WEISER, Idaho — Washington County Paramedics launched a first-of-its-kind program to address mental health and substance abuse needs in the rural communities they serve— like Weiser, Idaho.

“It’s not easy to talk about. It’s ugly, it’s scary, it’s something that people just want to pretend doesn’t exist, but it’s a huge need,” said Ashley Lynn, a Community Paramedic for Washington County Paramedics.

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The new Community Paramedic Program focuses solely on substance abuse, mental health, and wellness — connecting residents with vital services that are often difficult to access in remote areas.

“We’re isolated a bit, we’re a long ways out here, so limited resources across the board,” Lynn explained.

Lynn says that rural communities like Weiser are especially in need of behavioral health and substance abuse resources.

“People already struggle to get the help they need just because logistically, it’s a long road to get to Caldwell or Ada County or wherever it is you might need to go to get these specialty services,” she said.

The program, which is funded by a grant, aims to reduce strain on limited local resources by connecting people with mental health services instead of tying up police and the area’s single ambulance on non-emergency calls.

“First of its kind program that’s not going [on] anywhere else in the country, so it’s super exciting to have something like that right here in Weiser,” Lynn said. “So our goal here is to be able to facilitate getting those people plugged into the services they need.”

Before this new program existed, people experiencing mental health or substance abuse crises were typically taken to either the hospital or jail. Now, Lynn and her team can respond separately to avoid those outcomes.

“Law enforcement, our responders, we interact with people who are unstable and are in crisis and can be very unpredictable,” Lynn said.

The program includes special de-escalation training for law enforcement and the paramedic team to ensure safety for everyone involved during crisis situations.

“We’re here to help and meet you where you’re at and do what we can,” Lynn said.

If you are having a mental health or substance abuse crisis, call 988. They can connect you with people in your community who can help.

The Washington State HCA recently launched a campaign called “Start Your Path” to increase awareness of a range of behavioral health careers from substance use disorder prevention to mental health counseling (Courtesy Washington State Healthcare Authority)

Sponsored content provided by Washington State Healthcare Authority

Access to mental health care provides essential intervention for those in need of support, especially when care is localized and culturally relevant. Expanding services across Washington presents a unique set of challenges in rural communities.

Wendy Brzezny, director of clinical integration for Thriving Together North Central WA (NCW), serves four counties in Washington. Though this region spans a wide geography, there is just one inpatient mental health treatment center and only two inpatient substance use treatment facilities — with only one accepting voluntary commitment.

That means a two-hour one-way car ride or longer could be necessary to reach a detox facility, which might only accept daytime referrals. The distance to treatment often means leaving behind a supportive community, along with arranging childcare or pet care to accommodate the time away.

There also may be more acute needs within rural communities. Some of the highest rates due to overdose from any drug are in Washington’s least-populated counties, including Eastern Washington’s Okanagan, Ferry and Columbia counties.

Addressing staffing gaps and providing holistic local solutions are key steps to improving outcomes in rural communities.

Professional shortages

Addressing the critical shortage of behavioral health professionals has been a key priority of the Washington State Legislature and state agencies, like the Washington State Health Care Authority (HCA) in recent years. Increasing the volume of behavioral health practitioners in a range of roles is essential to supporting a robust prevention and crisis response system, shared Todd Jensen, behavioral health workforce analyst with Washington State HCA. All counties in Washington currently experience some degree of a shortage of mental health providers, with many of the rural areas in the state experiencing this county-wide.

“Recruitment for qualified mental health and substance use providers is very difficult,” Brzezny says. “It takes a deep commitment to rural living and a passion for service to move to a sparsely populated area with fewer than 10 people per square mile, such as in Okanogan County.”

“We’re trying to grow our own and promote behavioral health careers among our own population, but it takes time to do that,” she says.

Big Bend and Wenatchee Valley community colleges are creating a Bachelor of Applied Science in Behavioral Health, Brzezny says, with the first cohort entering in Fall 2025. The hybrid classes can be taken in-person or remotely, easing long drives and other barriers preventing continued education, while building a pipeline of behavioral health professionals within the region.

Statewide, the Washington State HCA has launched a campaign called “Start Your Path” to increase awareness of a range of behavioral health careers from substance use disorder prevention to mental health counseling. In addition to providing accessible career resources for jobseekers, the campaign is also specifically focused on reaching and including bilingual and BIPOC (Black, Indigenous and People of Color) providers who reflect the diverse communities of Washington.

Professional solutions

In 2023, the Washington State Legislature passed several bills with bipartisan support designed to improve the behavioral health care workforce and access. For example, professional amendments led to newly created peer-specialist professional designations, while another bill expanded mental health first aid training. HCA provides online training and credentialing for Peer Counselors. This role helps facilitate access to recovery support and provides a potential employment pathway for those with lived experience.

Other innovations include those launched by regional organizations. For example, Thriving Together NCW, has trained over 200 recovery coaches to provide intervention and support to local community members in emergency rooms, jails, behavioral health agencies and youth nonprofits.

The coaches have lived experience and help model “what recovery looks like,” Brzezny says. “For example, we’ve had tremendous support from our region’s jails to help individuals transition into recovery while incarcerated, which has been shown to reduce recidivism rates,” she says.

Programs that foster long-term recovery support are especially important in rural communities that may face an even greater strain on resources to support residents in crisis. Over time, maintaining stability and recovery means fewer people frequenting already crowded emergency rooms due to severe addiction and mental health crises.

One program to address emergency calls is described by Sharon Brown, chief executive officer, and Rebecca Betts, chief operations officer of Greater Health Now, which serves as a Community Care Hub for nine counties and the Yakama Nation in South Central Washington.

Betts and Brown describe how Mobile Integrated Health programs offer an innovative, community-centered approach to addressing mental health crises, helping to reduce the burden on emergency systems and ensuring individuals receive timely and appropriate care. Mobile Integrated Health programs allow paramedics and emergency medical technicians to respond to calls for mental health concerns rather than dispatching an ambulance crew and transporting them to an emergency department. Greater Health Now sponsors six Mobile Integrated Health programs in their region.

Mobile Integrated Health providers play a crucial role in improving responses to the mental health crisis by providing more personalized, accessible and holistic care. They are trained to assess mental health crises and provide support in a community setting. They can offer interventions such as de-escalation techniques and help connect individuals to mental health professionals. They also screen for “health-related social needs.”

These are defined as social and economic factors that complicate the ability to maintain mental and physical health and well-being. Factors could include a lack of food, safe housing or transportation, domestic violence, or a need for behavioral health services.

The provider then offers resources and follows up to ensure that the person in crisis has a plan to access resources.

“If you look at the return on that investment, you no longer have to transport someone in an ambulance, which can be costly and unnecessary,” Brown says. “The overall savings are pretty large when we consider health-related social needs.”

A similar Greater Health Now program sends “promotoras” or trusted bilingual community members, to liaison between migrant workers and social services to address all types of health issues, including mental and behavioral health.

“We all benefit from these investments when we improve the system and save lives,” Brown says.

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The program aims to train paramedics to handle mental health emergencies, filling crucial gap in rural healthcare services while taking pressure off law enforcement.

WEISER, Idaho — Paramedics are the first one on scene when seconds counts – and now they’re becoming the first line of defense for mental health crises in Washington County.

The Weiser Ambulance District is piloting a first-of-its kind program aimed at transforming how first responders handle mental health emergencies in its rural communities.

Through the new Community Paramedic Program, specially-trained paramedics respond directly to behavioral health emergencies and substance abuse calls received through 911.

“We can go meet that person where they’re at, figure out what the situation is, and hopefully de-escalate the crisis,” Ashley Lynn, the first Washington County paramedic to complete the specialized training said.

In the rural area described as an “island” when it comes to mental health resources, the program represents a significant step toward filling a critical healthcare gap for Washington County residents.

“The idea is to try and keep people in their homes, if possible. And if that’s not feasible, work on getting them directly into whatever resource is going to best help them,” Lynn said.

Southwest District Health partnered with the Weiser Ambulance District to develop the program addressing the significant gap in mental health resources in rural Washington County. The program also aims to provide appropriate care while reducing unnecessary law enforcement involvement in mental health situations.

“We want to take some pressure off of the 911 system, and those calls now can go to a community paramedic and not have to have law enforcement involved with something that doesn’t need law enforcement,” Wendy Young, Project Coordinator at Southwest District Health said.

There are more than 100 response teams nationwide, but experts say more research on their impact is needed.

Additional reporting by Ryan Levi

In the four years since George Floyd’s murder, many sweeping attempts to reform policing have faltered. But one proposal that has taken hold across the country, and continues to spread, is launching alternative first response units that send unarmed civilians, instead of armed officers, to some emergencies.

In Dayton, Ohio, trained mediators are dispatched to neighbor disputes and trespassing calls. In Los Angeles, outreach workers who have lived through homelessness, incarceration or addiction respond to 911 calls concerning people living on the street. In Anchorage, Alaska, trained clinicians and paramedics are showing up to mental health crises.

This article was published in partnership with Tradeoffs

As many programs transition out of the pilot phase, they face new challenges: How do they scale up and become big enough to meaningfully reduce the presence of police? How do cities sustainably fund these new agencies and find the right people to staff them? And are these teams on track to become the sea change in public safety that was promised?

“The Fifth Branch,” a podcast series from The Marshall Project and Tradeoffs, examines the results in Durham, North Carolina. (Listen to the podcast.) We also talked to experts across the country — some who are running these programs, some who are researching them, and some who are supporting them. Here’s what they said:

These programs are spreading.

For decades, Eugene, Oregon, was the rare city that sent unarmed crisis workers and EMTs to 911 calls. Now, researchers have tracked over 100 alternative crisis response units operating across the U.S. Over half of the country’s largest cities have created such teams.

How many there are depends on how you define them. Some distinguish between mobile crisis teams, which exclusively send clinicians to mental health emergencies, and community responder programs, which send civilians to a wider range of calls. The key tenets are that they can be the first response to an emergency situation and that they arrive without armed officers. (Many cities also send clinicians alongside police in what’s known as a co-response model.) But the kinds of specialists who are being sent out, and the kinds of calls they respond to, vary significantly.

Not sending one of these teams could be a civil rights violation.

In Washington, D.C., social service nonprofit Bread for the City has sued the city, claiming that sending police to mental health emergencies discriminates against people with mental health disabilities. The city started a program in 2021 to send mental health providers to those kinds of calls. But according to the lawsuit, just 327 calls were referred in the 2022 fiscal year, less than 1% of eligible calls. A similar lawsuit is ongoing in Washington County, Oregon, which includes part of Portland.

“The reason why the police response is so harmful may not be because there’s an excessive force incident — it’s because you’re not getting effective treatment,” said Michael Perloff, interim legal director for the ACLU of D.C. and one of the lawyers on the case. “If you called the EMTs for your broken leg and they sent someone who didn’t know how to set a broken bone, that’s denying you effective care. People with mental health crises, that’s their experience with emergency response services.”

The D.C. program may have been limited by overly strict criteria. At one point, calls would not be transferred to the team if they involved someone under 18, or someone who had ingested alcohol or drugs, the lawsuit states. Even if a call was deemed eligible, the team was frequently unavailable, and police were sent instead.

In an email, a spokesperson for the D.C. Department of Behavioral Health, which runs the city’s Community Response Team, noted that the team had recently increased its number of eligible call types and decreased the number of exclusionary criteria. In a motion to dismiss the case, lawyers for the city emphasized that they are working to improve mental-health emergency services but that “the creation of new services and standards of care presents a policy argument, not a legal claim.”

The U.S. Justice Department has weighed in. In February, department officials submitted a filing in the case, arguing that the Americans with Disabilities Act does apply to emergency response systems.

That filing echoed similar findings from the Civil Rights Division’s investigations into policing in Minneapolis, Louisville, Kentucky and most recently, Phoenix, where police and the city were found to be discriminating against people with behavioral health disabilities. In one instance, a 911 operator in Phoenix failed to refer a call from a mother worried about her 15-year-old daughter in distress to a mobile crisis team. When police showed up, they tackled and handcuffed the daughter and booked her in juvenile detention.

Getting 911 dispatchers on board is essential.

One challenge to scaling up these programs is dispatchers, who are often trained to err on the side of sending police. Cities have designated specific call categories to be sent to community response teams, and often use a “decision tree” of questions to determine whether a situation is safe for alternate response. But those questions take time, and 911 call centers are often overworked and under-resourced. And determining what is “dangerous” is highly subjective.

“Now there are way more layers of decision-making being added on to figure out, is this the type of call that gets police at all?” said Jessica Gillooly, a professor of sociology and criminal justice at Suffolk University in Boston, where she studies 911 dispatch. Gillooly worked as a call taker for two years and saw firsthand the “when in doubt, send [cops] out” mentality.

“In general it’s not a fear about an entire category of calls, it’s more fear based on one incident,” said Daut’e Martin with Law Enforcement Action Partnership, an advocacy organization of police, prosecutors and others working on criminal justice reform. “If you’re a call taker who’s worked for 20 years, you know about that one time an officer showed up to the noise complaint and someone started shooting.”

Cities are looking for ways to get dispatchers on board. In Chicago, the city’s Crisis Assistance Response and Engagement (known locally as CARE) team sends a quarterly update to dispatchers with data on diverted calls and examples of people connected to services. In Durham and other cities, mental health clinicians are embedded within the 911 call center to help determine the proper response.

So far, these programs rarely need to call for police backup.

There have been no known major injuries of any community responder on the job so far, according to experts. And data suggests unarmed responders rarely need to call in police. In Eugene, Oregon, which has operated the Crisis Assistance Helping Out On The Streets (known locally as CAHOOTS) response team since 1989, roughly 1% of their calls end up requiring police backup, according to the organization. Albuquerque responders have asked for police in 1% of calls, as of January. In Denver, the Support Team Assisted Response (STAR) had never called for police backup due to a safety issue as of July 2022, the most recent data available. In Durham, members of the Holistic Empathetic Assistance Response Team (HEART) reported feeling safe on 99% of calls.

Many communities are still sending alternative responders to a narrow subset of calls, and debating whether it’s safe to expand their scope. For example, many cities will only send community responders to situations that are outdoors or in public spaces. Programs are also divided on whether disputes between neighbors or within families are a proper place for crisis responders, or calls involving suicidal threats.

Some programs have avoided using 911.

Many people remain leery of dialing 911 in a crisis, especially when there’s no guarantee that someone will get an alternative responder instead of police. In a survey of hundreds of residents in Portland, Oregon — where the Street Response team has been operating since 2021 — nearly half said they did not feel safe calling 911. That rate was even higher among Black and Latino respondents.

Instead of being dispatched through 911, programs in cities like Atlanta have opted to use a non-emergency line. That way, if a call coming through 311 is deemed better suited for police, the caller can make the decision whether to transfer to 911 or hang up.

“People may have hesitancy about calling 911 because it might result in a police dispatch that they don’t want,” said Moki Macias, executive director of Atlanta’s Policing Alternatives & Diversion Initiative (PAD). Macias notes there’s a tradeoff in this approach. Fewer people know to call 311, meaning the team may miss a number of potentially eligible calls.

But the separation from the police was important, she said. “Community members were asking for an actual alternative,” Macias said. “It has been really important to us to have that clear definition of our team as entirely consent-based.” That also means PAD responders cannot hospitalize someone against their will.

Some mobile crisis teams that exclusively send trained specialists to mental health crises are being dispatched through 988, the national mental health hotline launched in 2022. Often, they require the caller to be the person who needs help or a family member, rather than a bystander. Most community responder programs, which work on a wider range of calls, are not connected to the national hotline.

Reaching their full potential will require more money and more staff.

Studies suggest that eventually, a large portion of current police work could be handed off to alternative responders. A 2020 review of 911 calls in eight major cities estimates that up to 68% of calls “could be handled without sending an armed officer,” according to a report by the Center for American Progress and the Law Enforcement Action Partnership.

Getting there will take buy-in from multiple government branches, a sizable and steady budget, and time. In Albuquerque — where the city created an entirely new Community Safety Department in 2021 — roughly 5% of police calls were being diverted as of September 2023. In Durham, roughly 1% of calls have been diverted from police to the city’s two-year-old crisis team so far, staffed by mental health clinicians, peer support specialists and EMTs. In Eugene, the CAHOOTS team answered around 17% of the city’s police department calls as of 2019, the most recent data available.

These are among the most established programs in the country. Most units are operating on a significantly smaller scale. Few programs operate 24/7, and many don’t yet cover their entire city.

Many programs have struggled to find sustainable funding. Some used federal money from the pandemic-related American Rescue Plan — money that is running out. Others have tried to tap into Medicaid funding, but that carries restrictions. Cities that have set aside money in their general funds have to find a way to grow these budgets in the face of deficits. New York City, for example, has halted plans to expand its mobile crisis team after significant budget cuts. The team currently operates in less than half of the city’s police precincts.

Experts also say these jobs need to be a viable career path, and that cities need to ensure there is a pipeline of people to staff the new agencies. The CAHOOTS team in Eugene has faced a staffing crisis for at least the last three years, said Mike Yoshioka, director of programs for the White Bird Clinic, which operates CAHOOTS. The positions require specialized skills, were previously paid much less than other first responders, and can easily lead to burnout as they face increasing demand. Recently, the organization increased pay for responders, which Yoshioka hopes will help with hiring.

We don’t yet know the full impact of this type of response.

There is still significant research to be done on the impact of these alternative response teams. A 2022 study on Denver’s STAR team found a 34% drop in low-level crime in neighborhoods where the team was operating, compared to neighborhoods where it had not yet been rolled out. The impact of these programs on other metrics, such as involuntary commitments, arrests and police use of force, is yet to be seen. Studies on these are ongoing in Durham, Madison, Wisconsin and other cities.

There’s limited data on how communities feel about these new programs. A survey of over 600 Durham residents found that 57% were more likely to call 911 because of the city’s HEART program. A larger survey of Durham residents’ views on HEART is currently underway.

Macias from Atlanta noted that without increasing other social services, like housing and mental health care, the teams risk being merely a Band-Aid for people in crisis. “There’s a lot of pressure put on these response agencies without the local government building up the destination and infrastructure that people need,” she said. “Sure, expand these response teams 24/7, but make sure that at 11 p.m. on a Sunday there’s actually a place to bring somebody to get their needs met. Otherwise you’re just making yourself feel better. But the problem’s not being solved.”

Programs that tackle stubborn problems like mental illness, addiction and homelessness, with or without police, are spreading across Wisconsin and the nation. Early results are promising, experts say.

The city of Madison’s CARES team practices during a simulation. Eric Kinderman, center, a crisis worker, takes notes while Mark Norton, right, a paramedic, checks vital signs. Photo courtesy of the Madison Fire Department.

By Peter Cameron, THE BADGER PROJECT

Call the cops. Let them handle it.

As long as nothing was on fire, or no one was having a physical health problem, emergency response in the U.S. has mostly involved sending police to deal with whatever the issue was.

“We over-rely on law enforcement to respond to anything and everything,” said Sarah Henrickson, a social worker in Madison.

But after years of treating most 911 calls with the same medicine, including more complex ones involving people in crisis, local governments in Wisconsin and across the country are now trying more targeted treatments as intractable issues like mental illness and homelessness have risen.

That shift has led to mental health professionals partnering with police officers on some calls, and also programs that remove cops from some emergency response entirely.

‘Very risky’

The missions of police and mental health professionals are very different, said Patrick Solar, an associate professor of criminal justice at UW-Platteville, and a former police chief.

“Cops are neither adequately trained nor educated on how to deal” with mental health crises, he wrote in an email.

“Leaving these issues to the police is very risky,” he continued. “I believe we need to narrow the focus for our police, not expand it even further beyond the basic mission” of crime solving and prevention.

Videos have gone viral of encounters turning bad between police and people in the grip of a mental health episode, leading to the loss of life, as well as millions of taxpayer dollars when police departments get sued for mismanaging a crisis.

Sarah Henrickson, the social worker who helped develop and now helps run the city of Madison’s Community Alternative Response Emergency Services (CARES) team

Providing skilled intervention services for emotionally disturbed individuals just makes sense, Solar said.

“You wouldn’t call your plumber to fix your teeth,” said Henrickson, the social worker who helped develop and now helps run the city of Madison’s Community Alternative Response Emergency Services (CARES) team, which consists of a paramedic and a crisis worker. “You want the expertise to match with what the issue is.”

Some cities partner crisis workers with police officers to respond to mental health calls. Others like Madison and Milwaukee also offer a nonpolice emergency response team for calls with a low risk of violence. 911 dispatchers must be skilled in knowing who to send for different types of calls, Henrickson said.

CARES in Madison had a budget of about $1.7 million in 2024 and answered more than 3,500 calls, calls that otherwise the police would have had to handle, said Cynthia Schuster, a spokeswoman for the city’s fire department, which oversees the program. In 2025, CARES is expanding into neighboring Sun Prairie, the second-largest city in the county.

In rural areas with fewer responders and resources, and more ground to cover, some law enforcement agencies are improvising. In states like Nevada, Oklahoma and South Dakota, some police officers now carry tablets on which they can video call a mental health professional to help assist with people in crisis.

Impacts

Thomas Dee, a professor at Stanford University who studies nonpolice emergency response, said the appeal of these types of programs are based on their “rugged common sense and basic humanity.”

In studying the city of Denver’s STAR program, he found that it was “quite effective” in reducing crime, and generated spillover benefits as well.

Many of the people who get proper treatment from these programs have fewer run-ins with police moving forward, as well as fewer detentions and hospitalizations, Dee noted.

That saves local governments and taxpayers money.

In Madison, only 25% of CARES patients had to be transported to a facility in 2024, compared to 85% of EMS patients, Schuster said. That’s a significant cost savings, though calculating exact numbers is difficult.

And when CARES does need to hospitalize someone, they can transport patients to more appropriate destinations, like detox centers or shelters, reducing strain on overcrowded ERs, Schuster added.

Caution moving forward

The rise and spread of non-police emergency response teams have the benefit of being both pro-police, by relieving stretched law enforcement agencies of a significant number of calls, many of them needing experts, and also being pro-patient, in which folks with mental health issues can have root causes treated rather than their symptoms.

Thomas Dee, a professor at Stanford University who studies nonpolice emergency response

“In these politically divisive times, these policy innovations have a broad appeal across the political spectrum,” Dee said.

Add on top that many law enforcement agencies across the country, Wisconsin included, are struggling to fill officer openings as the profession becomes less attractive to younger generations, and nonpolice emergency response might become even more important.

More study is still needed, but well-run, targeted emergency response programs “seem to achieve their goals,” Dee said. “It’s a really encouraging area of policy innovation in the country right now.”

Yet the professor still offers caution to governments considering launching any sort of alternative emergency response team.

“The success of these initiatives is not a foregone conclusion,” he said. “They require interagency cooperation. They require training.”

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