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While National Debate Over Homelessness Grows, Cities are Finding Ways to Disrupt the Cycle of Crisis

In the second in a series of issue briefs, the National League of Cities and Arnold Ventures examine how cities are coordinating responses from multiple agencies — first responders, hospitals, courts, and community groups — to better support crisis stabilization.

Partnering police and local EMS with behavioral health and social service providers can help ensure an emergency response connects seamlessly to treatment. (Getty Images)

If cities want to improve outcomes for people experiencing homelessness, they need to encourage more collaboration between agencies — including first responders, hospitals, housing authorities, courts, and community groups — to better support people in crisis.

That’s the key message from a new issue brief, the second in a series by the National League of Cities and Arnold Ventures, that examines city-level approaches to addressing the interconnected challenges of mental illness, substance use disorder, and homelessness.

The brief couldn’t have come at a better time. 

Conversations about homelessness, an issue often discussed only at the local level, have grown into a national debate. The White House recently released a report on homelessness that received pushback from critics who said it overemphasized punitive policing as a solution. President Trump also made headlines for his comments specifically targeting cities in California that are on the front lines of this public policy challenge.

While partisan debate seems to dominate at the federal level, local governments and emergency responders have become increasingly aware of how complex and interconnected issues like homelessness, mental illness, and substance use disorder require a reexamination of traditional approaches. New and better coordinated responses rely on the broad impact of cross-system collaboration: breaking down the siloization of services and linking together first responders, social services, and public health entities.

In too many places, law enforcement officers are called in to respond to people in crisis without proper mental health and de-escalation training, knowledge of appropriate and available community-based resources, and without a way to connect people to long-term services and effective treatment,” said Nicola Smith-Kea, a criminal justice manager at Arnold Ventures. The report offers examples of cross-system collaboration and emergency response models that cities have successfully implemented, with three key takeaways:

  1. Cross-system approaches can produce better outcomes for vulnerable populations during emergency and crisis stabilization responses.
  2. First responders play a unique role in emergency response and crisis stabilization initiatives by serving as an entry point to broader systems of care.
  3. Several cities across the country attribute the success of their emergency response and crisis stabilization efforts, in part, to cross-system collaboration.

Under cross-system collaboration, two or more sectors share their information, resources, activities, and capabilities to achieve an outcome they couldn’t accomplish on their own, according to the brief. This coordination allows for a more efficient use of resources, the creation of a continuum of support so that individuals don’t fall through the cracks, and shared performance measures so that efficacy can be measured systemwide.

U.S. adults living with a mental illness in 2017
U.S. adults living with substance use disorder in 2014
U.S. adults who experienced homelessness on a single night in January 2018

For example, the city of Huntington, W.V., which is grappling with the opioid crisis, created a Quick Response Team to treat and house individuals with behavioral health and drug issues. The QRT is a partnership between city agencies, medical providers, mental health specialists, law enforcement, university researchers, and the faith community. The goal: Visit every person who experienced an overdose within 72 hours, provide a personalized plan for intervention, and connect individuals with any needed local resources.

Ideally, every city would have robust psychiatric infrastructure to care for people in crisis. But the closure of long-term psychiatric hospitals has left a gap in care, requiring an expanded role of first responders like police, fire, and EMS. In response to this growing need, cities have begun to rely on the Crisis Intervention Team model that better trains and equips police to serve as mental health interventionists.”

In San Antonio, the city police department’s Mental Health Detail includes a mix of officers, social workers, and health care providers who are tasked with responding to behavioral health calls.

The San Antonio Police Department also has a unique homeless response partnership called the Integrated Mobile Partners Action Care Team (IMPACT). This partnership unites the Mental Health Detail, local EMS, and behavioral health and social service providers to ensure an emergency response can connect seamlessly to crisis stabilization and treatment.

And in Wichita, Kan., local police created a Homeless Outreach Team after the city’s chronic homelessness rate doubled between 2009 and 2011. HOT officers receive special training and are required to have proper certification and continuing education for homeless intervention, making them frontline experts in homelessness.

In addition to connecting people experiencing homelessness with specific programs, HOT also operates as part of the city’s federally funded Continuum of Care. This includes training business owners on communicating with people experiencing homelessness and educating community groups on how to support existing homelessness programs and services.

We’re starting to see cities build robust, collaborative system-level responses to intentionally and with success disrupt a cycle of crisis and incarceration,” said Smith-Kea.

Read the full issue brief here.