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A pilot program in Denver that had healthcare workers respond to certain emergency calls instead of police reduced less serious crimes by an estimated 34%, with no effect on more serious crimes, researchers found.

The Support Team Assistance Response (STAR) program prevented an estimated 1,400 criminal offenses over a 6-month study period beginning in June 2020, Thomas Dee, PhD, and James Pyne, PhD, of Stanford University in Palo Alto, California reported in .

"Based on what we're seeing, this is a reform that deserves our very best attention," Dee told MedPage Today.

The STAR program is an example of a "community response" model that's being tested by some U.S. cities amid a nationwide reckoning with police violence.

The researchers wrote that police officers are not extensively trained to assist individuals who are experiencing mental health or substance abuse crises. As a result, emergency calls for these issues "may be engaged as criminal violations, sometimes with unnecessarily violent or even tragic consequences," they wrote.

Some communities have moved to improve police training and cooperation with health professionals, the researchers said, while fewer have foregone police involvement, sending only healthcare teams to such calls. Yet neither of these models has been extensively studied, the researchers said.

To gather data on a model without police involvement, the researchers studied the STAR program, which involves sending a team of two healthcare staff -- a mental health clinician and a paramedic -- to respond to certain calls in a "specially equipped van" with the goal of quickly providing crisis treatment and directing people to further care.

These teams operated in eight police precincts in Denver, responding to certain non-violent 911 calls and other police referrals, including intoxication, indecent exposure, trespassing, and syringe disposal.

The pilot area was in the central downtown area of Denver and all but one of the neighborhoods was designated by the city as a "displacement-vulnerable" area -- a rapidly gentrifying space where "poor and otherwise at-risk residents are being pushed out," where there are often increasing demands on police to address nonviolent incidents.

The researchers relied on data from the federal National Incident-Based Reporting System (NIBRS), which collects reports of criminal offenses, whether or not they had led to arrests or citations. They used a "difference in differences" approach, where they measured a change not only in those 8 precincts before and after, but also in the surrounding ones, which Dee called a "workhorse program" for establishing causality.

Ultimately, they estimated that the program reduced less serious crimes by 34% in treated precincts compared with those untreated, and that the program prevented nearly 1,400 criminal offenses while it was in operation.

The reduction in crimes could reflect that health first responders were less likely to record a criminal offense on their service calls, as opposed to police officers. Instead of being labeled criminal offenders, people in mental health or substance abuse crisis, for example, would receive care. Also underlying the results could be a true reduction in the prevalence of these offenses, whether because the health interventions prevented escalation to other offenses, or because individuals receiving care would be less likely to re-offend.

In further analyses, the researchers found the effect on more serious crimes was small and statistically insignificant, suggesting that "targeted fielding of mental health professionals as first responders did not increase the frequency in reporting more serious criminal incidents in treated precincts."

"You wouldn't think there'd be an effect [on those more serious crimes not targeted by the program], and we don't see an effect there," Dee said.

The researchers wrote that this contradicts the "broken-windows" theory -- that less policing of low priority criminal violations will increase the prevalence of more serious and violent crimes.

As a further robustness check, researchers compared how crime was trending in the "treated" and "comparison" groups prior to the intervention, and they were moving in parallel -- until June, when the STAR program became active. They also used another "placebo" to rule out the role of seasonality in the reduction in STAR-related crimes, by looking at the same time period in 2017, 2018, and 2019 for similar drops, which they did not find.

These checks and the design of the study, Dee said, "speak of an unusually high standard of causal credibility and makes me really excited about the results we're seeing, which would be really dramatic reductions in focal crimes targeted by a policy."

Researchers also noted that because the Denver police had participated in crisis intervention training (CIT) already, the overall effect of the STAR program might be expected to be low or even nonexistent, assuming police also direct individuals to appropriate care. "But the fact that we see this big reduction really underscores that something different is happening when this team responds," Dee emphasized.

He added that "this is the kind of innovation on which there should be broad agreement," because generally, police say they don't want to deal with incidents like this.

"There are some arguments that taking this responsibility away from [police] will improve police morale and retention of the very best police officers," Dee said. At the same time, the approach could appeal to those who support defunding the police, "because it involves substantially reducing the operational footprint of the police in communities and creating a longer run argument for shrinking their budgets."

Even with the reduction in crime and the cost-effectiveness (low-priority calls cost the criminal justice system $500 to $600 per offense while STAR costs $151 per offense reduced), Dee added, "we shouldn't let those important social goals cause us to lose sight of the fact it's also just a deeply humane reform -- to bring healthcare rather than policing to people in a healthcare crisis."

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