Treatment, Not Handcuffs: How Cities Are Dismantling the Criminalization of Mental Health and Addiction

In the spring of 2021, a man experiencing a severe psychiatric episode walked into a Denver neighborhood park and began shouting. In previous years, a call to 911 would have dispatched armed officers whose training offered limited tools for de-escalation and whose presence — in a neighborhood with a history of police violence — was itself a source of fear. On that day, the response looked different: a van arrived carrying a paramedic and a licensed mental health clinician. No weapons. No handcuffs. No arrest.

The man received immediate support, was connected to a crisis stabilization center, and was not charged with any offense. He was also alive.

That response was made possible by STAR — Support Team Assisted Response — Denver's civilian crisis intervention program, which launched as a pilot in 2020 and, within its first six months, responded to more than 700 calls without a single police backup request. The program has since expanded, and its outcomes data has been cited by advocates in dozens of cities attempting to build similar alternatives.

Denver's experiment is one node in a much larger shift underway in the United States — a fundamental reconsideration of who should respond to mental health emergencies and substance use crises, and what those responses should look like.

The Criminalization Pipeline

To understand why this reconsideration matters, it is necessary to understand the scale of the problem that the existing system has created. The United States incarcerates more people with serious mental illness than it treats in psychiatric hospitals. An estimated 2 million people with mental health conditions are booked into jails each year, according to the National Alliance on Mental Illness. People experiencing psychosis or severe depression are far more likely to encounter a patrol officer than a psychiatrist — and that encounter frequently ends in arrest, injury, or death.

The pattern with substance use is equally damning. Despite decades of evidence that addiction is a public health condition rather than a moral failing, the dominant American response has been prosecution. The War on Drugs — launched in the early 1970s and never formally concluded — has resulted in the arrest of more than 40 million people for drug offenses since its inception, the vast majority for simple possession. It has devastated Black and Latino communities, destroyed families, consumed hundreds of billions of dollars in law enforcement resources, and produced no measurable reduction in drug use or addiction rates.

The carceral approach to mental health and addiction is not merely ineffective. It is actively harmful, cycling people through jails and courts in ways that worsen underlying conditions, sever community connections, and make recovery structurally more difficult.

Oregon Shows a Different Path — and Its Complications

In November 2020, Oregon voters approved Measure 110, the most sweeping drug decriminalization policy enacted in United States history. The measure eliminated criminal penalties for personal possession of all controlled substances and redirected a portion of cannabis tax revenue toward a statewide network of addiction recovery centers. It was, in its ambition, a direct repudiation of the criminalization paradigm.

The implementation has been instructive in both its promise and its difficulty. The funding mechanism — cannabis taxes — proved slower to generate revenue than advocates had projected, delaying the buildout of treatment infrastructure. Law enforcement agencies, accustomed to the discretion that criminalization afforded, were often reluctant partners in the transition. And the political backlash, fueled by media coverage that attributed visible street-level drug use to decriminalization rather than to decades of disinvestment in housing and treatment, was fierce.

In 2024, facing significant political pressure, the Oregon Legislature recriminalized possession of small amounts of drugs — a retreat that advocates described as a failure of political will rather than a failure of policy. The treatment infrastructure that Measure 110 funded, however, remained in place, and the debate it ignited has continued to shape conversations in state capitals across the country.

The Oregon experience offers a critical lesson for the movement: decriminalization without simultaneous, adequately funded investment in treatment and harm reduction is vulnerable. The demand cannot be simply to remove the police — it must be to build, concurrently, the care infrastructure that communities actually need.

Diversion Models That Are Working

Beyond decriminalization, a range of diversion programs have demonstrated that redirecting people away from the criminal legal system and toward care produces measurably better outcomes.

In Eugene, Oregon, CAHOOTS — Crisis Assistance Helping Out On The Streets — has operated since 1989, dispatching mobile crisis teams composed of a medic and a crisis worker to calls involving mental health, homelessness, and substance use. The program handles approximately 24 percent of the Eugene Police Department's total call volume annually, at a fraction of the cost of a police response. Its model has been studied and replicated in cities including Oakland, Olympia, and Olympia.

In New York City, the B-HEARD program — Behavioral Health Emergency Assistance Response Division — has deployed mental health teams to emergency calls in targeted precincts since 2021. Early data showed that B-HEARD teams connected a significantly higher percentage of callers to follow-up services than police-led responses, and that the vast majority of calls were resolved without any law enforcement involvement.

Harm reduction programs — needle exchanges, naloxone distribution, safe consumption sites — represent another front in this work. New York City opened the first legally sanctioned overdose prevention centers in the United States in November 2021, through the nonprofit OnPoint NYC. In the first year of operation, the two sites recorded more than 400 overdose reversals and zero deaths. Not one.

What Advocates Say — and What They Are Demanding

Organizers working at the intersection of decriminalization and public health are clear-eyed about what is required. Removing police from mental health and addiction responses is necessary but not sufficient. The resources currently consumed by criminalization — the patrol hours, the court processing, the incarceration costs — must be actively redirected into community-based infrastructure: peer support specialists, mobile crisis teams, long-term treatment beds, housing-first programs, and harm reduction services.

"People keep asking whether we're ready to replace police with something else," says one organizer with a drug policy reform coalition in the Midwest who asked not to be named due to concerns about professional retaliation. "We've been ready. What we haven't had is the political will to fund what we know works and stop funding what we know doesn't."

That political will is being built, incrementally, through campaigns that combine direct service, legislative advocacy, and public education. The National Harm Reduction Coalition, the Drug Policy Alliance, and dozens of local organizations are pressing city councils and state legislatures to adopt treatment-first frameworks — not as an act of compassion, but as a structural commitment grounded in evidence.

The Abolitionist Frame

For those working within an explicitly abolitionist framework, the decriminalization of mental health and addiction crises is not a reform at the margins of the system — it is a demonstration of what becomes possible when the system's foundational assumptions are challenged. The assumption that police are the appropriate response to human suffering. The assumption that punishment produces healing. The assumption that the state's capacity for coercion is a substitute for its obligation to care.

Each program that proves otherwise — each overdose reversed by a harm reduction worker, each psychiatric crisis resolved without an arrest, each person connected to treatment rather than prosecution — is evidence that the abolitionist argument is not utopian. It is practical.

The work of building a world in which mental health and addiction are met with care rather than cages is ongoing. It is also, demonstrably, already underway.