, Integral Care, and the Texas Health and Human Services Commission co-funded a pilot program expanding psychiatric emergency services to 24/7 operations. They also launched a Therapeutic Diversion Program for individuals with complex behavioral health needs, particularly those experiencing homelessness and frequently cycling through emergency services.

The pilot was explicitly designed to generate data and build stakeholder alignment for a larger, system-scale diversion center.¹² This phased approach, pilot first, scale second, offers a replicable model for counties that cannot politically or fiscally commit to a comprehensive system in a single budget cycle.

King County, Washington: MIDD Behavioral Health Sales Tax

King County demonstrates what is possible when communities vote to dedicate a local revenue stream exclusively to behavioral health. The Mental Illness and Drug Dependency (MIDD) sales tax fund directly served 28,113 residents in 2024, the highest in program history. This included more than 6,000 individuals who are ineligible for Medicaid and would otherwise have had no access to publicly funded care.

MIDD investments target prevention, crisis diversion, recovery, re-entry, and therapeutic courts. Participants have experienced a 29% decrease in emergency department visits and a 61% decrease in psychiatric inpatient hospitalizations.¹³ As the federal funding environment grows more volatile, MIDD offers a compelling model for counties willing to make the case to their voters.

Funding for mental health in Pennsylvania: Programs to draw inspiration from

Pennsylvania's counties are increasingly demonstrating that effective diversion is achievable when funding for mental health is prioritized. Pennsylvania behavioral health programs are using diversion across a range of geographies, from suburban communities to rural tri-county joinders, and at varying scales of investment. Three programs illustrate the Commonwealth's growing commitment to building community-based alternatives to criminalization.

Pike County: Carbon-Monroe-Pike CIT Program

Pike County is part of the tri-county Carbon-Monroe-Pike Mental Health/Developmental Services (CMP MH/DS) CIT Program, and it’s one of Pennsylvania's longest-running regional crisis intervention initiatives. It was established in 2010 and structured around the nationally recognized Memphis Model.  The program brings together law enforcement agencies, behavioral health providers, county legislators, advocacy organizations, and individuals with lived experience to improve crisis response across all three counties. Officers participate in a rigorous 40-hour certification course, covering mental health symptoms, de-escalation techniques, and community resource navigation.

What distinguishes this behavioral health program is its sustained investment in data and accountability. CIT officers complete a CIT Crisis Data Sheet after every behavioral health crisis encounter. This triggers rapid follow-up by case managers or crisis providers, often within hours of the initial law enforcement contact. Monthly stakeholder meetings in each county review outcomes, address complex cases, and identify systemic barriers. Since inception, 73 individuals have completed the 40-hour certification course, with 53 law enforcement officers now CIT certified across the tri-county area.¹⁴ The program's emphasis on building a feedback loop between law enforcement encounters and behavioral health follow-up reflects a key principle of effective diversion. The first contact is not the end of the intervention, but the beginning.

Bucks County: Human Services Co-Responder Program

Bucks County's Co-Responder Program was launched in December 2020 as a pilot in Bensalem Township, the county’s largest municipality. It has grown into one of the most expansive county-run co-responder models in Pennsylvania, recognized with a 2023 NACo Achievement Award.¹⁵ The program pairs county social service professionals with police departments to respond to 911 calls involving mental health, substance use, aging, and domestic concerns. Co-responders follow up on cases for weeks and months after the initial incident, providing a continuity of care that law enforcement alone cannot offer.

The results from the Bensalem pilot, evaluated by Holy Family University, are striking. Of cases where arrest was a possibility, 55% were diverted from jail and connected to behavioral health or human services instead. Before the program, 20% of callers to the Bensalem police department were identified as high utilizers, meaning individuals calling 911 three or more times in a given period. That figure dropped to 2% following co-responder engagement, as high-need individuals were successfully linked to community providers.¹⁶

The behavioral health program has since expanded countywide, with co-responders now embedded in 18 police departments across upper, central, and lower Bucks County and more than 1,100 people served. In November 2024, the county hosted its first Law Enforcement and Human Services Symposium. It brought together nearly 150 law enforcement and human services leaders to share best practices and advance the county's behavioral health crisis continuum, signifying that co-response has moved from pilot to institutional culture.¹⁷ However, a key sustainability challenge remains. The county initially pledged funding for mental health co-responders, in each area, for two years before municipalities assumed responsibility. This underscores the importance of planning long-term financing from the outset.

Huntingdon/Mifflin/Juniata (HMJ) Behavioral Health Joinder

The HMJ Joinder, administered by Juniata Valley Behavioral and Developmental Services (JVBDS), serves approximately 117,000 residents across 1,678 square miles of rural central Pennsylvania. This expansive geography makes traditional co-response staffing models economically and logistically difficult. Rather than attempting to replicate an urban co-response model, JVBDS built a layered diversion infrastructure tailored to rural realities. Crisis Intervention Team training is conducted annually in all three counties.

Every police officer, trooper, and sheriff's deputy in the tri-county area received resource cards with a QR code linking individuals directly to a self-referral page for the HMJ Base Service Unit. This simple, low-tech tool creates a warm handoff at any law enforcement encounter. JVBDS also piloted a co-responder program in Lewistown Borough, funded through a grant from the Pennsylvania Commission on Crime and Delinquency (PCCD). This program integrated behavioral health coordination with the courts and Criminal Justice Advisory Boards across all three counties.¹⁸

The HMJ model is a reminder that rural counties don’t need to choose between doing nothing and building a system they cannot afford. A phased, grant-funded approach, beginning with CIT training, adding resource navigation tools, and piloting co-response in a single municipality, can build the foundation for a more comprehensive diversion system over time. The lesson for similarly situated counties is both practical and political. Start where you can, demonstrate results, and use data to make the case for expanded investment.

These three Pennsylvania programs reflect the full spectrum of what county-level diversion can look like. Pennsylvania's statewide CIT Training and Technical Assistance Center (CIT TAC) launched with nearly $2 million in PCCD investment. It’s supported by U.S. Department of Justice Byrne SCIP funding and now provides a statewide infrastructure for counties (at any stage of development) to access training, peer learning, and one-on-one technical support, a model that other states would do well to replicate.¹⁹

What will the future of local government funding for mental health look like?

These county-level behavioral health programs show what can be done to effectively reroute people away from arrest in times of mental health crisis. Diversion is an achievable goal and can be successful across a wide range of settings, and at varying scales of investment. When counties prioritize funding for mental health and cross-collaboration with other private sector providers and local government response teams, impactful change is possible.

The evidence for diversion is strong. What is far less certain is the policy and financing environment these behavioral health programs depend on to survive.

In part 2, I’ll address Medicaid instability, federal block grant cuts, mental health parity rollbacks, and the Medicaid IMD exclusion, along with the concrete steps counties can take to build a more durable financial foundation.

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