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Last month in Louisville, Kentucky, Katelyn Hall was in exactly the kind of mental health crisis that has led cities across the country to seek a different kind of emergency response. It ended with police shooting her dead.
The 28-year-old was experiencing suicidal ideation and was harming herself in a locked bathroom on March 27, according to her cousin, who called 911 for help. An NPR analysis of body camera footage found that after police arrived, they broke down the bathroom door, and one officer shot Hall seven times as she took several steps towards them while holding a long, jagged piece of broken porcelain.
Louisville has a mental health “deflection” program that routes some emergency calls — including those involving suicidal ideation — to mental health professionals instead of police. But Hall’s case, with reports of a potential weapon and other people present in the apartment, wasn’t eligible.
Now, some in the Louisville community are questioning why the city does not have a “co-responder” program that allows police and mental health professionals to respond to cases like this together. They note that the city promised to launch the program in a settlement agreement with the estate of Breonna Taylor, whom police killed in 2020. Although Taylor’s death was not the result of a mental health call, her family sought several progressive police reforms in the negotiations, reaching far beyond her specific circumstances.
A representative for Mayor Craig Greenberg told the Louisville Courier-Journal that he couldn’t speak to promises made under the previous mayoral administration, but that Greenberg was actively considering plans for a co-response model.
Programs that send mental health professionals instead of police, or alongside police, to people in the midst of behavioral crises have spread rapidly in recent years, largely spurred by the 2020 racial justice protests. Some version of this concept now exists in 44 out of the country’s 50 largest cities, according to a 2024 study. But a lot actually turns on the seemingly technical question of “instead of” vs “alongside” police.
When the decision is binary, like in Louisville, it can lead to officers being dispatched by default in potentially volatile situations where a clinician might have been able to successfully de-escalate and get help for a person in crisis. Co-response programs can theoretically help to solve this problem, but critics say they create others. In a March report, the advocacy group Human Rights Watch argued that “the mere presence of officers, especially armed and uniformed officers, can escalate rather than de-escalate crisis situations.”
While that distinction between a co-responder and alternative responder strategy matters a lot, in the aftermath of a shooting or another disastrous encounter, families and communities are often making a more basic demand: A person in crisis should be met by someone equipped to help.
That impulse has surfaced in city after city. In Hartford, Connecticut, in February, two fatal police shootings of men reportedly experiencing mental-health crises prompted community members to call for more social workers and crisis-intervention capacity. In Baltimore County, Maryland, Helen Haley said she called the 988 mental health hotline instead of 911 when her son, who has autism, was in the midst of a suicidal crisis with a knife. She believed calling 988 would bring clinicians or other trained professionals. Police showed up instead and shot 27-year-old John Haley more than a dozen times, leaving him paralyzed.
“We did everything the system asked us to do, and it still nearly killed him. We are not asking for perfection. We are demanding humanity,” Helen Haley said at a press event earlier this month.
In New York City, Gothamist reported that in two recent police shootings involving people in behavioral crisis, family members explicitly asked 911 for medical help rather than police. The calls were classified in ways that automatically triggered an armed response.
In San Jose, California, demand is also taking the shape of legal pressure. This month, a group of advocacy organizations, including the American Civil Liberties Union, sent a letter to the city arguing that failing to divert a higher number of calls to non-police crisis teams violates the Americans with Disabilities Act.
Some cities are responding to that kind of demand, and to early signs of success with unarmed response teams, by formalizing or expanding crisis response infrastructure. In February, the Los Angeles City Council voted to make permanent an alternative response pilot program that has handled more than 17,000 service requests since 2024. And in New York, Mayor Zohran Mamdani recently created a new Office of Community Safety to oversee and expand programs like B-HEARD, the city's existing alternative response pilot — an expansion that the new head of the office discussed with my colleague Wilbert Cooper in a recent edition of this newsletter.
But elsewhere, many programs are strapped for cash and facing uncertainty, especially in smaller cities and counties with a rural footprint. In Santa Barbara County, California, four co-responder teams cost roughly $1.9 million a year, and a combination of precarious grant revenue and changes to state funding priorities may lead to service cutbacks. A co-responder program in Clive, Iowa, meanwhile, could be disbanded as state funding begins to sunset.
Crisis response involves clinicians providing mental health care. Theoretically, health insurance, including Medicaid, could foot a large part of the bill for these services. In reporting earlier this month, however, Kaiser Family Foundation Health News noted that many private insurers don’t cover mobile crisis care, and that in Montana, the state only allows for Medicaid to cover the time of an interaction, not the time they are traveling to or doing paperwork on a client. These, alongside other funding challenges, have already contributed to the closure of two programs in the state, with six remaining but struggling.
Angela Kimball, a mental health policy advocate, told Kaiser Family Foundation Health News that for crisis response to work, funding needs to be guaranteed in the ways that traditional emergency services are. “You need to pay for the capacity to be at the ready, just like we do with fire or police, regardless of whether somebody is going to be called out,” she said.
The city of Columbus, Ohio, is poised to take at least one step toward this kind of parity. Voters next month will consider a proposal to make the city the first in the country to enshrine a crisis response program in its official charter, the way that police and fire departments are. The measure would also allow crisis teams to respond to some kinds of calls without a police officer.