Mental Health Responders Gain Ground in U.S. Cities, but Funding Remains Uncertain

Over 40 major U.S. cities now operate some form of alternative crisis response, but a Louisville shooting and funding shortfalls expose deep gaps in the system.

Louisville Shooting Puts Spotlight on Mental Health Response Gaps

A mental health crisis in Louisville, Kentucky, ended in gunfire last month — and reignited a national debate about who should answer the call when someone is in distress.

According to The Marshall Project, Katelyn Hall, 28, was experiencing suicidal ideation and harming herself inside a locked bathroom on March 27 when her cousin called 911. Body camera footage analyzed by NPR showed that after officers arrived, they broke down the door and one officer shot Hall seven times as she moved toward them holding a broken piece of porcelain.

Louisville operates a mental health "deflection" program that routes certain emergency calls — including those involving suicidal ideation — to mental health professionals rather than police. Hall's case, however, was deemed ineligible because reports indicated a potential weapon and other people in the apartment.

The shooting has prompted questions in Louisville about why the city lacks a "co-responder" program, in which police and mental health clinicians respond to such calls together. Community members have pointed out that the city pledged to launch exactly such a program in a settlement with the estate of Breonna Taylor, whom officers killed in 2020. A representative for Mayor Craig Greenberg told the Louisville Courier-Journal that he could not speak to commitments made under the previous administration, but that Greenberg was actively weighing plans for a co-response model.

44 of 50 Largest Cities Have Some Form of Alternative Response

The Louisville case reflects a broader national shift. A 2024 study cited by The Marshall Project found that 44 of the 50 largest U.S. cities now operate some version of an alternative or co-response program — a rapid expansion driven largely by the racial justice protests of 2020.

But the distinction between sending mental health professionals instead of police versus alongside police carries significant practical consequences. When the choice is binary, as in Louisville, officers may be dispatched by default in volatile situations where a clinician might have de-escalated the encounter. Co-responder programs can address that gap, but critics argue they introduce new risks. A March report by Human Rights Watch stated that "the mere presence of officers, especially armed and uniformed officers, can escalate rather than de-escalate crisis situations."

Despite that debate, families and communities affected by crisis shootings are often making a more direct demand: that a person in crisis be met by someone trained to help them.

Families Describe System Failures Across Multiple States

That demand is surfacing in city after city. In Hartford, Connecticut, two fatal police shootings in February — both involving men reportedly in mental health crises — led community members to call for more social workers and crisis-intervention capacity.

In Baltimore County, Maryland, Helen Haley said she deliberately called the 988 mental health hotline rather than 911 when her son, John Haley, 27, who has autism, was in a suicidal crisis and holding a knife. She believed the call would bring trained clinicians. Police arrived instead and shot him more than a dozen times, leaving him paralyzed.

"We did everything the system asked us to do, and it still nearly killed him. We are not asking for perfection. We are demanding humanity," Haley said at a press event earlier this month.

In New York City, Gothamist reported that in two recent police shootings involving people in behavioral crisis, family members had explicitly requested medical help — not police — when they called 911. The calls were classified in ways that automatically triggered an armed response.

In San Jose, California, pressure is also coming through legal channels. A coalition of advocacy organizations, including the American Civil Liberties Union, sent a letter to the city this month arguing that its failure to divert a higher share of calls to non-police crisis teams violates the Americans with Disabilities Act.

Some Cities Expand Programs While Others Face Cuts

Several major cities are responding to both the demand and early evidence of effectiveness by formalizing their crisis response infrastructure. In February, the Los Angeles City Council voted to make permanent an alternative response pilot program that has handled more than 17,000 service requests since 2024.

In New York, Mayor Zohran Mamdani recently established a new Office of Community Safety to oversee and expand programs including B-HEARD, the city's existing alternative response pilot.

Elsewhere, however, programs are struggling financially — particularly in smaller cities and counties with rural coverage areas. In Santa Barbara County, California, four co-responder teams cost approximately $1.9 million per year, and a combination of unstable grant funding and shifting state priorities may force service reductions. A co-responder program in Clive, Iowa, faces possible dissolution as state funding phases out.

Insurance Coverage Leaves a Structural Gap

One potential funding mechanism — health insurance — has so far failed to fill the void. The Marshall Project notes that reporting by Kaiser Family Foundation Health News found that many private insurers do not cover mobile crisis care. Medicaid coverage gaps compound the problem, leaving programs dependent on patchwork grants and municipal budgets that are themselves under pressure.

The result is a system that has grown rapidly in scope but unevenly in sustainability. Cities that have invested in alternative response programs point to thousands of calls handled without police involvement. But as the deaths of Katelyn Hall and John Haley's near-fatal shooting illustrate, the infrastructure to consistently route the right call to the right responder remains incomplete — and in some places, still entirely absent.

Source: The Marshall Project