Tucson Mental Health Diversion



In recent years, policymakers and other leaders have established new systems intended to divert people experiencing mental health crises away from the criminal legal system before an arrest occurs. While there is some research supporting the effectiveness of police-mental health collaboration models, the evidence is mixed and very little is known about long-term outcomes. Additionally, a lack of rigorous evaluation of 911 dispatch diversion programs specifically represents a significant gap in knowledge in this area.

MDRC’s Tucson Mental Health Diversion (TMHD) project is a five-year retrospective study assessing the impact of the dispatch diversion program in Tucson, Arizona. In collaboration with Dr. Margie Balfour of Connections Health Solutions and the Council of State Governments Justice Center, the study compares the criminal justice contact and treatment engagement outcomes of individuals whose 911 crisis calls are diverted to the Pima County Crisis Center via the 911 crisis call center with those who receive a traditional 911 response.

A combined suite of impact, benefit-cost, and process studies of an emerging 911 dispatch diversion model, TMHD’s findings should offer important guidance for policymakers seeking to understand “what works” in the field of pre-arrest diversion of individuals with mental and behavioral health issues.

Agenda, Scope, and Goals

The goal of TMHD is to evaluate the effects of a 911 dispatch diversion program, as well as assess the relative costs and benefits of Tucson’s collaborative approach to mental health emergency response. Project collaborators will present findings in a policy brief and a final report, making policy recommendations relevant to jurisdictions across the country. MDRC plans to answer the following research questions:

  • How has the 911 dispatch diversion model impacted outcomes for individuals who contact 911 with a mental health crisis? How, if at all, do these outcomes differ from individuals who received a traditional police response?
  • How has mental health collaboration in Tucson and Pima County evolved over time? How was the ICC first developed, and how is it currently implemented?
  • What are the measurable costs and benefits of Pima County’s integrated mental health and 911 crisis call center?

Design, Sites, and Data Sources

TMHD in Tucson is comprised of three research components: an impact study, a process and implementation study, and a benefit-cost study.

  1. The impact study will employ a quasi-experimental approach to examine the impact of Tucson’s crisis call mental health diversion, comparing the outcomes of individuals whose mental health 911 calls were diverted away from law enforcement response to those who received no integrated mental health crisis diversion response. MDRC will use existing administrative data maintained by Pima County, the City of Tucson, and Connections Health Solutions.
  2. The process study will employ qualitative methods to document the evolution and the current status of law enforcement and mental health collaborations across Pima County, as well as to inform our understanding of the implementation and current practices of the diversion program and co-responder strategies in Tucson. For this component, MDRC will conduct structured observations of 911 call center processes, interview line staff and managers, and review documents related to the Tucson Policy Department’s mental health diversion efforts.
  3. Finally, the benefit-cost study will compare the costs and benefits of the diversion program with traditional 911 responses. Interviews with system actors and stakeholders will be used to understand the resources required to run the diversion call center and traditional 911 response centers. Additional cost data will be gathered from agency expense reports and publicly available sources.