In New Orleans, when someone calls 911 in crisis, they might meet a different kind of responder: not a police officer with a gun, but a trained counselor trained to talk someone down from the ledge. In its first year, the city's Mobile Crisis Intervention Unit responded to almost 30 percent of all behavioral health-related 911 calls—a staggering proportion that points to both the scale of mental health emergencies and the possibility of handling them without handcuffs.
This shift matters because it addresses a stubborn, painful reality: mental illness has become deeply entangled with the criminal justice system in ways that harm the most vulnerable. Research consistently shows that people with substance use disorders, homeless individuals, and those cycling between jail and the streets face far higher rates of illness than the general population. Yet the system that detains them often worsens their condition rather than healing it.
The evidence for alternatives is growing clearer. Research on CAHOOTS—a crisis response model developed in Eugene, Oregon—found that program expansions into new areas and times reduced the likelihood that a 911 call resulted in an arrest and increased access to medical services instead. This is not a small shift; it reorients an entire response ecosystem away from criminalization and toward care.
The human stakes are stark. At New York's Rikers Island jail, the rate of missed mental health appointments per 1,000 incarcerated people nearly tripled from 784 in September 2020 to 2,207 in September 2025—a figure that speaks to both deteriorating conditions and unmet need. Older adults face unique vulnerability in correctional facilities, where the physical environment itself can compound poor physical, cognitive, and mental health. Children languish in detention despite eligibility for release to community-based mental health care; a 2026 report found that seventy-five facilities across 25 states were incarcerating youth who could be treated outside the system instead.
The ripple effects reach far beyond those in custody. Research on parental arrest shows that children exposed to the experience report emotional distress even when arrest is peaceful—and heightened trauma when force is used. Veterans, too, bear a disproportionate burden: justice system involvement is linked to racial and ethnic minority status, lower income and education, combat exposure, and other lifetime traumas.
Yet policy responses have sometimes missed the mark. New York's Kendra's Law, for instance, was premised on a tragedy but overlooked what experts had long understood: the state's well-known, long-standing, and persistent lack of mental health services. Addressing the crisis requires not surveillance tools but real investment in community-based care.
The path forward is neither mysterious nor unproven. It involves expanding mobile crisis teams, protecting access to Medicaid for youth in detention, increasing substance use treatment—especially for opioid disorders—and building mental health capacity outside the walls of jails and prisons. Cities like New Orleans are demonstrating that when given a choice between handcuffs and help, systems can choose help. The question now is whether that choice will spread.