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

The survey, carried out by the National Poll on Healthy Aging, found that 31% of adults over 50 have never heard of any mental health crisis helpline, with 69% unfamiliar with the 988 number specifically. Notably, 38% fell into a subgroup who were unaware of 988 but knew of other crisis lines. Encouragingly, once provided with a brief explanation of the 988 service, 75% indicated they would feel at least somewhat comfortable reaching out if faced with a mental health crisis. However, comfort levels varied by gender; men were less likely to express willingness compared to women.

This disparity in awareness and readiness holds particular urgency in light of demographic suicide statistics. Men exhibit a suicide death rate nearly four times higher than women, and suicide rates among Hispanic adults have escalated recently. Among all adults over 50, suicide rates have notably surpassed those of teens and young adults, underscoring the critical need for effective outreach and education about crisis resources within this age group.

The 988 Lifeline links callers not only to mental health support but also provides immediate access to specialized Veterans Crisis Line services. Importantly, 988 is confidential and aims to protect privacy, a common concern cited by poll respondents. The service offers multilingual support, including Spanish and interpretation for deaf or hard-of-hearing individuals, addressing accessibility across diverse populations.

Further insights from the poll suggest that over 80% of those surveyed would turn to friends, healthcare providers, or mental health professionals during crises, pointing to the importance of equipping caregivers and community members with information about available resources like 988. Despite the evident benefits, ongoing funding challenges threaten the sustainability of 988 services nationwide, with many states yet to establish permanent financing structures.

A related Harvard study highlights a promising trend: suicide rates among younger populations have decreased more substantially post-988 launch than in older adults, suggesting that targeted awareness campaigns for older adults could improve outcomes. Mental health experts advocate for continued public education to close knowledge gaps and encourage utilization of available crisis interventions.

As the mental health landscape evolves, ensuring that all Americans, especially those over 50, are informed and comfortable accessing emergency mental health services remains a pressing public health priority.

Subject of Research: People
Article Title: Not specified
News Publication Date: 2025
Web References:
– https://988lifeline.org/
– https://michmed.org/PPXwv
– https://www.veteranscrisisline.net/
– https://ihpi.umich.edu/national-poll-healthy-aging/michigan-findings
References: Not specifically listed
Image Credits: Emily Smith – University of Michigan
Keywords: Crisis intervention, Mental health, Clinical psychology, Suicide, Older adults, Substance abuse

Dr. Kessler’s journey into psychiatric epidemiology started from an unlikely place: a Quaker village in Pennsylvania. Initially aspiring for a legal career as a first-generation college student, his academic curiosity was awakened by a mentor who recognized his analytical potential. Transitioning through sociology and criminology, Kessler’s empiricism matured with methodological rigor under the tutelage of experts at the University of Wisconsin and the New York State Psychiatric Institute. This eclectic academic foundation enabled him to approach psychiatric epidemiology with unique survey methodologies and an appreciation for longitudinal research designs—critical for disentangling the complex trajectories of mental disorders over time.

A turning point in his career emerged during his tenure at NBC, where Kessler confronted high-stakes, fast-paced survey research applied to television violence and child mental health. This exposure to real-world decision-making and rapid evaluation of data instilled in him an urgency to produce actionable knowledge. Unlike conventional academic settings, this environment demanded robust analytic strategies that could influence programming and advertising in near real-time, fueling Kessler’s commitment to methodological excellence coupled with pragmatic relevance.

At the University of Michigan, Kessler honed his expertise, benefiting from one of the world’s premier survey research institutions. Here, he directed an interdisciplinary psychiatric epidemiology training initiative and contributed to probing how socio-economic crises influenced mental health at the population level. His work expanded understanding of the interplay between social determinants and psychiatric morbidity, and he helped pioneer longitudinal designs that captured the evolution of mental health outcomes in changing social contexts. The collaborations formed during this period laid the groundwork for his most influential projects.

Among the most defining chapters was Kessler’s role in the MacArthur Foundation’s Research Network on Successful Midlife Development (MIDMAC), which pioneered the MIDUS (Midlife Development in the United States) project. This initiative integrated diverse data types—including cognitive testing, biomarker assays, and neuroscience sub-studies—to deliver an unprecedented, multidimensional portrait of mental and physical health in midlife adults. The insights gleaned continue to inform contemporary psychiatric and public health paradigms, influencing interventions targeting wellness and resilience.

Kessler’s seminal contribution, however, resides in the National Comorbidity Survey (NCS), which he led with a mission to chart the first nationally representative epidemiologic profile of DSM-defined disorders in the United States. Utilizing the Composite International Diagnostic Interview (CIDI), an instrument standardized for international use, the NCS unveiled the staggering prevalence of mental disorders, their early age of onset, and the profound societal burdens they impose. The survey’s longitudinal design and nuanced recall techniques allowed reconstruction of disorder trajectories, exposing critical windows for intervention and advocating for parity in mental health care — findings that reverberated globally.

Capitalizing on burgeoning interest and demand from international collaborators, Kessler spearheaded the World Mental Health (WMH) Survey Initiative, aggregating psychiatric epidemiological data from over 30 countries. This unprecedented consortium dismantled prior silos in mental health research, standardizing survey methodology across diverse cultural settings, and thus enabling direct cross-national comparisons of mental disorder prevalence and treatment gaps. The corpus of over 1,000 peer-reviewed publications and numerous monographs drawn from WMH data constitutes an encyclopedic resource shaping global policy discourse.

In pursuit of translational impact, Kessler’s recent work channels epidemiological insights into precision interventions. His SAFEGUARD program, deployed within the U.S. Army, exemplifies targeted suicide prevention strategies using algorithmic risk detection coupled with integrative experimental interventions. Parallelly, his collaboration through Menssano LLC advances scalable mental health solutions for university students, integrating pre-matriculation life skills training with digital therapeutic platforms designed to augment limited campus counseling resources. These hybrid approaches exemplify the future nexus between population-level surveillance and personalized care models.

Kessler envisions the development of continuous, hybrid mental health tracking systems that amalgamate probability-based panels with digital data collection, enabling near real-time evaluations of treatment needs and policy outcomes at the population scale. He advocates for embedding continuous quality improvement frameworks within academic institutions to monitor and enhance mental health outcomes, a model with broad applicability internationally amid rising youth psychological distress. These innovations promise to revolutionize the precision and efficiency of mental health service delivery.

Central to Kessler’s methodology is a commitment to rigor, transparency, and interdisciplinary collaboration. He underscores the necessity to question longstanding assumptions, employ optimal measurement strategies, and foster intellectual honesty about study limitations. Equally, he emphasizes the catalytic role of diverse expertise converging to solve complex problems, reflecting the multifaceted nature of psychiatric epidemiology. Importantly, mentorship and inclusivity remain bedrock principles, as Kessler seeks to democratize access to knowledge and networks, particularly for emergent scientists from underrepresented groups and institutions.

Kessler’s reflections on diversity, equity, and inclusion (DEI) in the sciences highlight the underappreciated dimensions of social class within DEI efforts. He argues for expanding the lens beyond racial and ethnic minorities to include socioeconomically disadvantaged populations who face structural educational and resource barriers. By advocating upstream interventions targeting early education disparities and promoting community college pathways as bridges within higher education, Kessler calls for structural reforms that address foundational inequities impacting scientific careers and research outcomes.

Beyond his scholarly persona, the interview reveals a multifaceted individual whose passion for antiques and sport illustrate a balanced life philosophy grounded in curiosity and connection. Rejecting notions of “perfect happiness,” Kessler aspires instead to sustained well-being anchored in purpose and relationships, shaped by his unique vantage point assessing human mental health. His personal narrative intertwines with his scientific odyssey, reminding readers that the pursuit of knowledge is inseparable from human experience.

As he contemplates the future, Kessler acknowledges uncertainties surrounding the politicization of science and research funding but remains optimistic about technological innovations poised to enhance psychosocial intervention quality. His enduring legacy arguably lies in establishing a global psychiatric epidemiologic infrastructure and mentoring a generation of investigators empowered to perpetuate this work worldwide. His aphorism—“Do the best you can, with the evidence you have, in the service of others”—encapsulates a career devoted to translating data into meaningful societal benefits.

The comprehensive interview, available open access in Genomic Psychiatry, offers an indispensable resource for scientists, clinicians, and policymakers aiming to harness advanced epidemiological methods to tackle mental health challenges on a global scale. Dr. Kessler’s career trajectory and current initiatives provide a blueprint for integrating rigorous science with compassionate application, exemplifying how epidemiological innovation can illuminate the path toward improved mental health for populations everywhere.

—

Subject of Research: People

Article Title: Ronald C. Kessler: Elucidating the population burden of mental disorders

News Publication Date: 3-Feb-2026

Web References:
https://doi.org/10.61373/gp026k.0021
https://url.genomicpress.com/2zwndyph

Image Credits: Ron Kessler, PhD

Keywords: psychiatric epidemiology, mental disorders, National Comorbidity Survey, World Mental Health Survey Initiative, mental health policy, suicide prevention, precision interventions, longitudinal survey, psychiatric diagnostics, mental health disparities, epidemiologic methods, global mental health