Despite promises of reform after the murder of George Floyd, police officers in the U.S. killed at least 1,247 people in 2023 — more than in any other year in over a decade. These deaths are symptoms of a disease born of investing in reactive punishment instead of violence prevention and supportive services. Chicago provides an exemplary case study of the consequences of such investments and how we might reverse them.
The city spent $295 million between 2019 and 2022 to settle more than 1,000 cases of alleged police misconduct. This is reflective of a Police Department, long relied upon by lawmakers as a catch-all agency for responding to mental health, social and economic crises, that has built a pronounced legacy of corruption, torture, racist brutality and white-supremacist affiliations.
It is appropriate to condemn the Chicago Police Department for its ongoing failure to institute meaningful reforms. It’s also important to see that CPD has been set up to fail and is unlikely to change unless reforms are made not just internally but also to the city’s budgetary decisions, specifically to chronic overinvestment in police alongside underinvestment in the Chicago Department of Public Health.
The last three decades have featured the intensive privatization of public health as the city has sent billions of dollars to private, exploitative nonprofits rather than investing in durable public care systems based on rights rather than charity. Until the 1990s, CDPH operated 19 mental health centers; today, only five are left. CDPH positions have been slashed by 60% since 2000, while police funding has rapidly increased. There is now little supportive infrastructure left to prevent or respond to the manifestations of poverty, isolation and healthcare exclusion.
The thousands of calls with a mental health component that CPD responds to each month frustrate officers. Police are forced to address problems for which they are not trained. In this context, many police officers are feeling demoralized and betrayed by their bosses. According to a July 2022 report, CPD has approximately 1,800 open positions, most unfilled for years.
After years of labor by a coalition of organizers, Treatment Not Trauma is poised to change this. Treatment Not Trauma, which I have worked with the Collaborative for Community Wellness to design, seeks to build a CDPH-run community care system to remove mental health and behavioral crises from CPD’s plate. It revolves around three interdependent parts: non-police crisis response, community care centers and a transformative model of mental health delivery led by community care workers. Mayor Brandon Johnson has embraced the program as one of his central priorities and convened a working group whose recommendations for Treatment Not Trauma’s implementation are due this month.
Treatment Not Trauma applies a public health model for community mental health and shared safety that begins from the recognition that crisis response works best, and is needed least, when interwoven with crisis prevention based on relationships. The program is thus designed around hiring, training and properly compensating nonprofessional care workers from within communities to work in collaboration with professional mental health workers to:
Provide a non-police mobile crisis response.
Prevent crises by providing supportive everyday care to their neighbors who are at greatest risk of mental health and social crises, violence, police contact and hospitalization.
Public health approaches to mental health that invest resources in employing community members to provide care to one another, rather than simply focus on expanding clinical services, are underused in the U.S. But there is abundant evidence from international contexts of their effectiveness, especially in the face of the dearth of existing services and professionals in Chicago’s Black and brown neighborhoods.
To support this work, Treatment Not Trauma includes reopening 14 city-run mental health centers, returning the total number to 19 and redesigning them as holistic community care centers rather than traditional medical clinics. They will operate as 24-hour walk-in facilities. To cultivate community wellness, they will also serve as hubs for community gatherings to rebuild the social fabric in neighborhoods suffering from fragmentation and distrust.
But to make any of this happen, the city must rebalance its budget. Evidence shows that investing in community-based health infrastructure dramatically reduces costs. One study found that mobile crisis intervention services reduced hospitalization costs by 79% over the six months following each crisis call. Estimates suggest that a program for non-police crisis response would yield $537 million in annual savings if implemented across Cook County or $279 million if restricted to Chicago. This should be unsurprising, as data shows that each dollar invested in prevention produces fourfold or fivefold returns, and a 2017 systematic review found that every $1 invested in health protection interventions yielded $34 in savings.
From a criminal-legal perspective, nearly every study of preventive measures finds benefits far outweigh costs. A 2022 study of Denver’s non-police crisis response system similar to what’s included in Treatment Not Trauma found it reduced low-level crimes by 34% and that “direct costs of having police as the first responders to individuals in mental health and substance abuse crises are over four times as large as those associated with a community response model.”
Treatment Not Trauma’s popularity among voters is well established. What remains to be seen is whether the Johnson administration will make the major investments the program requires and speed up the disappointingly slow start to its implementation. Johnson’s inclusion of a substantial increase in police funding in his 2024 budget alongside a relatively unchanged allocation for CDPH has alarmed organizers who are concerned about his commitment to Treatment Not Trauma, and specifically to building its community care corps. To retain their support, Johnson must now move quickly toward realizing the program’s vision.
We should stop using police as scapegoats for the fallout of politicians’ choices to defund public care systems. Police reform is too important and too difficult to leave to police alone.
Meaningful reform requires investing in supportive systems to shrink the outsize footprint of police and punishment. City Hall should follow the evidence and build the infrastructure that we all — police officers included — need to live safely together rather than in fear and isolation.
Eric Reinhart, M.D., is a psychoanalytic clinician and political anthropologist of law, psychiatry, and public health.
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