What Are the Risks?

A leader who launches a Community Safety Department without understanding how these programs can fail is unprepared for the failure modes she will encounter. The risks below are not theoretical objections. They are documented patterns from cities that have tried, and in some cases failed, to build and sustain civilian response programs. Named failures with identified causes are more useful for implementation planning than success stories.

Named Program Failures

Eugene shutdown (Oregon, April 2025). The oldest civilian crisis response program in the country, operating for 36 years, shut down in Eugene after its nonprofit operator suffered financial collapse (CAHOOTS service continues in neighboring Springfield).¹ The root cause was structural: the program was funded per response (encounter-based revenue), but the organizational infrastructure required sustained capacity funding that encounter revenue could not cover. Training, supervision, facilities, and administration all require money whether or not a call comes in during a given hour. The program was widely cited as proof of concept for civilian crisis response. It collapsed after 36 years of operation. Any department funded only through billable encounters, without capacity funding for the infrastructure that makes those encounters possible, faces the same structural vulnerability.

Harris County contractor collapse (Texas, mid-2024). Harris County’s crisis program initially contracted with a nonprofit operator to provide civilian crisis response. The contractor failed so badly that the county brought the program fully in-house by a 3-1 Commissioner Court vote in December 2024.² After the transition, service linkages increased 228%. The structural lesson: the nonprofit contractor model, which offers speed and flexibility at launch, carries contract vulnerability risk. When the contractor fails, the jurisdiction must be prepared to absorb the program or lose it entirely. Durham’s decision to make department staff direct city employees, rather than contractors, was designed to prevent exactly this scenario. Durham’s Director Smith noted that because staffers work “for the city, rather than a private contractor, they can’t refuse calls that fall within the program’s criteria.”³

Montana rural crisis program defunding. Multiple rural crisis programs in Great Falls and Billings were defunded after state support was withdrawn, leaving just six civilian crisis units statewide.¹ A February 2026 NPR investigation documented that despite at least 1,800 civilian crisis teams nationwide, “financial support for them is often inadequate and inconsistent.” The programs demonstrated demand and effectiveness while funded but had no path to continued operation when state priorities shifted.¹

The claimed-versus-actual coverage gap (national). A 2024 NRI survey found that 70% of crisis programs nationally claim 24/7 availability, but only 40% actually staff all shifts.⁴ The gap between marketed capability and operational reality is a national pattern that likely extends beyond 24/7 claims to geographic coverage, response times, and service connection follow-through. Albuquerque achieved 24/7 coverage in September 2023, but most CSDs have not.⁵ Durham expanded to 12 hours daily.⁶ The overnight hours remain police-only in almost every other jurisdiction. Before Albuquerque’s expansion, former director Ruiz-Angel described the consequences: “We have calls pending when we get to the office at 7am and we have calls that we have to unfortunately sometimes kick back to the police department at 8pm.”⁷

The Coverage Gap and Its Fatal Consequence

The coverage gap between when the department is available and when crises occur is the risk that operational data documents most clearly. Crises do not observe business hours. Substance use emergencies, psychiatric breaks, and behavioral disturbances peak in overnight hours when most CSDs are closed.

In Albuquerque, The New Yorker documented the fatal cost of this gap before the department achieved 24/7 operations.⁸ During overnight hours when ACS was not operating, police responded to an intoxicated man at a gas station, described in the article as “the kind of ‘down and out’ call that might otherwise have gone to A.C.S.” Officers “fired at him sixteen times,” killing 27-year-old Keshawn Thomas immediately. Albuquerque closed this specific gap by expanding to 24/7 operations in September 2023.⁵ But the Thomas case remains a documented illustration of the stakes: every hour that a CSD is unavailable, calls that should go to trained behavioral health responders go instead to armed officers.

The coverage gap is a workforce problem, a funding problem, and a political problem. Expanding to 24/7 requires doubling or tripling staffing. HRSA data shows half the U.S. lives in designated behavioral health workforce shortage areas.²¹ Clinicians willing to work overnight shifts in crisis field response are an even smaller subset of an already constrained workforce. Albuquerque and three smaller programs (Indianapolis, Placer County, and UC Davis) have achieved 24/7 coverage, but most large-city CSDs have not.

The Scale Gap

Even within its operating hours, the largest CSD in the country handles a fraction of eligible calls. Albuquerque’s ACS responds to roughly 3% of the city’s million-plus annual 911 calls (The New Yorker).⁸ Denver’s crisis program covers only about 44% of eligible calls within its defined scope.⁹ Austin’s analysis found the city needs three times its current staffing to meet demand.¹⁰

The University of Chicago Health Lab found that over 75% of 911 calls dispatched to police do not involve serious crime or public safety threats.¹¹ If even a fraction of those calls are eligible for civilian response, the gap between what CSDs could handle and what they actually staff for is enormous. Mayor Keller sees Albuquerque’s department “doubling in size,” but even that “would only scratch the surface of actual need.”⁸

The scale gap creates a political risk: opponents can accurately say the department handles only 3% of calls, framing it as a symbolic gesture rather than an operational response. The counter, which is accurate, is that 3% of a million calls is 30,000 encounters, each one a person who received clinical care instead of armed response. But the gap between aspiration and capacity is documented, and a leader should be prepared to explain both the achievement and the distance remaining.

The Workforce Constraint

The binding constraint on CSD expansion is not political will or funding. It is the workforce pipeline.

Licensed mental health clinicians are the highest-cost and hardest-to-recruit responder category, with salaries ranging from $60,000 to $90,000 or more. Half the U.S. population lives in designated behavioral health workforce shortage areas. Twenty-six states report social worker shortages; three describe the shortage as “catastrophic” (NRI data).⁴ Finding clinicians who are both qualified and willing to do crisis field response work, which involves unpredictable hours, physical risk, and emotional intensity, narrows the pool further.

Peer support specialists, who bring lived experience with mental illness, addiction, or homelessness, are a growing workforce category but face their own constraints: credentialing requirements vary by state, compensation is often lower than clinical staff, and turnover is high in demanding field roles.

Albuquerque addressed the pipeline by building a formal training academy that produces cohorts of new responders.¹² Portland passed a resolution directing first-responder designation with full employment benefits (retirement, healthcare, pay parity), which functions as a retention strategy as much as a political statement.¹³ Durham recruits peer support specialists who are “people in recovery or who have lived unhoused in Durham,” which provides the lived-experience trust the model requires but limits the candidate pool to people with specific backgrounds who are also stable enough for field crisis work.³

Dispatch Hesitancy

A persistent operational barrier is getting dispatchers to route calls to the CSD. A department with a trained workforce accomplishes nothing if 911 dispatchers do not send it calls.

NYU researchers documented the problem in Denver: dispatchers “forget” the alternative response option, worry about personal liability, and default to sending police because that is what they have done for their entire careers.¹⁴ Denver’s crisis program answers only about 50% of eligible calls, with dispatch hesitancy identified as a primary cause.⁹

The problem is rational, not irrational. If a dispatcher sends an unarmed team and the situation escalates, the dispatcher faces potential consequences. Cities that have achieved higher routing rates have done so through structural changes: Durham’s dual-mechanism dispatch (automated CAD flagging plus embedded clinicians) produces the highest documented capture rate by removing the decision from the dispatcher’s discretion for eligible calls.⁶ This treats dispatch hesitancy as an engineering problem, not a training problem. Cities that rely solely on dispatcher training see persistent underutilization.

The Funding Structural Mismatch

Angela Kimball, executive vice president of Inseparable, a national mental health policy organization, articulated the structural funding problem that underlies most CSD fragility: cities pay police and fire departments for the capacity to be ready.¹⁵ Officers and firefighters are funded whether or not they answer a call in a given hour. CSD programs are typically funded only for active response. Medicaid reimburses billable encounters for enrolled individuals. The unfunded gap includes training, supervision, travel time, community relationship-building, follow-up contacts that do not meet billing thresholds, and staff availability time (responders on shift but not currently on a call).

Eugene’s program collapsed because encounter-based revenue could not sustain organizational capacity.¹ Montana programs were defunded because state funding covered operations but not the infrastructure to sustain them.¹ Both cases involved programs funded for active response without separate capacity funding.

The Medicaid pathway provides an 85% federal match for three years.¹⁶ No state has completed the transition to its standard match rate, so how program funding holds up beyond the enhanced period is unknown. Programs built on American Rescue Plan Act dollars face an expiration cliff. The pattern from cities that lost programs is consistent: budgets built on expiring grants without a transition plan to sustainable public funding proved structurally fragile, regardless of how well the program performed.

Initial Police Resistance

Durham Police Chief Patrice Andrews described the dynamic plainly: “There was this cloud that hung over the Community Safety Department” from political fights surrounding its creation. “Many patrol officers were initially skeptical, believing they’d have to constantly rescue amateurs.”¹⁷ The resistance in Durham was overcome by demonstrated competence and the experience of workload relief. Officers who initially resisted now request department teams on the radio.

But the path from resistance to acceptance is not automatic. It requires the police chief’s visible support, clear fallback protocols, explicit language protecting officer staffing, and time for the operational track record to build. A CSD launched without police buy-in faces active or passive sabotage: officers who refuse to hand off calls, dispatchers who route around the program, union campaigns that frame it as anti-police. The substance of the program may be excellent. The political execution determines whether it survives long enough for the substance to matter.

The Evidence Gaps

No study has evaluated the CSD as an institutional form. All independently evaluated evidence examines specific programs (Denver’s crisis program, Durham’s department) or specific response models (civilian-only vs. co-response). Whether housing programs in a unified department produces better outcomes than housing the same programs in separate agencies is an untested organizational theory.

The evidence base is concentrated in a small number of cities. Denver, Durham, Harris County, St. Petersburg, Austin, Minneapolis, Oklahoma City, Albuquerque, and Guilford County appear repeatedly across analyses. The field includes at least 1,800 civilian crisis teams nationally,¹ but rigorous outcome data comes from roughly a dozen cities. The cities with CSDs are not representative: Albuquerque, Durham, Portland, and Seattle are mid-to-large cities with political environments favorable to the model.

Longitudinal data is thin. Short-term outcomes are well-documented. Whether people connected to services through CSD teams stay connected over years, have fewer crises, and experience improved long-term outcomes is largely unknown.

The Congressional Research Service’s 2023 review found that “it remains less clear whether these changes translate into actual improved outcomes for people with mental health needs, such as fewer arrests and reduced use of force against them.”¹⁸ The field has since added the Durham fiscal evaluation¹⁹ and the Wayne State comparative study,²⁰ which partially address this critique. But the CRS concern about the gap between operational metrics (calls handled, officer hours freed) and individual-level outcomes (are people actually better off?) remains relevant.

What Happens After a Serious Incident

No documented case exists of a CSD responder being seriously harmed on a call. The safety record across every documented program is consistent: zero or near-zero serious injuries to responders across hundreds of thousands of encounters.⁵

But a field this young almost certainly has failure modes that have not yet materialized at scale. It takes only one high-profile incident to change the public conversation. A CSD responder seriously harmed on a call would produce immediate political pressure, regardless of the safety record across the previous 100,000 encounters.

The absence of documented safety failures could mean the model is genuinely safe (the dispatch screening and fallback protocols work as designed). It could also mean that the scale of operations, while impressive, has not yet been large enough or long enough to encounter the full range of scenarios that large-scale emergency response encounters over decades. Both explanations can be simultaneously true.

---

The Bottom Line

The risks are real and documented: coverage gaps with fatal consequences,⁸ a scale gap where even the largest CSD handles 3% of eligible calls, a workforce shortage that is the binding constraint on expansion, dispatch hesitancy that can quietly kill a program,¹⁴ a structural funding mismatch that has collapsed programs elsewhere,¹ and an evidence base concentrated in a small number of favorable cities. Three named failures (Eugene, Harris County contractor, Montana) illustrate that funding fragility and contractor dependence are the primary causes of collapse. The safety record is strong but untested at the scale and duration that would make it definitive. None of these risks are arguments against building a CSD. All of them are arguments for building one with eyes open.

---

Source Appendix

1. NPR / KFF Health News / Montana Public Radio, Aaron Bolton, “They help police with mental health calls. So why are ‘mobile crisis’ teams in crisis?” February 5, 2026. Eugene shutdown, Montana defunding, 1,800 teams nationwide, “financial support for them is often inadequate and inconsistent.” https://www.npr.org/2026/02/05/nx-s1-5693908/police-mental-health-calls-988-911-mobile-crisis-teams

2. Houston Landing, McKenna Oxenden, “Harris County health dept. to operate 911 call diversion program following vendor scrutiny,” December 11, 2024. 3-1 Commissioner Court vote (December 10, 2024), in-house transition, $6.6M annual cost. https://houstonlanding.org/harris-county-health-dept-to-take-over-911-call-diversion-program-following-vendor-scrutiny/. Prior context: FOX 26 Houston, May 23, 2024. https://www.fox26houston.com/news/harris-county-mental-health-program-faces-uncertain-future-amid-financial-concerns

3. Jeff Billman, “A New Model for Public Safety in Durham,” The Assembly NC, June 26, 2024. Smith on city employees vs. contractors, lived-experience hiring. https://www.theassemblync.com/politics/criminal-justice/durhams-new-model-for-public-safety/

4. Goldman, Looper, and Odes, “National Mobile Crisis Team Survey Report,” National Council for Mental Wellbeing / NRI, November 2024. 70% claim 24/7, 40% actually staff all shifts, workforce shortage data. https://988crisissystemshelp.samhsa.gov/sites/default/files/2024-11/National%20Mobile%20Crisis%20Survey%20ReportvFINAL.pdf

5. City of Albuquerque, “Albuquerque Community Safety Department Marks Four Years of Impact and Innovation,” September 2025. 120,000+ calls, <1% police backup, 24/7 since September 2023. https://www.cabq.gov/acs/news/albuquerque-community-safety-department-marks-four-years-of-impact-and-innovation

6. CSG Justice Center, “Durham, NC — Expanding First Response Program Highlights,” updated December 2024. Dual-mechanism dispatch, 12-hour daily coverage. https://csgjusticecenter.org/publications/expanding-first-response/program-highlights/durham-nc/

7. KRQE News 13, Alexa Skonieski, early ACS interview with Mariela Ruiz-Angel. “Calls pending when we get to the office at 7am.” Original broadcast; URL not independently verified.

8. Murat Oztaskin, “Sending Help Instead of the Police in Albuquerque,” The New Yorker, February 4, 2023. Keshawn Thomas shooting, 3% of calls, “doubling in size” quote. https://www.newyorker.com/news/dispatch/sending-help-instead-of-the-police-in-albuquerque

9. Urban Institute, “Evaluating Alternative Crisis Response in Denver’s Support Team Assisted Response (STAR) Program,” 2024. ~44% eligible call coverage, dispatch hesitancy as primary cause. https://www.urban.org/research/publication/evaluating-alternative-crisis-response-denvers-support-team-assisted-response

10. KVUE (Austin), Melia Masumoto. Marisa Malik (Integral Care): EMCOT “needs three times the number of members it currently has.” https://www.kvue.com/article/news/politics/austin-mayor-and-council/austin-city-council-expand-integral-cares-mental-health-crisis-outreach-team/269-e85ce07b-74b0-4fd7-b420-f6fc6d92e855

11. University of Chicago Health Lab / Transform911, “Blueprint for Change, Chapter 7: Ensuring the Right Response at the Right Time.” Over 75% of police-dispatched calls not related to serious crime or public safety threats. https://www.transform911.org/blueprint/chapter-7-response/

12. CNM, “CNM and City of Albuquerque Launch Annual ACS Academy to Train Alternative First Responders,” October 2025. https://www.cnm.edu/news/cnm-and-city-of-albuquerque-launch-annual-acs-academy-to-train-alternative-first-responders

13. Portland City Council Resolution No. 37709, June 25, 2025. First-responder designation, full benefits. https://www.portland.gov/council/documents/resolution/adopted/37709

14. Policing Project at NYU School of Law, “Transforming Denver’s First Response Model,” 2023. Dispatcher hesitancy, liability concerns, “forget” the option. https://www.policingproject.org/transforming-denvers-first-response-model-report

15. Angela Kimball, Chief Advocacy Officer, Inseparable (mental health policy organization). Capacity vs. encounter funding structural mismatch analysis. Kimball’s framework documented in Inseparable policy publications and congressional testimony on crisis response funding.

16. Milbank Memorial Fund, “Mobile Crisis Teams and Medicaid Funding,” June 2025. 85% FMAP for three years, 21 states opted in. https://www.milbank.org/quarterly/opinions/mobile-crisis-teams-and-medicaid-funding-advancing-behavioral-health-crisis-response-across-the-united-states/

17. Tradeoffs / The Marshall Project, “How Durham Got Police Onboard with Unarmed Crisis Response,” May 2, 2025. Andrews quotes on initial skepticism, “cloud that hung over.” https://tradeoffs.org/2025/05/02/how-durham-north-carolina-got-police-onboard-with-unarmed-crisis-response/

18. Lisa N. Sacco and Isobel Sorenson, “Issues in Law Enforcement Reform: Responding to Mental Health Crises,” Congressional Research Service, Report R47285. https://www.congress.gov/crs-product/R47285

19. Bocar A. Ba et al., NBER Working Paper No. 34344, October 2025. https://www.nber.org/system/files/working_papers/w34344/w34344.pdf

20. Leonard Swanson et al., Wayne State Michigan study, Psychiatric Research and Clinical Practice, May 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12418740/

21. HRSA, Health Professional Shortage Area (HPSA) data. Behavioral health workforce shortage designations. https://data.hrsa.gov/topics/health-workforce/shortage-areas