Crisis Teams Without Cops: Landmark Review Finds Evidence Base Lags Rapid Expansion

Across the United States, cities have rushed to replace police officers with mental health professionals at the scenes of psychiatric crises. Programs like Eugene, Oregon’s CAHOOTS, Denver’s STAR, and Portland Street Response have become fixtures of policy debates, celebrated as humane alternatives to armed response. Yet according to a new scoping review published in Community Mental Health Journal, the scientific evidence underpinning this rapid expansion remains strikingly thin. Researchers Emily Leickly and Liat Kriegel of Washington State University Spokane and Christian Porter of the University of Pittsburgh screened 2,510 records and found just 16 peer-reviewed studies meeting their criteria, all published since 2019 and most since 2022. The finding is a sobering counterweight to the enthusiasm: implementation, the authors conclude, has decisively outpaced the development of an empirical evidence base.

The review, conducted according to the PRISMA-ScR reporting guideline for scoping reviews, set out to map how alternative first response programs are defined, studied, and evaluated in the academic literature. The inclusion criteria were deliberately broad but precise: eligible studies had to describe non-law-enforcement teams dispatched to calls for service involving mental or behavioral health crises. The team searched PubMed using a comprehensive set of keywords, supplemented by author-curated sources and backward searches through reference lists. That exhaustive strategy yielded only sixteen studies, a number that surprised even the investigators given the prominence of these programs in public discourse and municipal budgeting.

One of the review’s most consequential findings concerns language. Terminology across the sixteen studies varied substantially, with the phrases alternative first response and mobile crisis teams appearing most frequently. This lexical fragmentation is not merely cosmetic. When programs are labeled inconsistently, systematic comparison becomes difficult, funding applications describe different things under the same name, and policymakers struggle to know which evidence applies to which intervention. The authors found that programs were typically defined in contrast to police response rather than on their own operational terms, and were staffed by multidisciplinary teams that might include medics, social workers, peer support specialists, and counselors.

The scope of the programs studied was also revealing. Most of the existing research focused on mental health crisis response, often overlapping with homelessness and substance use, reflecting the reality that these problems are deeply intertwined on city streets. The programs emphasized three core functions: de-escalation of acute crises, linkage to services such as housing and treatment, and diversion away from the criminal legal system and emergency departments. In effect, alternative first response sits at the intersection of public health, social welfare, and public safety, attempting to resolve with clinical and social tools what has historically been handled with badges and handcuffs.

The timing of the literature is itself a data point. Every included study appeared after 2019, and the majority after 2022, which coincides with the national reckoning over policing that followed 2020. Municipalities seeking visible, concrete reforms turned to crisis response models as a politically feasible intervention, and programs proliferated faster than journals could evaluate them. The review’s authors note that this creates a peculiar situation in which cities are making multi-million-dollar staffing and dispatch decisions with limited rigorous evidence about outcomes, cost, and unintended consequences.

The gaps the review identified are as informative as the studies it found. Client experiences received limited attention, particularly among marginalized populations, the very people these programs most often serve. Only a small number of studies, such as qualitative work documenting the experiences of unhoused community members with Portland Street Response, have centered the voices of those receiving the service. Longitudinal research tracking outcomes over time is nearly absent, experimental designs are rare, and cost-effectiveness analyses, which are essential for justifying sustained municipal funding, are lacking altogether. Without such evidence, it remains difficult to answer basic questions about whether alternative response reduces arrests, emergency department use, or hospitalizations over the long term.

Some early quantitative signals from outside the review’s sixteen studies suggest the models hold promise. An analysis published in Science Advances in 2022 found that a community response approach to mental health and substance use crises in Eugene was associated with reduced crime, and subsequent work has attempted to quantify CAHOOTS’s impact on police workload through call diversion and prevention. A pragmatic randomized effectiveness trial published in Social Science & Medicine in 2024 compared police-mental health co-response with police-as-usual response to behavioral health emergencies, illustrating the kind of rigorous design the field will need more of. But the review’s authors caution that such studies remain exceptions, and that co-response models involving police are methodologically distinct from fully civilian teams.

The review also highlights structural dependencies that complicate the alternative response vision. Related research cited in the paper has documented that mobile crisis teams frequently rely on law enforcement for multiple key functions, from scene security to transportation, meaning that even civilian programs often operate within a police-centered ecosystem. National surveys have further shown that simply reaching a mobile crisis team can be difficult, with access varying widely across jurisdictions, and that new Medicaid funding opportunities are shaping implementation in ways that researchers are only beginning to track. Rural areas face additional capacity challenges, raising questions about whether models developed in dense urban settings can translate to communities without a deep bench of behavioral health professionals.

For the researchers behind the review, the path forward is clear even if the road is long. They call for more rigorous, longitudinal, and client-focused research to assess program impacts and inform implementation, policy, and funding decisions. That means randomized or quasi-experimental designs where feasible, consistent terminology and program definitions that allow cross-site comparison, deliberate inclusion of marginalized participants in studies of client experience, and economic evaluations that quantify what these programs save or cost relative to the status quo. It also means studying the full chain of response, from how calls are routed at dispatch to what happens to individuals after the crisis team leaves the scene.

The stakes of closing this evidence gap extend well beyond academic housekeeping. Alternative first response has become one of the most prominent and politically charged reforms in American public safety, embraced by advocates as a way to reduce police violence and criminalization of mental illness and homelessness, and scrutinized by skeptics worried about responder safety and accountability. Whether the model fulfills its promise will ultimately be an empirical question, not an ideological one. This scoping review provides the field’s first comprehensive map of what is known, and, more importantly, a candid inventory of what is not. Sixteen studies, all less than a decade old, is a starting point, not a foundation, and the authors’ message to funders and policymakers is unambiguous: the experiments are running, but the measurements have yet to catch up.

Subject of Research: Peer-reviewed evidence on non-police alternative first response programs for mental health crisis and homelessness

Article Title: A Scoping Review of the Peer-Reviewed Research on Alternative First Response for Mental and Behavioral Health Crisis and Homelessness

Article References: Leickly, E., Porter, C., & Kriegel, L. (2026). A Scoping Review of the Peer-Reviewed Research on Alternative First Response for Mental and Behavioral Health Crisis and Homelessness. Community Mental Health Journal. https://doi.org/10.1007/s10597-026-01730-6

Image Credits: AI Generated

DOI: 10.1007/s10597-026-01730-6

Keywords: alternative first response, mobile crisis teams, mental health crisis, homelessness, scoping review, police diversion, de-escalation, behavioral health, CAHOOTS, crisis intervention, criminal legal diversion, public health