Restructuring Crisis Response Programs as Civilian-Led: A Scoping Review

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Rowe, Allannah Nguyen, Leyna Lowe, Kara Fletcher, Andrew D. Eaton This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6674129/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Civilian-led crisis response teams provide emergency mental healthcare for acute distress in community settings, without the involvement of police at first response. Civilian-led teams are relatively new, diverse in team composition and scope, and a promising alternative to police-led crisis teams. This scoping review synthesizes the key processes of civilian-led crisis response programs. Methods Included reports discussed: the development, need, potential, implementation, and outcomes of civilian-led crisis response models. Covidence software was utilized by two independent reviewers to search 11 databases, with a third reviewer resolving conflicts. A dataset of 46 reports were then analyzed with thematic content analysis by a multidisciplinary team using critical social theories to offer an exploration of how civilian-led crisis teams have begun to address the harms of policing mental health. Results In exploring the key processes for civilian-led crisis response teams, three themes emerged. The first theme, Decentering Police , explores the growing collective awareness of the harms associated with policing mental health and the corresponding need for alternative approaches, alongside efforts to establish a team composition that is intentionally distinct. The second theme, Team Scope of Practice , explores the subthemes of dispatch logistics and defining criteria for response. Team Sustainability is the third theme and explores how social and political will to introduce how alternative crisis response teams shape the uptake and long-term sustainability of civilian-led crisis programs, as well as efforts to resource these teams. Civilian-led crisis response non-police crisis response alternative crisis response teams mental health Figures Figure 1 Figure 2 Introduction The involvement of police in responding to crisis situations, referred to as policing mental health (Koziarski, 2018 ), has drawn increasing scrutiny (Haag, 2022 ; Marcoux & Nicholson, 2018). Crisis situations are typically marked by acute distress and are often defined by perceptions of an individual being in a mental state considered “erratic, threatening, or dangerous” (Iacobucci, 2014 , p. 49). These incidents frequently lead to family, friends, and bystanders placing emergency calls, which traditionally get dispatched to police as the primary responders to crisis situations, as emergency services perceive these individuals in crisis as posing significant potential for self-harm or harm to others (Jackson & Bradford, 2019; Pepler & Barber, 2021 ). Although individuals experiencing emotional distress are more likely to be subject to violence than perpetrate it (Black & Calhoun, 2022 ; Cotton & Coleman, 2010 ; Shore, 2015 ), the biases that underpin policing mental health often lead police to approach crisis situations with the expectation of violence (Shore, 2015 ). This default response sees individuals experiencing acute distress or emotional crises disproportionately met with law enforcement responses that too often escalate into violent (including fatal) outcomes for the distressed individual (Haag, 2022 ; Marcoux & Nicholson, 2018). This paper explores the restructuring of crisis response models into civilian-led teams: teams that exclude or remove police and instead rely on trained, unarmed personnel, including mental health practitioners, crisis response workers, and/or peers (DeLaus, 2020). We examine how these teams begin to respond to the harms of policing mental health. Our findings are framed through critical social theories to understand these models not only as operational alternatives, but as efforts to sever the ties between the criminal legal and mental healthcare systems. Policing Mental Health Policing mental health cannot be understood solely as a matter of emergency protocol but must also be situated within broader systemic conditions that have shaped how distress is defined, perceived, and responded to (Hon-Sing Wong, 2022; Meerai et al., 2016 ; Yee, 2022 ). The relationship between the criminal legal and mental healthcare systems has been reinforced by the global proliferation of austerity measures and neoliberal policies that prioritize cost-efficiency and individual responsibility over adequate public investment in mental health care (Brown et al., 2022 ; Harvey, 2005 ). These systemic shifts have contributed to what Shimrat ( 2013 ) terms “the tragic farce of community mental health” (p. 144), where the ideals of community-based care have largely failed to materialize. Instead, it has often been supplanted by an expanded role for law enforcement (Walby, 2022 ). In the absence of accessible, well-resourced mental health services, law enforcement has increasingly become the default response to crisis situations (Brown et al., 2022 ; Mukherjee, 2022 ). Policing mental health is not a neutral practice; it is shaped by sanist, racist, and Western colonial logics. Sanism is a central concept within mad studies and refers to the systemic oppression and marginalization of individuals who have received a mental health diagnosis or who are otherwise perceived as mentally ill (Poole et al., 2012), framing them as “incompetent, unable to do things for themselves, constantly in need of supervision and assistance, unpredictable, violent, and irrational” (Chamberlin, 1990 , p. 2). Sanism denies individuals’ ability to make sense of their own experiences, often framing distress and human suffering as irrational or disordered (Johnstone & Boyle, 2018 ; Poole et al., 2012). Sanism is rarely experienced in isolation; to fully understand its reach and impact, it must be examined alongside racism and settler colonialism (Liegghio, 2013 ; Meerai et al., 2016 ; Yee, 2022 ). The intersection of sanism and racism has been described as anti-Black and anti-Indigenous sanism (Meerai et al., 2016 ; Yee, 2022 ), highlighting how racialized individuals are uniquely targeted by pathologizing distress and conflating it with violence (Meerai et al., 2016 ). The subjugation of Black people through the legacy of enslavement created the conditions under which anti-Black racism, defined as the “prejudice, stereotyping, and discrimination that is directed at people of Black-African descent” (Benjamin, 2003 , p. ii), has been sustained and normalized. Similarly, anti-Indigenous racism is rooted in the logics of Western settler colonialism, which frame Indigenous bodies, cultures, and knowledge systems as inferior, justifying their control, assimilation, and erasure (Hon-Sing Wong, 2016 ; Maynard, 2017 ; Simpson, 2017 ). As Meerai et al. ( 2016 ) note, “sanism exists on a continuum depending on privilege, and it is always and especially compounded when it is visited on racialized bodies” (p. 22). Together, sanism, racism, and settler colonialism shape how distress is interpreted and how individuals – particularly those who are psychiatrized (Hon-Sing Wong, 2022; Lee, 2013 ; Liegghio, 2013 ) and/or racialized (Hon-Sing Wong et al., 2022 ; Maynard, 2017 ; Meerai et al., 2016 ) – are perceived and treated in moments of crisis. The Current State of Crisis Response Individuals experiencing acute distress, particularly in public, are at an increased risk of encountering lethal force in interactions with police (Winters et al., 2015 ). Black and Indigenous people experiencing distress are particularly overrepresented among those killed by police (Marcoux & Nicholson, 2018; Singh, 2020). Data from a Canadian database tracking police-involved fatalities between 2000 and 2017 show that 68% (n = 377) of those killed were individuals experiencing acute distress (Marcoux & Nicholson, 2018; Singh, 2020). Black and Indigenous people were disproportionately represented: Black individuals comprised 8.63% of deaths but only 2.92% of the population, while Indigenous people accounted for 16% of deaths despite being only 4.21% of the population (Marcoux & Nicholson, 2018; Singh, 2020). Efforts to improve crisis response interventions have led to the development of Crisis Intervention Teams and co-responder models. Crisis Interventions Teams are specialized police-led crisis response programs that train officers to recognize and de-escalate situations involving an individual experiencing acute distress, while facilitating connections to services. Extant research suggests they have little effect on use-of-force rates, arrests, or fatalities during intervention (Rogers et al., 2019 ; Shadravan et al., 2021 ; Taheri, 2016 ). Co-responder teams pair police with mental health professionals, aiming to bridge gaps between law enforcement and healthcare (Iacobucci, 2014 ; Rosenbaum, 2010 ). While their use has expanded, critics argue that by maintaining police involvement, co-responder teams continue to criminalize emotional distress rather than providing an alternative that responds to the systemic harms of policing (Removed for Review., in press; Pepler & Barber, 2021 ). Civilian-led crisis response teams begin to recognize and respond to the harms of sanism, racism, and Western colonialism by divesting from police involvement in crisis care. Excluding police from crisis response models offers a means of challenging the pathologization of distress and its conflation with violence and the need to be policed (Haag, 2024). Civilian-led crisis response teams are beginning to gain momentum, with teams being introduced in the United States (Townsend et al., 2023), Canada (Egan-Elliott, 2021) Australia (Justice Action, 2023 ), and Norway (Karlsson et al., 2012 ). While there exists a strong theoretical basis for the potential of these teams, particularly in their divestment from police, research on civilian-led models is still in its early stages. Objective In this paper, we aim to synthesize published research and grey literature to analyze how crisis mental health response has been restructured into civilian-led models. Our findings are analyzed through critical social theories to examine how these teams are beginning to address the historical and theoretical conditions that have shaped the policing of mental health in Western contexts. Theoretical Foundations This scoping review is positioned as a transformative justice study approached through a lens of prison industrial complex abolition. Prison industrial complex abolition is a movement committed to dismantling the interconnected systems of policing and prisons, surveillance, incarceration, and punishment (Davis, 2000 ; Kaba & Ritchie, 2022 ). It challenges the reliance on confinement, control, and force as solutions to harm, instead advocating for accountability and social support that address the underlying causes of harm (Davis, 2000 ; Kaba & Ritchie, 2022 ). Within mental healthcare, the dominance of policing as a primary response to crisis reflects the very logics that prison industrial complex abolition seeks to challenge and undo (Kaba & Ritchie, 2022 ). While the broader abolitionist movement aims to abolish the entire carceral state (Davis, 2000 ; Kaba & Ritchie, 2022 ) – including the medical industrial complex (Page & Woodland, 2023) – this study draws specifically on a prison industrial complex abolition-informed perspective. This distinction is important because, despite removing police from team staffing, non-police crisis response models remain embedded within traditional mental healthcare systems, which often perpetuate carceral patterns (Page & Woodland, 2023; Seltzer et al., 2024 ). As such, this work does not fully align with psychiatric abolition, reinforcing the rationale for applying a prison-specific abolitionist lens. To critically examine how carceral logics shape responses to crisis response, and to begin to explore alternatives, the scoping review is theoretically informed by mad studies, the Power Threat Meaning Framework (Johnstone & Boyle, 2018 ), and critical race theory. Mad studies theorists oppose the logics of policing mental health and instead sees distress as a legitimate expression of human suffering often rooted in structural violence, trauma, or marginalization (Poole et al., 2012). The Power Threat Meaning Framework (PTMF) complements the ethos of mad studies by offering a structured yet non-pathologizing approach to understanding crisis situations (Johnstone & Boyle, 2018 ). It calls for an understanding of distress and crisis as a meaningful, and painful, response to adverse experiences (Johnstone & Boyle, 2018 ). Rather than asking what’s wrong with you , the PTMF asks, what has happened to you and how is it affecting you , encouraging responses rooted in collaborative meaning-making and context in the care process (Johnstone & Boyle, 2018 ). The PTMF challenges policing mental health by shifting how crisis situations are understood and responded to (Johnstone & Boyle, 2018 ). Rather than assuming that crisis is inherently violent, it views distress as real and frightening for the person experiencing it, requiring responses that are committed to meeting the person emotionally and relationally where they are (Johnstone & Boyle, 2018 ). Critical race theory further strengthens this theoretical grounding by highlighting how the criminalization of distress is embedded within racialized and colonial systems of power (Badwall, 2022 ). It asserts that racism is endemic to Western society (Badwall, 2022 ), woven into its institutions, policies, and cultural logics through the legacy of colonialism. Within the context of policing mental health, Western colonial ideologies construct racialized bodies as sites of disorder, deviance, and threat (Badwall, 2022 ; Maynard, 2017 ; Page & Woodland, 2023), seeing their distress as more dangerous, more violent, and more deserving of forceful or coercive intervention (Maynard, 2017 ). Through this lens, crisis responses are understood not simply as reactions to individual behaviour, but as practices that sustain broader patterns of racism rooted in Western colonial systems (Hon-Sing Wong, 2022; Maynard, 2017 ) Mad studies, the PTMF, and critical race theory offer a foundation for reimagining crisis response. Together, they provide a critical framework for examining how crisis response models have been restructured into civilian-led teams, and how these efforts have begun to recognize and respond to the intersecting impacts of sanism, racism, and Western colonialism. Methods Civilian-led (i.e., non-police) crisis response teams have only recently started gaining traction within prevailing discourse, resulting in a still-developing body of literature. Thus, a scoping review was employed to comprehensively map and synthesize existing knowledge on civilian-led crisis response teams, ensuring a broad exploration of the available literature. Search Procedure Following scoping review guidelines (Munn et al., 2018; Pham et al., 2014 ) we registered the review with Open Science Framework and conducted scholarly database searches alongside searching relevant professional networks and works in progress. We identified relevant studies by completing 11 database searches that included APA PsychInfo, APA PsycArticles, CINAHL & MEDLINE Combined Search, Criminal Justice Database (collection and abstracts), CQ Researcher, ProQuest Health & Medical Collection, ProQuest Nursing & Allied Health Database, SAGE Journals, Sociological Collection (Sociological Abstracts), Social Work Abstracts, and ProQuest Dissertations and Theses. We included grey literature, media, and reports. Key terms used to conduct the searches included “non police” AND [“mental health” or “crisis” or “emotional distress”] AND [“community crisis response” OR “non police crisis response”]. We also conducted manual searches to identify literature that might have been missed within our search of scholarly databases. Complete search syntax is available on Borealis (Removed for Review, 2025). Inclusion Criteria A report was included if it examined a civilian-led crisis response team and focused on acute distress (or "mental health") specific crisis intervention. For this research, a civilian response model is defined as a crisis response approach involving trained mental health response workers, including but not limited to mental health clinicians such as social workers, psychologists, nurses, and/or trained peers, with no sworn members (primarily police officers and occasionally paramedics). Paramedics may serve as sworn members, particularly in integrated public safety departments where personnel are cross-trained to perform multiple roles (Hilal & Jones, 2014). To be included, the literature needed to recognize or explore at least one of the following dimensions: The need for non-police crisis response models The potential of these models Their development Their implementation Outcomes associated with their use Their impact on crisis response The efficacy of such models Additionally, studies were required to discuss programs that serve the public and act as the first point of contact during crisis situations. We included empirical research and grey literature. Only English-language literature published from the year 1999 onward was considered. Screening Screening was conducted using Covidence software by two independent reviewers following the established eligibility criteria. Upon completion, the reviewers met to discuss the screening results, and a third reviewer was involved to resolve screening discrepancies where needed. Subsequently, each reviewer was assigned articles to complete a full-text screen. In total, 46 articles were deemed eligible for inclusion. Refer to Fig. 1 for the PRISMA flow chart. Data Extraction and Analysis Data extraction and analysis was completed by four trained research assistants, extracting data pertaining to team composition, funding, and dispatch of team (i.e., 911, 211), amongst other key data points. The extraction spreadsheet is available on Borealis (Removed for Review, 2025). Thematic content analysis was completed by eight independent coders, each of whom was either someone working within crisis response, a student in a health-related field, a policy analyst, a mental health advocate, and/or someone who brings with them lived experience of psychological distress. Each coder was assigned 5–6 articles and provided with detailed coding guidelines (see supplementary file) to ensure consistency in their analysis. NVIVO 12 software was used to systematically organize and analyze the data. Coders independently reviewed and coded their assigned articles, after which the team met to discuss findings, resolve discrepancies, and refine the thematic framework. The first and last authors drafted themes and subthemes based on the team meeting and all authors approved the results as presented herein. Quality During the screening stage, it was identified that most literature came from grey or media sources. Accordingly, the Mixed Methods Appraisal Tool (MMAT) Version 2018 (Hong et al., 2018) was not an appropriate tool for evaluation. Instead, an adapted version of the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) tool (Tyndall, 2010) was used. Originally developed to assess grey literature, the AACODS framework was modified for this scoping review to ensure its applicability to both grey and media sources. The adapted tool included 10 questions to evaluate authority and source credibility, corroboration of information, topic coverage, objectivity, and publication date (see supplementary file). Each question was dummy-coded: a 1 was given if the response to the criteria was a “Yes” or a 0 if the response was a “No” or “Can’t Tell.”, with a total possible score of 10. Articles were given scores ranging from 0% (low quality) to 100% (high quality). Appraisal was conducted independently by one reviewer. A second reviewer cross-checked their work, making appropriate changes where necessary, such as determining publication source and/or clarifying publication date. The appraisal results are posted on Borealis (Removed for Review, 2025). Results A total of 46 articles were included in this scoping review, the majority of which were grey literature (n = 22) and media reports (n = 21). Additionally, the review incorporated two qualitative reviews and one descriptive quantitative study. An adapted version of the AACODS tool was used to appraise the quality of each included article. Twenty-three articles received a score of 100%, five articles received a score of 90%, eight articles received a score of 80%, eight articles received a score of 70%, and two articles received a score of 60%. Three primary themes were identified regarding key processes involved in restructuring crisis response models into civilian-led teams, each with corresponding subthemes. The first theme, Decentering Police , captures the role of collective awareness and the importance of establishing a distinct team composition. The second theme, Team Scope of Practice , addresses considerations related to dispatch number and defining criteria for response. The third theme, Team Sustainability , highlights the influence of interest holder perceptions and political will, as well as the need for adequate resourcing. Figure 2 illustrates these thematic findings. Theme 1: Decentering Police Thirty-nine articles discussed the decentering of police within crisis response as a central component to structuring civilian-led crisis response services. The theme of decentering police consists of two subthemes: collective awareness of the harms policing mental health and establishing a distinct team composition. Sub-Theme 1.1: Collective Awareness Twenty-seven articles identify collective awareness of the harms of policing mental health – including the recognition that police involvement in crisis intervention often escalates situations (e.g., Beck et al., 2022 ; Reach Out Response Network, 2020 ) and disproportionately harms racialized communities (e.g., Anene et al., 2023 ; Canady, 2021 ) – as a key driver in the shift toward establishing civilian-led crisis response teams in Norway, Canada, Australia, and the United States. Racialized communities and individuals with lived experience of acute distress or crisis have long advocated against the disproportionate policing they face and the resulting harms, including fatal outcomes (Reach Out Response Network, 2020 ). The literature suggests that calls to reimagine public safety by reducing police involvement in healthcare – particularly in crisis response – are driven in part by the argument that situations requiring emotional support and de-escalation should not be met with a police response (Karlsson et al., 2012 ; Livingston, 2024 ) as law enforcement “are not trained or equipped to handle [crisis intervention] appropriately” (Townsend et al., 2023). The literature describes a consciousness-raising process in which these efforts gained broader recognition in public and political discourse, largely due to the impact of global and local events. In jurisdictions that have implemented civilian-led crisis teams, increasing awareness of the disproportionately harmful consequences of police interactions – particularly for Black, Indigenous, and individuals experiencing acute distress – has further reinforced the urgency of these efforts. Anene and colleagues ( 2023 ), Canady ( 2021 ), Van Lier ( 2021 , 2022 ), Yousif (2020), Zaffrann (2022), amongst others, cite the tragic murder of George Floyd by police officer Derick Chauvin in May 2020 in Minneapolis, U.S.A., as a catalyst event that precipitated calls for police reform and abolition. This event caused the public to question the legitimacy of policing more broadly and its involvement in crisis intervention more specifically, making longstanding demands for systemic change more difficult for policymakers to ignore. As Watson and El-Sabawi ( 2023 ) explain, it was in the wake of George Floyd’s murder that “policymakers have begun to take seriously demands to…provide the public with alternatives to police when they are in need of help” (p. 1). Similarly, van Lier ( 2021 ) notes that initiatives to explore non-police crisis response models gained traction as high-profile killings of Black people by police have “vaulted the actions of law enforcement” (p. 1) into the public eye. While George Floyd’s murder exposed the deadly realities of police violence, the death of Regis Korchinski-Paquet during a crisis intervention highlighted the specific dangers of police involvement in crisis response, further building momentum for systemic transformation. Chambers and Deshman (2024), CityNews Staff (2021), Ngabo ( 2021 ), and Yousif (2022) highlight the death of Regis Korchinski-Paquet during a police-led crisis intervention in Toronto in 2020 as pivotal in advancing the push for non-police crisis response services, directly contributing to the development of the Toronto Community Crisis Service. In sum, sustained collective mobilization, particularly through pressure on elected officials, played a crucial role in advancing these discussions and prompting key decision-makers to consider alternative crisis response models S ub-Theme 1.2: Establishing a Distinct Team Composition All literature included in this scoping review emphasized the importance of establishing a distinct team composition when restructuring crisis response programs into civilian-led models, particularly by removing and excluding police from these teams to provide safer, more appropriate care to individuals experiencing acute distress. While the literature suggests civilian-led crisis teams vary in their staffing and team composition (e.g., Karlsson et al., 2012 ), a consistent defining feature across models is the deliberate exclusion of police from team staffing. Civilian-led models recognize the inherent harm introduced by police presence in any form and have responded by eliminating police from team composition. In addition to this fundamental distinction, these teams also stand out for their intentional inclusion of ‘peers,’ referring to individuals who bring with them the knowledge and wisdom of living or lived experiences of mental health challenges and/or experiences of acute distress (Mental Health Commission of Canada, 2025 ). As per Wyton (2022), “the comfort and non-judgement from peers is so sacred and so needed," (p. 2). The United States’ (US) Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2020 National Guidelines for Behavioral Health Crisis Care emphasize non-police crisis response teams as best practice for mental health crisis intervention and are heavily cited as the evidence base to support the legitimacy of civilian crisis teams, including ones outside of the US (Canady, 2021 ; Karlsson et al., 2012 ; Ryder and Nash, 2024). These guidelines outline that a public health approach rather than a law enforcement response should be the foundation for crisis care. Gillis ( 2023 ) notes “we hope that by removing police, we’ll reduce stigma, and people will be able to see that [emotional distress] isn’t a crime, it’s a health crisis” (p.6). Beck and colleagues ( 2022 ) outline that police involvement often escalates emotional distress, resulting in harm towards the individual in crisis. This is particularly true for Black and other non-white people; “Black people, in contrast to most white people, live with the fear that police will hurt them or their family members” (Beck et al., 2022 , p. 2). In an anonymous online survey conducted across Nova Scotia, Canada, participants who self-identified as having lived experience with mental health or substance use challenges reported low trust in police when responding to crises (Livingston, 2024 ). The findings also highlighted that non-police, civilian-led crisis teams were widely perceived as “beneficial, comfortable, helpful, appropriate, and preferred” (Livingston, 2024 , p. 4). The importance of developing civilian-led programs in collaboration with community members to meet the needs and priorities of those most impacted was equally emphasized (e.g., CSG Justice Center, 2024; Spolum et al., 2023 ; Yousif, 2020). Zaffrann (2022) notes “community engagement that centers the voices and input of those most likely to be served by [civilian-led programs] is critical” (p. 18), while Reach Out Response Network’s Asante Haughton cited by Yousif (2020) expresses the importance of “prioritizing the community voice [such that] whatever is built is representing what folks are asking for” (p. 2). Nonko (2020) explains that a civilian-led pilot program in California was informed by “family members of individuals killed by police, as well as experts in non-police responses to crises” (p. 1). Chrastil (2023), Yousif (2020), and van Lier ( 2022 ) each explain that within cities that have implemented civilian-led models (e.g., Toronto, New Orleans, Ohio), a task force was first implemented to consult and engage community members and other key interest holders, ensuring their insights were involved in program design and development. In Toronto, Canada, specific attention was placed on Black and Indigenous-led engagement in initial development process for the Toronto Community Crisis Service (Yousif, 2020). Within this scoping review’s included literature, civilian-led teams were described as consisting of: nurses paired with mental health workers including clinicians and/or peers (Kearnes, 2022 ; Mental Health Weekly, 2022a , 2022b ; Yousif 2022, 2023), mental health workers (Reach Out Response Network, 2020 ; Townsend et al., 2023), behavioral health crises workers and licensed clinicians (Ryder & Nash, 2024; Towles, 2021), trained crisis responder volunteers (Nonko, 2020; Welborn, 1999), and most commonly, mental health professionals and peers (Campbell, 2022; CityNews Staff, 2023; Fleming, 2021 ; Provincial System Support Program & Shkaabe Makwa, 2023; Towles, 2021; van Lier, 2022 , Wyton, 2022; Ziafati, 2022). Theme 2: Operational Framework Thirty-two of the included literature sources discussed the overarching role of determining an operational framework in the process of restricting crisis response models into civilian-led teams. Particularly, navigating dispatch logistics and the defining criteria for a response emerged across the literature as critical components of establishing a team’s operational framework. Sub-Theme 2.1: Dispatch Logistics Determining dispatch logistics, including the number by which a team can be contacted as well as its hours of operation, was discussed in 25 articles. The literature points to deliberations regarding the point of access for a team as well as the hours of operation that a service is available, indicating there is no universal standard. The most common dispatch points indicated throughout the literature include the phone numbers 911, 211, and 988. The dispatch procedure consistently described across the literature included the initial calls for service, subsequent screening by the dispatch receiver, and finally dispatch of the team. Some articles argue that using 911 as the dispatch number for civilian-led crisis response teams is crucial for seamless integration with emergency services such as police, fire, and EMS (e.g., Ryder & Nash, 2024; Yousif, 2020, 2023). Additionally, 911 is widely considered the most accessible option, as it is a universal emergency number that can be dialed free of charge from cell phones or payphones, even without a working SIM card (Yousif, 2020). For calls made to 911, some sources suggest a transfer process where calls are first screened by a 211 operator before being dispatched to the appropriate response team (e.g., Chrastil, 2023; CityNews Staff, 2021). Others propose direct integration, allowing 911 operators to dispatch civilian-led teams alongside traditional emergency responders (e.g., CSG Justice Center, 2024). However, some of the literature raised concerns about linking crisis response teams to 911, cautioning that alternative contact points may feel safer and more trustworthy, particularly for communities that do not associate 911 with safety (e.g., Beck et al., 2022 ; Mellins, 2021; Mental Health Weekly, 2022; Townsend et al., 2022). A hybrid approach was also discussed in the literature, suggesting multiple access points – such as being able to access teams by calling 911, 211, or a dedicated crisis team number – to ensure broader accessibility and choice for those in crisis (e.g., Chrastil, 2023; Reach Out Response Network; Yousif, 2022). The literature demonstrates variations regarding the hours of operation of civilian-led crisis response services. While some programs were described as in operation 24/7/365 (e.g., Karlsson et al., 2012 ; Kearnes, 2022 ; Reach Out Response Network, 2020 ), others were limited in their hours and days of operation, noting the primary barriers to offering the service 24/7/365 included limitations in funding and securing staff (e.g., Wyton, 2022). Notwithstanding, across all models discussed, the goal is to “to offer rapid assessment with 24/7 availability” (Karlsson et al., 2012 , p. 3). Sub-Theme 2.2: Defining Criteria for a Response The literature (n = 37) examined the types of situations that civilian-led crisis teams are designed to respond to. This "scope of response" refers to the specific kinds of situations the teams are equipped to handle. Typically, these teams are dispatched when a caller uses certain key words or phrases that match the team's predefined criteria for intervention. Across the literature, the most common keywords used to delineate the types of situations these teams respond to include ‘ mental health crisis’ and ‘substance use crisis’ (e.g., Fagan, 2023; Ziafati, 2022), ‘ non-emergency crisis’ (e.g., CSG Justice Center, 2024; Kearnes, 2022 ), and ‘ non-violent incidents’ (e.g., Egan-Elliott, 2021; Provincial System Support Program & Shkaabe Makwa, 2023; van Lier, 2022 ). Operators are trained to assess incoming emergency calls and identify those that meet the established criteria, ensuring a civilian-led team is dispatched when appropriate (CityNews Staff, 2021; Reach Out Response Network, 2020 ). The literature reveals a lack of clear, consistent definitions for the terms ‘non-emergency’ and ‘non-violent’. Two sources (Beck et al., 2022 ; Provincial System Support Program & Shkaabe Makwa, 2023) discuss the need to better clarify what situations fall within and outside these domains. Provincial System Support Program & Shkaabe Makwa (2023) explain “a particular challenge has been establishing a clear understanding of the violence threshold for when to involve (or re-involve) 911 and police in Toronto Community Crisis Service” (p. 38), while (Beck et al., 2022 ) notes a need to “identify the types of calls that are appropriate for civilian crisis response beyond those narrowly defined as behavioral health crises” (p. 5). Mellins (2021) explains that the Person in Crisis team in Rochester has been unreliable and somewhat ineffective, particularly due to the “strict criteria limiting who it can assist” (p. 2). Specifically, the Person in Crisis team does not respond to individuals under the influence of substances, which significantly limits who can access support from this team (Mellins, 2021). Theme 3: Team Uptake and Sustainability Thirty of the articles included in this scoping review discussed the uptake and sustainability of civilian-led programs, emphasizing the importance of both initial interest and long-term support in restructuring crisis response models. The theme of Team Uptake and Sustainability highlights that social and political will for alternative crisis models, along with adequate resourcing, are critical factors that enable the development, implementation, and long-term viability of civilian-led crisis response teams. Sub-Theme 3.1: Social and Political Will Twenty-eight of the included sources discussed the interplay between the social and political will to introduce alternative crisis response teams in shaping the uptake and long-term sustainability of civilian-led crisis programs. Social will refers to the support and perceptions of community (Chalabi, 2019), while political will pertains to the commitment of elected officials and government bodies (Post et al., 2010 ). This relationship was discussed within the literature as reciprocal, with community advocacy influencing political action, and political decisions, in turn, shaping public engagement. In areas that have established civilian-led teams, support from local governments was a common trend in solidifying plans to establish alternative crisis response models (e.g., Fleming, 2021 ; Gorman, 2024; Townsend et al., 2023). Beck et al. ( 2022 ), Chrastil (2023), and Fleming ( 2021 ) highlight the impact of public perception and support in driving efforts to reimagine crisis response programs, acting as a push to inspire political will. Additionally, the support or "buy-in" from health professionals and law enforcement was identified as crucial in promoting civilian-led teams, particularly in championing their safety and effectiveness to local officials (Fleming, 2021 ; Gorman, 2024; Nonko, 2020). Zaffrann (2022) notes that “as public interest in alternative responses has increased, so too has interest by local elected officials” (p. 5), while Fleming ( 2021 ) explains, “if not initially championed by community advocates, local officials may face pushback from community members” (p. 2). Sub-Theme 3.2: Resourcing Thirty-five articles discussed factors relating to the resourcing of civilian-led programs in contributing to their implementation and ongoing operation sustainability. Specifically, the literature spoke to partnership considerations and the provision of funding to support, operate, and uphold civilian-led teams. The importance of creating partnerships and collaborating with interest holders to support the operation of civilian-led services was discussed across the literature, particularly regarding the role of network formation in securing funding to sustain these teams (e.g., Mental Health Weekly, 2022b ; Ryan, 2024; van Lier, 2021 , 2022 ; Welborn, 1999). While the literature consistently emphasizes the need for sustained funding to support civilian-led programs, there are varying perspectives regarding the source and allocation of this funding. Some sources indicate that the funding of civilian-led programs should come directly from cuts to policing budgets (e.g., Towles, 2021; van Lier, 2021 , 2022 ), such that these teams can be sustainably funded without relying on short-term grants or pilot project funding. Irwin and Pearl ( 2020 ) emphasize that areas looking to implement civilian-led teams should aim to provide a dedicated funding stream to sustain these teams, while recognizing that “local leaders may need to explore private funding sources to support the early implementation of the program, especially as governments are facing pandemic-related budget deficits” (p. 15). Alternatively, others (e.g., Egan-Elliot, 2021; Welborn, 1999) argue that civilian-led programs should be “adding to the system, rather than cutting the police department’s budget” (Egan-Elliott, 2021, p. 4). Mellins (2021) discusses three incidents of police violence in Rochester: a) the arrest and pepper-spraying of a 9-year-old girl in crisis; b) the tackling and pepper-spraying of a woman with her 3-year-old child following an alleged shoplifting incident; and c) and the fatal shooting of Tyshon Jones, a 29-year-old man in distress, who was threatening self-harm with a knife outside a homeless shelter. All three individuals were Black. These incidents occurred despite the implementation and operation of Rochester’s Person in Crisis team, a civilian-led crisis response model. Mellins (2021) notes, “that these incidents occurred after the [Person in Crisis] team was announced demonstrates that the team is either underfunded and therefore ill-equipped, or intentionally toothless and ill-conceived” (p. 2). Without proper resourcing, civilian-led teams risk being rendered futile. Discussion The findings from this scoping review demonstrate the key processes involved in the restructuring of crisis response models into civilian-led teams. This review provides a synthesis of these key processes and can serve as a roadmap for communities interested in establishing civilian-led crisis response teams. Further, our findings illustrate how civilian-led models begin to recognize and respond to sanist, racist, and settler colonial underpinnings of policing mental health. Transformative justice seeks to inspire small, intentional steps toward creating a world where reliance on carceral systems, including police, is rendered obsolete (Ritchie, 2023 ). Accordingly, excluding police from staffing of crisis response teams is positioned toward advancing transformative change within mental healthcare. The influence of collective awareness in shifting crisis response away from police highlights the power of mobilized efforts in driving systems level change (Ritchie, 2022). The recognition of longstanding community advocacy, and the accompanied pressure on elected officials, facilitated the decision to decenter police and reflects a broader redistribution of power toward the community, aligning with the transformative ethos of nothing about us without us that is central to peer support. (Antojado, 2023 ; Charlton, 1998). Establishing a distinct team composition that removes and intentionally excludes police within team staffing begins to respond to the harms of policing mental health, and its sanist, racist, and Western colonial underpinnings. Removing police from crisis response teams responds to the disproportionate harm experienced by individuals experiencing acute distress, particularly Black and Indigenous people, during encounters with police. Establishing non-police avenues of support for individuals to access during moments of distress or crisis actively challenges the legacies of sanism, racism, and Western colonialism, acknowledging the importance of shifting care away from carceral systems (Interrupting Criminalization et al., 2022). The inclusion of peers in civilian-led models marks a meaningful shift toward valuing lived experience in mental health care. It challenges dominant assumptions that equate mental illness with incapacity (Kara, 2014, as cited in Shore, 2015 , p. 10), and aligns with the PTMF’s emphasis on understanding distress through the lens of lived experience and meaning-making (Johnstone & Boyle, 2018 ). In this view, peer knowledge is positioned as a vital and legitimate source of insight. Importantly, however, are two considerations. First, although these teams do not staff police and first responders, they may nevertheless involve police as secondary or tertiary responders: “we can escalate [involve police] where needed” (Ryan, 2024, p. 2). More complete transparency is warranted within discussions of civilian-led crisis response models, particularly in clarifying when and how police will be involved. Second, the involvement of regulated health professionals within civilian-led teams upholds carceral dynamics and reinforces connections to carceral systems (Seltzer et al., 2022). Although their scope is different than that of law enforcement, mental health clinicians do maintain the power to pathologize distress, initiate coercive/forced interventions, and are inextricably linked to the carceral state (Jones & Jacobs, 2024). Ultimately, while removing police from crisis response begins to challenge carceral practices, it does not fully disentangle crisis care from the broader systems of control and coercion that characterize carceral mental healthcare (Hon-Sing Wong, 2022). The operational framework of each team, including the dispatch logistics and criteria for a response, requires careful consideration. As recognized by some of the included literature (e.g., Townend et al., 2023), calling 911 does not introduce the same sense of supposed universal safety for all, given its ties to policing. To respond to this, as per the literature, some teams have created alternative avenues to access civilian-led teams. Decisions relating to team contact point should always be made in close consultation with community members, to ensure that teams remain accessible for all (Reach Out Response Network, 2020 ). Further, the literature identified a series of consistent criteria for a civilian-led response (i.e., situations that a civilian-led team may respond to) including the keywords ‘non-violent’ and ‘non-emergency’. However, as demonstrated in our findings, no clear parameters defining what constitutes a non-violent or non-emergency situation have been set. Considering the often sanist and racist connotations of how violence manifests or who perpetrates violence, and the conflation of violence with displays of distress, the lack of transparency in defining these terms is cause for concern (Johnstone & Boyle, 2018 ). These criteria must be better identified and interrogated to better challenge sanism and racism within crisis response. The sustainability of civilian-led response models, shaped by social and political will that advocates for the advancement of alternative teams, is of timely consideration. Given the current shifts in the social, political, and economic climate of the Western world – characterized by the rapid resurgence of conservative nationalism (Chryssogelos, 2024), growing authoritarianism (Ritchie, 2023 ), and the continued entrenchment of policies that underfund community-based services (Brown et al., 2022 ) – the expansion and long-term viability of community-based, transformative models may be at risk. It is of critical importance that local elected leaders, community members, advocates, and healthcare professionals continue to push for and champion alternative crisis response models such as civilian-led teams. The pursuit of social justice and liberation is a steadfast force that “enable[es] us to resist increasing authoritarianism” (Ritchie, 2023 , p. 69), and will remain at the heart of driving transformative change. Implications for Policy and Practice This scoping review of 46 sources provides an overview of the key processes involved in restructuring crisis response programs into civilian-led teams. Our findings demonstrate consistent overarching themes and associated subthemes involved in this restructuring and provide insight into how these teams have begun to respond to the legacies of sanism and racism within mental healthcare systems. We suggest areas looking to establish civilian-led crisis response teams consider the pathways to restructuring presented here. To better advance civilian-led crisis teams as transformative healthcare models, we suggest that funding provision follow a divestment and reinvestment approach, such that funding is taken from policing and allocated toward non-police crisis teams. This approach is in line with prison industrial complex abolitionist principles and represents an intentional step to creating transformative worlds. At the practice level, we recommend civilian-led teams establish transparent, clear guidelines about their ties to police (i.e., when police will be involved, what their relationship to police looks like), as well as look to better define what constitutes ‘non-emergency’ or ‘non-violent’ situations, ensuring that human distress is not being conflated with violence, particularly along sites of race. Limitations A systematic review and meta-analysis were not possible due to the limited availability of empirical research on civilian-led crisis teams (Cumpston et al., 2019). Restricting the review to English reports limited the search scope. Due to the diverse language used to describe civilian-led teams, some articles may have been missed despite our multifaceted search strategy. In addition, we did not include anti-carceral crisis lines (e.g., Walls Down Collective, Trans Lifeline) as these services typically do not offer in-person intervention, and therefore did not meet our eligibility criteria for a civilian-led crisis response team. Areas for Future Research Future research programs can explore the comparative effectiveness (i.e., service user experiences, linkage to resources), operational dynamics (e.g., number of calls received/responded to, time from call to response, length of intervention), and community perceptions between co-responder and civilian-led crisis response teams. Examining how these teams interact, differ in their approaches, and influence crisis outcomes could provide valuable insights into the strengths and limitations of each model, as well as inform best practices for scaling civilian-led crisis response. Further, exploring entirely anti-carceral crisis response teams (i.e., ones that have a strict, transparent policy against involving police) remains an important area for future research. Anti-carceral, peer-led care work offers insight into crisis intervention strategies that do not rely on law enforcement at any stage, demonstrating that entirely anti-carceral care is possible. Conclusion The growing recognition of the harms of policing mental health within mainstream discourse has generated calls for alternative, non-police crisis response programs in form of civilian-led teams. This review provides a synthesis of the existing literature on civilian-led crisis teams and outlines the overarching themes associated with restructuring crisis models into civilian-led teams. It also examines how these teams have begun responding to the legacies of sanism, racism, and colonialism in policing mental health. In sum, this review brings together existing literature on civilian-led models, providing a foundation by which local leaders, policymakers, and communities can build off in exploring civilian-led crisis models. Abbreviations PTMF Power Threat Meaning Framework (Johnstone & Boyle 2018) Declarations Ethics approval and consent to participate: Not applicable Consent for publication: Not applicable Availability of data and materials: Data and materials from this review are available on Borealis at https://doi.org/10.5683/SP3/OXKHUZ Competing interests: The authors declare that they have no competing interests. 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(2020, July 23). 2020 already a particularly deadly year for people killed in police encounters, CBC research shows . CBC News. https://newsinteractives.cbc.ca/features/2020/fatalpoliceencounters/ Spolum, M., Lopez, W. D., Watkins, D. C., & Fleming, P. J. (2023). Police violence: reducing the harms of policing through public health-informed alternative response program. AM J Public Health, 113 (51), 537-542. https://doi.org./10.2105/AJPH.2022.307107. Taheri, S. A. (2016). Do Crisis Intervention Teams reduce arrest and improve officer safety? A systematic review and meta-analysis. Criminal Justice Policy Review , 27 (1), 76-96. https://doi.org/10.1177/0887403414556289 Towles, A. G. (2021a). Three ways state leaders can support community responder programs. Justice Center: The Council of State Governments. https://csgjusticecenter.org/2021/09/07/three-ways-state-leaders-can-support-community-responder-programs/ Towles, A. G. (2021b). Explainer: A Breakdown of Community Responder program staff models and structures . CSG Justice Center. https://csgjusticecenter.org/2021/09/07/explainer-a-breakdown-of-community-responder-program-staff-models-and-structures/ Townsend, T. G., Dillard-Wright, J., Prestwich, K., Alapatt, V., Kouame, G., Kubicki, J. M., Johnson, K. F., & Williams, C. D. (2023). Public safety redefined: Mitigating trauma by centering the community in community mental health. American Psychologist , 78(2) , 227–243. https://doi.org/10.1037/amp0001081 van Lier, P. (2021, July 21). Reimagining public safety in Cleveland . Policy Matters Ohio. https://www.policymattersohio.org/research-policy/quality-ohio/justice-reform/reimagining-public-safety-in-cleveland van Lier, P. (2022). Creating a care response model in Cleveland for those in crisis . Policy Matters Ohio. https://policymattersohio.org/research/creating-a-care-response-model-in-cleveland-for-those-in-crisis/#:~:text=Care VIVIC Research. (2021, March). Alternatives for a Safer Ottawa: Non-Police Mental Health Crisis Response Executive Summary. https://vivicresearch.ca/PDFS/BH-Final-Executive-Summary.pdf Walby, K. (2022). Against the social harms of policing. In S. Pasternak, K. Walby & A. Stadnyk (Eds.), Disarm, Defund, Dismantle: Police abolition in Canada (pp. 44-51). Between the Lines. Watson, A.C., & El-Sabawi, T. (2023). Expansion of the police role in responding to mental health crises over the past fifty years: driving factors, race inequities and the need to rebalance roles. Law and Contemporary Problem, 86 (1), 1-28. Wellborn, J. (1999). Responding to individuals with mental illness. FBI Law Enforcement Bulletin , 68 (11), 6-8. https://www.thefreelibrary.com/Responding-to-individuals-with-mental-illness-a058177901. Winters, S., Magalhaes, L., & Kinsella, E. A. (2015). Interprofessional collaboration in mental health crisis response systems: a scoping review. Disability and Rehabilitation, 37 (23), 2212–2224. https://doi.org/10.3109/09638288.2014.1002576 Wyton, M. (2022, Nov 25). A new model for responding to mental health crises . The Tyee. https://thetyee.ca/News/2022/11/24/New-Model-Responding-Mental-Health-Crises/ Yee, K. (2022). Indigenous resurgence in colonial urban parks: Possibilities and potential for urban Indigenous land-based practices [Master’s thesis, University of Toronto]. TSpace. Yousif, N. (2020, September 17). Toronto moves forward on consultations to create a non-police mental health crisis response team . Toronto Star . https://www.thestar.com/news/gta/toronto-moves-forward-on-consultations-to-create-a-non-police-mental-health-crisis-response-team/article_a69b69ca-7bc2-5ed2-a8e3-9cb6aefac021.html Yousif, N. (2022a, January). Toronto’s first-ever mental healthcrisis response teams — without police— to launch in March. Toronto Star. https://www.thestar.com/news/gta/toronto-s-fi rst-ever-mental-health-crisis-response-teams-withoutpolice- to-launch-in-march/article_fbd429c1-46a6-57b6-9727-e93b9fda39d7.html Yousif, N. (2022b, October 17). Toronto approved a non-police crisis response team. This woman is trying to build them. Toronto Star . https://www.thestar.com/news/gta/toronto-approved-non-police-crisis-response-teams-this-woman-is-trying-to-build-them/article_5cbd7130-c4f9-5bf7-b4f1-cb067caad97d.html Ziafati, N. (2022, March 24). ‘ Time for change': Toronto launching services to respond to mental health crisis . The Canadian Press. https://www.ctvnews.ca/toronto/article/time-for-change-toronto-launching-service-to-respond-to-mental-health-crisis-calls/ Supplementary Material The Supplementary Material file is not available with this version. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6674129","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":459639345,"identity":"bef1dfa2-bcae-4018-830e-1f4cfca2a6f6","order_by":0,"name":"Megan W. Rowe","email":"","orcid":"","institution":"University of Regina","correspondingAuthor":false,"prefix":"","firstName":"Megan","middleName":"W.","lastName":"Rowe","suffix":""},{"id":459639346,"identity":"87e01232-c736-4803-8f59-00d16fd9439e","order_by":1,"name":"Allannah Nguyen","email":"","orcid":"","institution":"University of Regina","correspondingAuthor":false,"prefix":"","firstName":"Allannah","middleName":"","lastName":"Nguyen","suffix":""},{"id":459639347,"identity":"1f543201-29a2-4252-96af-8b62fb6107fd","order_by":2,"name":"Leyna Lowe","email":"","orcid":"","institution":"Canadian Mental Health Association","correspondingAuthor":false,"prefix":"","firstName":"Leyna","middleName":"","lastName":"Lowe","suffix":""},{"id":459639348,"identity":"245b1f14-a97d-48e9-86d9-2655933026b3","order_by":3,"name":"Kara Fletcher","email":"","orcid":"","institution":"University of Regina","correspondingAuthor":false,"prefix":"","firstName":"Kara","middleName":"","lastName":"Fletcher","suffix":""},{"id":459639353,"identity":"81918bf1-005b-4526-ae4d-d726cd770e5b","order_by":4,"name":"Andrew D. Eaton","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYHACAwTzA4hgJloLGwMD4wyStTDzEOMq/tnN2z58bGOQ45/ffOyxbds9OXl33oMfGGrscGqRuHOseObMNgZjiWNs6ca5bcXGhof5kiUYjiXjtuZGjjEz7zaGxIZjPGbSuW0JiRubeQwkGBtw+0gepOXvNob6+SAtlm0J9UAtxj8YG+pxajEAaWHcxpBgANLC2JaQIM/MYwa05TBOLYY30ooZe/9JGG48lpYm2XMuwXADUItFwrHjOLXI3UjezPDjjI283OHDxyR+lCXIy/efMb7xoaYat/chQALJqQeARAIhDShAvoEk5aNgFIyCUTACAAB+F0vGWmCzywAAAABJRU5ErkJggg==","orcid":"","institution":"University of Regina","correspondingAuthor":true,"prefix":"","firstName":"Andrew","middleName":"D.","lastName":"Eaton","suffix":""}],"badges":[],"createdAt":"2025-05-15 15:38:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6674129/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6674129/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83612035,"identity":"95e378be-b1bf-40e7-b2aa-bbd00f0d2525","added_by":"auto","created_at":"2025-05-29 12:29:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":232917,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA CHART\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6674129/v1/f337049dc1e922d0bddce64a.png"},{"id":83611160,"identity":"0ae9e783-ca22-41f5-aefd-681bf2255359","added_by":"auto","created_at":"2025-05-29 12:21:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":94847,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThematic Analysis\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6674129/v1/d1dc412742875d1c380bac86.png"},{"id":83612780,"identity":"5a3a28a2-1236-44fb-b399-a0da4ba74c0c","added_by":"auto","created_at":"2025-05-29 12:45:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1153233,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6674129/v1/a2b51188-ceaa-420d-950f-573755ffa023.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Restructuring Crisis Response Programs as Civilian-Led: A Scoping Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe involvement of police in responding to crisis situations, referred to as policing mental health (Koziarski, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), has drawn increasing scrutiny (Haag, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Marcoux \u0026amp; Nicholson, 2018). Crisis situations are typically marked by acute distress and are often defined by perceptions of an individual being in a mental state considered \u0026ldquo;erratic, threatening, or dangerous\u0026rdquo; (Iacobucci, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2014\u003c/span\u003e, p. 49). These incidents frequently lead to family, friends, and bystanders placing emergency calls, which traditionally get dispatched to police as the primary responders to crisis situations, as emergency services perceive these individuals in crisis as posing significant potential for self-harm or harm to others (Jackson \u0026amp; Bradford, 2019; Pepler \u0026amp; Barber, \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Although individuals experiencing emotional distress are more likely to be subject to violence than perpetrate it (Black \u0026amp; Calhoun, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Cotton \u0026amp; Coleman, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Shore, \u003cspan citationid=\"CR147\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), the biases that underpin policing mental health often lead police to approach crisis situations with the expectation of violence (Shore, \u003cspan citationid=\"CR147\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). This default response sees individuals experiencing acute distress or emotional crises disproportionately met with law enforcement responses that too often escalate into violent (including fatal) outcomes for the distressed individual (Haag, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Marcoux \u0026amp; Nicholson, 2018).\u003c/p\u003e \u003cp\u003eThis paper explores the restructuring of crisis response models into civilian-led teams: teams that exclude or remove police and instead rely on trained, unarmed personnel, including mental health practitioners, crisis response workers, and/or peers (DeLaus, 2020). We examine how these teams begin to respond to the harms of policing mental health. Our findings are framed through critical social theories to understand these models not only as operational alternatives, but as efforts to sever the ties between the criminal legal and mental healthcare systems.\u003c/p\u003e\n\u003ch3\u003ePolicing Mental Health\u003c/h3\u003e\n\u003cp\u003ePolicing mental health cannot be understood solely as a matter of emergency protocol but must also be situated within broader systemic conditions that have shaped how distress is defined, perceived, and responded to (Hon-Sing Wong, 2022; Meerai et al., \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Yee, \u003cspan citationid=\"CR178\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The relationship between the criminal legal and mental healthcare systems has been reinforced by the global proliferation of austerity measures and neoliberal policies that prioritize cost-efficiency and individual responsibility over adequate public investment in mental health care (Brown et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Harvey, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). These systemic shifts have contributed to what Shimrat (\u003cspan citationid=\"CR145\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) terms \u0026ldquo;the tragic farce of community mental health\u0026rdquo; (p. 144), where the ideals of community-based care have largely failed to materialize. Instead, it has often been supplanted by an expanded role for law enforcement (Walby, \u003cspan citationid=\"CR168\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In the absence of accessible, well-resourced mental health services, law enforcement has increasingly become the default response to crisis situations (Brown et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Mukherjee, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePolicing mental health is not a neutral practice; it is shaped by sanist, racist, and Western colonial logics. Sanism is a central concept within mad studies and refers to the systemic oppression and marginalization of individuals who have received a mental health diagnosis or who are otherwise perceived as mentally ill (Poole et al., 2012), framing them as \u0026ldquo;incompetent, unable to do things for themselves, constantly in need of supervision and assistance, unpredictable, violent, and irrational\u0026rdquo; (Chamberlin, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e1990\u003c/span\u003e, p. 2). Sanism denies individuals\u0026rsquo; ability to make sense of their own experiences, often framing distress and human suffering as irrational or disordered (Johnstone \u0026amp; Boyle, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Poole et al., 2012).\u003c/p\u003e \u003cp\u003eSanism is rarely experienced in isolation; to fully understand its reach and impact, it must be examined alongside racism and settler colonialism (Liegghio, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Meerai et al., \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Yee, \u003cspan citationid=\"CR178\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The intersection of sanism and racism has been described as anti-Black and anti-Indigenous sanism (Meerai et al., \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Yee, \u003cspan citationid=\"CR178\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), highlighting how racialized individuals are uniquely targeted by pathologizing distress and conflating it with violence (Meerai et al., \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The subjugation of Black people through the legacy of enslavement created the conditions under which anti-Black racism, defined as the \u0026ldquo;prejudice, stereotyping, and discrimination that is directed at people of Black-African descent\u0026rdquo; (Benjamin, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2003\u003c/span\u003e, p. ii), has been sustained and normalized. Similarly, anti-Indigenous racism is rooted in the logics of Western settler colonialism, which frame Indigenous bodies, cultures, and knowledge systems as inferior, justifying their control, assimilation, and erasure (Hon-Sing Wong, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Maynard, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Simpson, \u003cspan citationid=\"CR148\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). As Meerai et al. (\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) note, \u0026ldquo;sanism exists on a continuum depending on privilege, and it is always and especially compounded when it is visited on racialized bodies\u0026rdquo; (p. 22). Together, sanism, racism, and settler colonialism shape how distress is interpreted and how individuals \u0026ndash; particularly those who are psychiatrized (Hon-Sing Wong, 2022; Lee, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Liegghio, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) and/or racialized (Hon-Sing Wong et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Maynard, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Meerai et al., \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) \u0026ndash; are perceived and treated in moments of crisis.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe Current State of Crisis Response\u003c/h2\u003e \u003cp\u003eIndividuals experiencing acute distress, particularly in public, are at an increased risk of encountering lethal force in interactions with police (Winters et al., \u003cspan citationid=\"CR174\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Black and Indigenous people experiencing distress are particularly overrepresented among those killed by police (Marcoux \u0026amp; Nicholson, 2018; Singh, 2020). Data from a Canadian database tracking police-involved fatalities between 2000 and 2017 show that 68% (n\u0026thinsp;=\u0026thinsp;377) of those killed were individuals experiencing acute distress (Marcoux \u0026amp; Nicholson, 2018; Singh, 2020). Black and Indigenous people were disproportionately represented: Black individuals comprised 8.63% of deaths but only 2.92% of the population, while Indigenous people accounted for 16% of deaths despite being only 4.21% of the population (Marcoux \u0026amp; Nicholson, 2018; Singh, 2020).\u003c/p\u003e \u003cp\u003eEfforts to improve crisis response interventions have led to the development of Crisis Intervention Teams and co-responder models. Crisis Interventions Teams are specialized police-led crisis response programs that train officers to recognize and de-escalate situations involving an individual experiencing acute distress, while facilitating connections to services. Extant research suggests they have little effect on use-of-force rates, arrests, or fatalities during intervention (Rogers et al., \u003cspan citationid=\"CR133\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Shadravan et al., \u003cspan citationid=\"CR143\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Taheri, \u003cspan citationid=\"CR154\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Co-responder teams pair police with mental health professionals, aiming to bridge gaps between law enforcement and healthcare (Iacobucci, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Rosenbaum, \u003cspan citationid=\"CR135\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). While their use has expanded, critics argue that by maintaining police involvement, co-responder teams continue to criminalize emotional distress rather than providing an alternative that responds to the systemic harms of policing (Removed for Review., in press; Pepler \u0026amp; Barber, \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCivilian-led crisis response teams begin to recognize and respond to the harms of sanism, racism, and Western colonialism by divesting from police involvement in crisis care. Excluding police from crisis response models offers a means of challenging the pathologization of distress and its conflation with violence and the need to be policed (Haag, 2024). Civilian-led crisis response teams are beginning to gain momentum, with teams being introduced in the United States (Townsend et al., 2023), Canada (Egan-Elliott, 2021) Australia (Justice Action, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), and Norway (Karlsson et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). While there exists a strong theoretical basis for the potential of these teams, particularly in their divestment from police, research on civilian-led models is still in its early stages.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eObjective\u003c/h3\u003e\n\u003cp\u003eIn this paper, we aim to synthesize published research and grey literature to analyze how crisis mental health response has been restructured into civilian-led models. Our findings are analyzed through critical social theories to examine how these teams are beginning to address the historical and theoretical conditions that have shaped the policing of mental health in Western contexts.\u003c/p\u003e\n\u003ch3\u003eTheoretical Foundations\u003c/h3\u003e\n\u003cp\u003eThis scoping review is positioned as a transformative justice study approached through a lens of prison industrial complex abolition. Prison industrial complex abolition is a movement committed to dismantling the interconnected systems of policing and prisons, surveillance, incarceration, and punishment (Davis, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Kaba \u0026amp; Ritchie, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). It challenges the reliance on confinement, control, and force as solutions to harm, instead advocating for accountability and social support that address the underlying causes of harm (Davis, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Kaba \u0026amp; Ritchie, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Within mental healthcare, the dominance of policing as a primary response to crisis reflects the very logics that prison industrial complex abolition seeks to challenge and undo (Kaba \u0026amp; Ritchie, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). While the broader abolitionist movement aims to abolish the entire carceral state (Davis, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Kaba \u0026amp; Ritchie, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) \u0026ndash; including the medical industrial complex (Page \u0026amp; Woodland, 2023) \u0026ndash; this study draws specifically on a prison industrial complex abolition-informed perspective. This distinction is important because, despite removing police from team staffing, non-police crisis response models remain embedded within traditional mental healthcare systems, which often perpetuate carceral patterns (Page \u0026amp; Woodland, 2023; Seltzer et al., \u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). As such, this work does not fully align with psychiatric abolition, reinforcing the rationale for applying a prison-specific abolitionist lens.\u003c/p\u003e \u003cp\u003eTo critically examine how carceral logics shape responses to crisis response, and to begin to explore alternatives, the scoping review is theoretically informed by mad studies, the Power Threat Meaning Framework (Johnstone \u0026amp; Boyle, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), and critical race theory. Mad studies theorists oppose the logics of policing mental health and instead sees distress as a legitimate expression of human suffering often rooted in structural violence, trauma, or marginalization (Poole et al., 2012). The Power Threat Meaning Framework (PTMF) complements the ethos of mad studies by offering a structured yet non-pathologizing approach to understanding crisis situations (Johnstone \u0026amp; Boyle, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). It calls for an understanding of distress and crisis as a meaningful, and painful, response to adverse experiences (Johnstone \u0026amp; Boyle, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Rather than asking \u003cem\u003ewhat\u0026rsquo;s wrong with you\u003c/em\u003e, the PTMF asks, \u003cem\u003ewhat has happened to you\u003c/em\u003e and \u003cem\u003ehow is it affecting you\u003c/em\u003e, encouraging responses rooted in collaborative meaning-making and context in the care process (Johnstone \u0026amp; Boyle, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The PTMF challenges policing mental health by shifting how crisis situations are understood and responded to (Johnstone \u0026amp; Boyle, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Rather than assuming that crisis is inherently violent, it views distress as real and frightening for the person experiencing it, requiring responses that are committed to meeting the person emotionally \u003cem\u003eand\u003c/em\u003e relationally where they are (Johnstone \u0026amp; Boyle, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCritical race theory further strengthens this theoretical grounding by highlighting how the criminalization of distress is embedded within racialized and colonial systems of power (Badwall, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). It asserts that racism is endemic to Western society (Badwall, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), woven into its institutions, policies, and cultural logics through the legacy of colonialism. Within the context of policing mental health, Western colonial ideologies construct racialized bodies as sites of disorder, deviance, and threat (Badwall, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Maynard, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Page \u0026amp; Woodland, 2023), seeing their distress as more dangerous, more violent, and more deserving of forceful or coercive intervention (Maynard, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Through this lens, crisis responses are understood not simply as reactions to individual behaviour, but as practices that sustain broader patterns of racism rooted in Western colonial systems (Hon-Sing Wong, 2022; Maynard, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eMad studies, the PTMF, and critical race theory offer a foundation for reimagining crisis response. Together, they provide a critical framework for examining how crisis response models have been restructured into civilian-led teams, and how these efforts have begun to recognize and respond to the intersecting impacts of sanism, racism, and Western colonialism.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eCivilian-led (i.e., non-police) crisis response teams have only recently started gaining traction within prevailing discourse, resulting in a still-developing body of literature. Thus, a scoping review was employed to comprehensively map and synthesize existing knowledge on civilian-led crisis response teams, ensuring a broad exploration of the available literature.\u003c/p\u003e\n\u003ch3\u003eSearch Procedure\u003c/h3\u003e\n\u003cp\u003eFollowing scoping review guidelines (Munn et al., 2018; Pham et al., \u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) we registered the review with Open Science Framework and conducted scholarly database searches alongside searching relevant professional networks and works in progress. We identified relevant studies by completing 11 database searches that included APA PsychInfo, APA PsycArticles, CINAHL \u0026amp; MEDLINE Combined Search, Criminal Justice Database (collection and abstracts), CQ Researcher, ProQuest Health \u0026amp; Medical Collection, ProQuest Nursing \u0026amp; Allied Health Database, SAGE Journals, Sociological Collection (Sociological Abstracts), Social Work Abstracts, and ProQuest Dissertations and Theses. We included grey literature, media, and reports. Key terms used to conduct the searches included \u0026ldquo;non police\u0026rdquo; AND [\u0026ldquo;mental health\u0026rdquo; or \u0026ldquo;crisis\u0026rdquo; or \u0026ldquo;emotional distress\u0026rdquo;] AND [\u0026ldquo;community crisis response\u0026rdquo; OR \u0026ldquo;non police crisis response\u0026rdquo;]. We also conducted manual searches to identify literature that might have been missed within our search of scholarly databases. Complete search syntax is available on Borealis (Removed for Review, 2025).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInclusion Criteria\u003c/h2\u003e \u003cp\u003eA report was included if it examined a civilian-led crisis response team and focused on acute distress (or \"mental health\") specific crisis intervention. For this research, a civilian response model is defined as a crisis response approach involving trained mental health response workers, including but not limited to mental health clinicians such as social workers, psychologists, nurses, and/or trained peers, with no sworn members (primarily police officers and occasionally paramedics). Paramedics may serve as sworn members, particularly in integrated public safety departments where personnel are cross-trained to perform multiple roles (Hilal \u0026amp; Jones, 2014).\u003c/p\u003e \u003cp\u003eTo be included, the literature needed to recognize or explore at least one of the following dimensions:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe need for non-police crisis response models\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe potential of these models\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTheir development\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTheir implementation\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOutcomes associated with their use\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTheir impact on crisis response\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe efficacy of such models\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAdditionally, studies were required to discuss programs that serve the public and act as the first point of contact during crisis situations. We included empirical research and grey literature. Only English-language literature published from the year 1999 onward was considered.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eScreening\u003c/h3\u003e\n\u003cp\u003eScreening was conducted using Covidence software by two independent reviewers following the established eligibility criteria. Upon completion, the reviewers met to discuss the screening results, and a third reviewer was involved to resolve screening discrepancies where needed. Subsequently, each reviewer was assigned articles to complete a full-text screen. In total, 46 articles were deemed eligible for inclusion. Refer to Fig.\u0026nbsp;1 for the PRISMA flow chart.\u003c/p\u003e\n\u003ch3\u003eData Extraction and Analysis\u003c/h3\u003e\n\u003cp\u003eData extraction and analysis was completed by four trained research assistants, extracting data pertaining to team composition, funding, and dispatch of team (i.e., 911, 211), amongst other key data points. The extraction spreadsheet is available on Borealis (Removed for Review, 2025). Thematic content analysis was completed by eight independent coders, each of whom was either someone working within crisis response, a student in a health-related field, a policy analyst, a mental health advocate, and/or someone who brings with them lived experience of psychological distress. Each coder was assigned 5\u0026ndash;6 articles and provided with detailed coding guidelines (see supplementary file) to ensure consistency in their analysis. NVIVO 12 software was used to systematically organize and analyze the data. Coders independently reviewed and coded their assigned articles, after which the team met to discuss findings, resolve discrepancies, and refine the thematic framework. The first and last authors drafted themes and subthemes based on the team meeting and all authors approved the results as presented herein.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eQuality\u003c/h2\u003e \u003cp\u003eDuring the screening stage, it was identified that most literature came from grey or media sources. Accordingly, the Mixed Methods Appraisal Tool (MMAT) Version 2018 (Hong et al., 2018) was not an appropriate tool for evaluation. Instead, an adapted version of the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) tool (Tyndall, 2010) was used. Originally developed to assess grey literature, the AACODS framework was modified for this scoping review to ensure its applicability to both grey and media sources. The adapted tool included 10 questions to evaluate authority and source credibility, corroboration of information, topic coverage, objectivity, and publication date (see supplementary file). Each question was dummy-coded: a 1 was given if the response to the criteria was a \u0026ldquo;Yes\u0026rdquo; or a 0 if the response was a \u0026ldquo;No\u0026rdquo; or \u0026ldquo;Can\u0026rsquo;t Tell.\u0026rdquo;, with a total possible score of 10. Articles were given scores ranging from 0% (low quality) to 100% (high quality). Appraisal was conducted independently by one reviewer. A second reviewer cross-checked their work, making appropriate changes where necessary, such as determining publication source and/or clarifying publication date. The appraisal results are posted on Borealis (Removed for Review, 2025).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 46 articles were included in this scoping review, the majority of which were grey literature (n\u0026thinsp;=\u0026thinsp;22) and media reports (n\u0026thinsp;=\u0026thinsp;21). Additionally, the review incorporated two qualitative reviews and one descriptive quantitative study. An adapted version of the AACODS tool was used to appraise the quality of each included article. Twenty-three articles received a score of 100%, five articles received a score of 90%, eight articles received a score of 80%, eight articles received a score of 70%, and two articles received a score of 60%.\u003c/p\u003e \u003cp\u003eThree primary themes were identified regarding key processes involved in restructuring crisis response models into civilian-led teams, each with corresponding subthemes. The first theme, \u003cem\u003eDecentering Police\u003c/em\u003e, captures the role of collective awareness and the importance of establishing a distinct team composition. The second theme, \u003cem\u003eTeam Scope of Practice\u003c/em\u003e, addresses considerations related to dispatch number and defining criteria for response. The third theme, \u003cem\u003eTeam Sustainability\u003c/em\u003e, highlights the influence of interest holder perceptions and political will, as well as the need for adequate resourcing. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates these thematic findings.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Decentering Police\u003c/h2\u003e \u003cp\u003eThirty-nine articles discussed the decentering of police within crisis response as a central component to structuring civilian-led crisis response services. The theme of decentering police consists of two subthemes: collective awareness of the harms policing mental health and establishing a distinct team composition.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSub-Theme 1.1: Collective Awareness\u003c/h2\u003e \u003cp\u003eTwenty-seven articles identify collective awareness of the harms of policing mental health \u0026ndash; including the recognition that police involvement in crisis intervention often escalates situations (e.g., Beck et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Reach Out Response Network, \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and disproportionately harms racialized communities (e.g., Anene et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Canady, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) \u0026ndash; as a key driver in the shift toward establishing civilian-led crisis response teams in Norway, Canada, Australia, and the United States. Racialized communities and individuals with lived experience of acute distress or crisis have long advocated against the disproportionate policing they face and the resulting harms, including fatal outcomes (Reach Out Response Network, \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The literature suggests that calls to reimagine public safety by reducing police involvement in healthcare \u0026ndash; particularly in crisis response \u0026ndash; are driven in part by the argument that situations requiring emotional support and de-escalation should not be met with a police response (Karlsson et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Livingston, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) as law enforcement \u0026ldquo;are not trained or equipped to handle [crisis intervention] appropriately\u0026rdquo; (Townsend et al., 2023). The literature describes a consciousness-raising process in which these efforts gained broader recognition in public and political discourse, largely due to the impact of global and local events. In jurisdictions that have implemented civilian-led crisis teams, increasing awareness of the disproportionately harmful consequences of police interactions \u0026ndash; particularly for Black, Indigenous, and individuals experiencing acute distress \u0026ndash; has further reinforced the urgency of these efforts.\u003c/p\u003e \u003cp\u003eAnene and colleagues (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), Canady (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), Van Lier (\u003cspan citationid=\"CR162\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, \u003cspan citationid=\"CR164\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), Yousif (2020), Zaffrann (2022), amongst others, cite the tragic murder of George Floyd by police officer Derick Chauvin in May 2020 in Minneapolis, U.S.A., as a catalyst event that precipitated calls for police reform and abolition. This event caused the public to question the legitimacy of policing more broadly and its involvement in crisis intervention more specifically, making longstanding demands for systemic change more difficult for policymakers to ignore. As Watson and El-Sabawi (\u003cspan citationid=\"CR170\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) explain, it was in the wake of George Floyd\u0026rsquo;s murder that \u0026ldquo;policymakers have begun to take seriously demands to\u0026hellip;provide the public with alternatives to police when they are in need of help\u0026rdquo; (p. 1). Similarly, van Lier (\u003cspan citationid=\"CR162\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) notes that initiatives to explore non-police crisis response models gained traction as high-profile killings of Black people by police have \u0026ldquo;vaulted the actions of law enforcement\u0026rdquo; (p. 1) into the public eye.\u003c/p\u003e \u003cp\u003eWhile George Floyd\u0026rsquo;s murder exposed the deadly realities of police violence, the death of Regis Korchinski-Paquet during a crisis intervention highlighted the specific dangers of police involvement in crisis response, further building momentum for systemic transformation. Chambers and Deshman (2024), CityNews Staff (2021), Ngabo (\u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), and Yousif (2022) highlight the death of Regis Korchinski-Paquet during a police-led crisis intervention in Toronto in 2020 as pivotal in advancing the push for non-police crisis response services, directly contributing to the development of the Toronto Community Crisis Service. In sum, sustained collective mobilization, particularly through pressure on elected officials, played a crucial role in advancing these discussions and prompting key decision-makers to consider alternative crisis response models\u003c/p\u003e \u003cp\u003eS\u003cem\u003eub-Theme 1.2: Establishing a Distinct Team Composition\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAll literature included in this scoping review emphasized the importance of establishing a distinct team composition when restructuring crisis response programs into civilian-led models, particularly by removing and excluding police from these teams to provide safer, more appropriate care to individuals experiencing acute distress. While the literature suggests civilian-led crisis teams vary in their staffing and team composition (e.g., Karlsson et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), a consistent defining feature across models is the deliberate exclusion of police from team staffing. Civilian-led models recognize the inherent harm introduced by police presence in any form and have responded by eliminating police from team composition. In addition to this fundamental distinction, these teams also stand out for their intentional inclusion of \u0026lsquo;peers,\u0026rsquo; referring to individuals who bring with them the knowledge and wisdom of living or lived experiences of mental health challenges and/or experiences of acute distress (Mental Health Commission of Canada, \u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). As per Wyton (2022), \u0026ldquo;the comfort and non-judgement from peers is so sacred and so needed,\" (p. 2).\u003c/p\u003e \u003cp\u003eThe United States\u0026rsquo; (US) Substance Abuse and Mental Health Services Administration\u0026rsquo;s (SAMHSA) \u003cem\u003e2020 National Guidelines for Behavioral Health Crisis Care\u003c/em\u003e emphasize non-police crisis response teams as best practice for mental health crisis intervention and are heavily cited as the evidence base to support the legitimacy of civilian crisis teams, including ones outside of the US (Canady, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Karlsson et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Ryder and Nash, 2024). These guidelines outline that a public health approach rather than a law enforcement response should be the foundation for crisis care. Gillis (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) notes \u0026ldquo;we hope that by removing police, we\u0026rsquo;ll reduce stigma, and people will be able to see that [emotional distress] isn\u0026rsquo;t a crime, it\u0026rsquo;s a health crisis\u0026rdquo; (p.6). Beck and colleagues (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) outline that police involvement often escalates emotional distress, resulting in harm towards the individual in crisis. This is particularly true for Black and other non-white people; \u0026ldquo;Black people, in contrast to most white people, live with the fear that police will hurt them or their family members\u0026rdquo; (Beck et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, p. 2). In an anonymous online survey conducted across Nova Scotia, Canada, participants who self-identified as having lived experience with mental health or substance use challenges reported low trust in police when responding to crises (Livingston, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The findings also highlighted that non-police, civilian-led crisis teams were widely perceived as \u0026ldquo;beneficial, comfortable, helpful, appropriate, and preferred\u0026rdquo; (Livingston, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, p. 4).\u003c/p\u003e \u003cp\u003eThe importance of developing civilian-led programs in collaboration with community members to meet the needs and priorities of those most impacted was equally emphasized (e.g., CSG Justice Center, 2024; Spolum et al., \u003cspan citationid=\"CR152\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Yousif, 2020). Zaffrann (2022) notes \u0026ldquo;community engagement that centers the voices and input of those most likely to be served by [civilian-led programs] is critical\u0026rdquo; (p. 18), while Reach Out Response Network\u0026rsquo;s Asante Haughton cited by Yousif (2020) expresses the importance of \u0026ldquo;prioritizing the community voice [such that] whatever is built is representing what folks are asking for\u0026rdquo; (p. 2). Nonko (2020) explains that a civilian-led pilot program in California was informed by \u0026ldquo;family members of individuals killed by police, as well as experts in non-police responses to crises\u0026rdquo; (p. 1).\u003c/p\u003e \u003cp\u003eChrastil (2023), Yousif (2020), and van Lier (\u003cspan citationid=\"CR164\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) each explain that within cities that have implemented civilian-led models (e.g., Toronto, New Orleans, Ohio), a task force was first implemented to consult and engage community members and other key interest holders, ensuring their insights were involved in program design and development. In Toronto, Canada, specific attention was placed on Black and Indigenous-led engagement in initial development process for the Toronto Community Crisis Service (Yousif, 2020).\u003c/p\u003e \u003cp\u003eWithin this scoping review\u0026rsquo;s included literature, civilian-led teams were described as consisting of: nurses paired with mental health workers including clinicians and/or peers (Kearnes, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Mental Health Weekly, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e2022a\u003c/span\u003e, \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e2022b\u003c/span\u003e; Yousif 2022, 2023), mental health workers (Reach Out Response Network, \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Townsend et al., 2023), behavioral health crises workers and licensed clinicians (Ryder \u0026amp; Nash, 2024; Towles, 2021), trained crisis responder volunteers (Nonko, 2020; Welborn, 1999), and most commonly, mental health professionals and peers (Campbell, 2022; CityNews Staff, 2023; Fleming, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Provincial System Support Program \u0026amp; Shkaabe Makwa, 2023; Towles, 2021; van Lier, \u003cspan citationid=\"CR164\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Wyton, 2022; Ziafati, 2022).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Operational Framework\u003c/h2\u003e \u003cp\u003eThirty-two of the included literature sources discussed the overarching role of determining an operational framework in the process of restricting crisis response models into civilian-led teams. Particularly, navigating dispatch logistics and the defining criteria for a response emerged across the literature as critical components of establishing a team\u0026rsquo;s operational framework.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSub-Theme 2.1: Dispatch Logistics\u003c/h2\u003e \u003cp\u003eDetermining dispatch logistics, including the number by which a team can be contacted as well as its hours of operation, was discussed in 25 articles. The literature points to deliberations regarding the point of access for a team as well as the hours of operation that a service is available, indicating there is no universal standard. The most common dispatch points indicated throughout the literature include the phone numbers 911, 211, and 988. The dispatch procedure consistently described across the literature included the initial calls for service, subsequent screening by the dispatch receiver, and finally dispatch of the team.\u003c/p\u003e \u003cp\u003eSome articles argue that using 911 as the dispatch number for civilian-led crisis response teams is crucial for seamless integration with emergency services such as police, fire, and EMS (e.g., Ryder \u0026amp; Nash, 2024; Yousif, 2020, 2023). Additionally, 911 is widely considered the most accessible option, as it is a universal emergency number that can be dialed free of charge from cell phones or payphones, even without a working SIM card (Yousif, 2020). For calls made to 911, some sources suggest a transfer process where calls are first screened by a 211 operator before being dispatched to the appropriate response team (e.g., Chrastil, 2023; CityNews Staff, 2021). Others propose direct integration, allowing 911 operators to dispatch civilian-led teams alongside traditional emergency responders (e.g., CSG Justice Center, 2024). However, some of the literature raised concerns about linking crisis response teams to 911, cautioning that alternative contact points may feel safer and more trustworthy, particularly for communities that do not associate 911 with safety (e.g., Beck et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Mellins, 2021; Mental Health Weekly, 2022; Townsend et al., 2022). A hybrid approach was also discussed in the literature, suggesting multiple access points \u0026ndash; such as being able to access teams by calling 911, 211, or a dedicated crisis team number \u0026ndash; to ensure broader accessibility and choice for those in crisis (e.g., Chrastil, 2023; Reach Out Response Network; Yousif, 2022).\u003c/p\u003e \u003cp\u003eThe literature demonstrates variations regarding the hours of operation of civilian-led crisis response services. While some programs were described as in operation 24/7/365 (e.g., Karlsson et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Kearnes, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Reach Out Response Network, \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), others were limited in their hours and days of operation, noting the primary barriers to offering the service 24/7/365 included limitations in funding and securing staff (e.g., Wyton, 2022). Notwithstanding, across all models discussed, the goal is to \u0026ldquo;to offer rapid assessment with 24/7 availability\u0026rdquo; (Karlsson et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, p. 3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSub-Theme 2.2: Defining Criteria for a Response\u003c/h2\u003e \u003cp\u003eThe literature (n\u0026thinsp;=\u0026thinsp;37) examined the types of situations that civilian-led crisis teams are designed to respond to. This \"scope of response\" refers to the specific kinds of situations the teams are equipped to handle. Typically, these teams are dispatched when a caller uses certain key words or phrases that match the team's predefined criteria for intervention. Across the literature, the most common keywords used to delineate the types of situations these teams respond to include \u003cb\u003e\u0026lsquo;\u003c/b\u003emental health crisis\u0026rsquo; and \u0026lsquo;substance use crisis\u0026rsquo; (e.g., Fagan, 2023; Ziafati, 2022), \u003cb\u003e\u0026lsquo;\u003c/b\u003enon-emergency crisis\u0026rsquo; (e.g., CSG Justice Center, 2024; Kearnes, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and \u003cb\u003e\u0026lsquo;\u003c/b\u003enon-violent incidents\u0026rsquo; (e.g., Egan-Elliott, 2021; Provincial System Support Program \u0026amp; Shkaabe Makwa, 2023; van Lier, \u003cspan citationid=\"CR164\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Operators are trained to assess incoming emergency calls and identify those that meet the established criteria, ensuring a civilian-led team is dispatched when appropriate (CityNews Staff, 2021; Reach Out Response Network, \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe literature reveals a lack of clear, consistent definitions for the terms \u0026lsquo;non-emergency\u0026rsquo; and \u0026lsquo;non-violent\u0026rsquo;. Two sources (Beck et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Provincial System Support Program \u0026amp; Shkaabe Makwa, 2023) discuss the need to better clarify what situations fall within and outside these domains. Provincial System Support Program \u0026amp; Shkaabe Makwa (2023) explain \u0026ldquo;a particular challenge has been establishing a clear understanding of the violence threshold for when to involve (or re-involve) 911 and police in Toronto Community Crisis Service\u0026rdquo; (p. 38), while (Beck et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) notes a need to \u0026ldquo;identify the types of calls that are appropriate for civilian crisis response beyond those narrowly defined as behavioral health crises\u0026rdquo; (p. 5). Mellins (2021) explains that the Person in Crisis team in Rochester has been unreliable and somewhat ineffective, particularly due to the \u0026ldquo;strict criteria limiting who it can assist\u0026rdquo; (p. 2). Specifically, the Person in Crisis team does not respond to individuals under the influence of substances, which significantly limits who can access support from this team (Mellins, 2021).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Team Uptake and Sustainability\u003c/h2\u003e \u003cp\u003eThirty of the articles included in this scoping review discussed the uptake and sustainability of civilian-led programs, emphasizing the importance of both initial interest and long-term support in restructuring crisis response models. The theme of \u003cem\u003eTeam Uptake and Sustainability\u003c/em\u003e highlights that social and political will for alternative crisis models, along with adequate resourcing, are critical factors that enable the development, implementation, and long-term viability of civilian-led crisis response teams.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSub-Theme 3.1: Social and Political Will\u003c/h2\u003e \u003cp\u003eTwenty-eight of the included sources discussed the interplay between the social and political will to introduce alternative crisis response teams in shaping the uptake and long-term sustainability of civilian-led crisis programs. Social will refers to the support and perceptions of community (Chalabi, 2019), while political will pertains to the commitment of elected officials and government bodies (Post et al., \u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). This relationship was discussed within the literature as reciprocal, with community advocacy influencing political action, and political decisions, in turn, shaping public engagement. In areas that have established civilian-led teams, support from local governments was a common trend in solidifying plans to establish alternative crisis response models (e.g., Fleming, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Gorman, 2024; Townsend et al., 2023). Beck et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), Chrastil (2023), and Fleming (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) highlight the impact of public perception and support in driving efforts to reimagine crisis response programs, acting as a push to inspire political will. Additionally, the support or \"buy-in\" from health professionals and law enforcement was identified as crucial in promoting civilian-led teams, particularly in championing their safety and effectiveness to local officials (Fleming, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Gorman, 2024; Nonko, 2020). Zaffrann (2022) notes that \u0026ldquo;as public interest in alternative responses has increased, so too has interest by local elected officials\u0026rdquo; (p. 5), while Fleming (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) explains, \u0026ldquo;if not initially championed by community advocates, local officials may face pushback from community members\u0026rdquo; (p. 2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eSub-Theme 3.2: Resourcing\u003c/h2\u003e \u003cp\u003eThirty-five articles discussed factors relating to the resourcing of civilian-led programs in contributing to their implementation and ongoing operation sustainability. Specifically, the literature spoke to partnership considerations and the provision of funding to support, operate, and uphold civilian-led teams. The importance of creating partnerships and collaborating with interest holders to support the operation of civilian-led services was discussed across the literature, particularly regarding the role of network formation in securing funding to sustain these teams (e.g., Mental Health Weekly, \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e2022b\u003c/span\u003e; Ryan, 2024; van Lier, \u003cspan citationid=\"CR162\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, \u003cspan citationid=\"CR164\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Welborn, 1999).\u003c/p\u003e \u003cp\u003eWhile the literature consistently emphasizes the need for sustained funding to support civilian-led programs, there are varying perspectives regarding the source and allocation of this funding. Some sources indicate that the funding of civilian-led programs should come directly from cuts to policing budgets (e.g., Towles, 2021; van Lier, \u003cspan citationid=\"CR162\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, \u003cspan citationid=\"CR164\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), such that these teams can be sustainably funded without relying on short-term grants or pilot project funding. Irwin and Pearl (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) emphasize that areas looking to implement civilian-led teams should aim to provide a dedicated funding stream to sustain these teams, while recognizing that \u0026ldquo;local leaders may need to explore private funding sources to support the early implementation of the program, especially as governments are facing pandemic-related budget deficits\u0026rdquo; (p. 15). Alternatively, others (e.g., Egan-Elliot, 2021; Welborn, 1999) argue that civilian-led programs should be \u0026ldquo;adding to the system, rather than cutting the police department\u0026rsquo;s budget\u0026rdquo; (Egan-Elliott, 2021, p. 4).\u003c/p\u003e \u003cp\u003eMellins (2021) discusses three incidents of police violence in Rochester: a) the arrest and pepper-spraying of a 9-year-old girl in crisis; b) the tackling and pepper-spraying of a woman with her 3-year-old child following an alleged shoplifting incident; and c) and the fatal shooting of Tyshon Jones, a 29-year-old man in distress, who was threatening self-harm with a knife outside a homeless shelter. All three individuals were Black. These incidents occurred despite the implementation and operation of Rochester\u0026rsquo;s Person in Crisis team, a civilian-led crisis response model. Mellins (2021) notes, \u0026ldquo;that these incidents occurred after the [Person in Crisis] team was announced demonstrates that the team is either underfunded and therefore ill-equipped, or intentionally toothless and ill-conceived\u0026rdquo; (p. 2). Without proper resourcing, civilian-led teams risk being rendered futile.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings from this scoping review demonstrate the key processes involved in the restructuring of crisis response models into civilian-led teams. This review provides a synthesis of these key processes and can serve as a roadmap for communities interested in establishing civilian-led crisis response teams. Further, our findings illustrate how civilian-led models begin to recognize and respond to sanist, racist, and settler colonial underpinnings of policing mental health.\u003c/p\u003e \u003cp\u003eTransformative justice seeks to inspire small, intentional steps toward creating a world where reliance on carceral systems, including police, is rendered obsolete (Ritchie, \u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Accordingly, excluding police from staffing of crisis response teams is positioned toward advancing transformative change within mental healthcare. The influence of collective awareness in shifting crisis response away from police highlights the power of mobilized efforts in driving systems level change (Ritchie, 2022). The recognition of longstanding community advocacy, and the accompanied pressure on elected officials, facilitated the decision to decenter police and reflects a broader redistribution of power toward the community, aligning with the transformative ethos of \u003cem\u003enothing about us without us that is central to peer support.\u003c/em\u003e (Antojado, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Charlton, 1998).\u003c/p\u003e \u003cp\u003eEstablishing a distinct team composition that removes and intentionally excludes police within team staffing begins to respond to the harms of policing mental health, and its sanist, racist, and Western colonial underpinnings. Removing police from crisis response teams responds to the disproportionate harm experienced by individuals experiencing acute distress, particularly Black and Indigenous people, during encounters with police. Establishing non-police avenues of support for individuals to access during moments of distress or crisis actively challenges the legacies of sanism, racism, and Western colonialism, acknowledging the importance of shifting care away from carceral systems (Interrupting Criminalization et al., 2022). The inclusion of peers in civilian-led models marks a meaningful shift toward valuing lived experience in mental health care. It challenges dominant assumptions that equate mental illness with incapacity (Kara, 2014, as cited in Shore, \u003cspan citationid=\"CR147\" class=\"CitationRef\"\u003e2015\u003c/span\u003e, p. 10), and aligns with the PTMF\u0026rsquo;s emphasis on understanding distress through the lens of lived experience and meaning-making (Johnstone \u0026amp; Boyle, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In this view, peer knowledge is positioned as a vital and legitimate source of insight.\u003c/p\u003e \u003cp\u003eImportantly, however, are two considerations. First, although these teams do not staff police and first responders, they may nevertheless involve police as secondary or tertiary responders: \u0026ldquo;we can escalate [involve police] where needed\u0026rdquo; (Ryan, 2024, p. 2). More complete transparency is warranted within discussions of civilian-led crisis response models, particularly in clarifying when and how police will be involved. Second, the involvement of regulated health professionals within civilian-led teams upholds carceral dynamics and reinforces connections to carceral systems (Seltzer et al., 2022). Although their scope is different than that of law enforcement, mental health clinicians do maintain the power to pathologize distress, initiate coercive/forced interventions, and are inextricably linked to the carceral state (Jones \u0026amp; Jacobs, 2024). Ultimately, while removing police from crisis response begins to challenge carceral practices, it does not fully disentangle crisis care from the broader systems of control and coercion that characterize carceral mental healthcare (Hon-Sing Wong, 2022).\u003c/p\u003e \u003cp\u003eThe operational framework of each team, including the dispatch logistics and criteria for a response, requires careful consideration. As recognized by some of the included literature (e.g., Townend et al., 2023), calling 911 does not introduce the same sense of supposed universal safety for all, given its ties to policing. To respond to this, as per the literature, some teams have created alternative avenues to access civilian-led teams. Decisions relating to team contact point should always be made in close consultation with community members, to ensure that teams remain accessible for all (Reach Out Response Network, \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Further, the literature identified a series of consistent criteria for a civilian-led response (i.e., situations that a civilian-led team may respond to) including the keywords \u0026lsquo;non-violent\u0026rsquo; and \u0026lsquo;non-emergency\u0026rsquo;. However, as demonstrated in our findings, no clear parameters defining what constitutes a non-violent or non-emergency situation have been set. Considering the often sanist and racist connotations of how violence manifests or who perpetrates violence, and the conflation of violence with displays of distress, the lack of transparency in defining these terms is cause for concern (Johnstone \u0026amp; Boyle, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). These criteria must be better identified and interrogated to better challenge sanism and racism within crisis response.\u003c/p\u003e \u003cp\u003eThe sustainability of civilian-led response models, shaped by social and political will that advocates for the advancement of alternative teams, is of timely consideration. Given the current shifts in the social, political, and economic climate of the Western world \u0026ndash; characterized by the rapid resurgence of conservative nationalism (Chryssogelos, 2024), growing authoritarianism (Ritchie, \u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), and the continued entrenchment of policies that underfund community-based services (Brown et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) \u0026ndash; the expansion and long-term viability of community-based, transformative models may be at risk. It is of critical importance that local elected leaders, community members, advocates, and healthcare professionals continue to push for and champion alternative crisis response models such as civilian-led teams. The pursuit of social justice and liberation is a steadfast force that \u0026ldquo;enable[es] us to resist increasing authoritarianism\u0026rdquo; (Ritchie, \u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, p. 69), and will remain at the heart of driving transformative change.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Policy and Practice\u003c/h2\u003e \u003cp\u003eThis scoping review of 46 sources provides an overview of the key processes involved in restructuring crisis response programs into civilian-led teams. Our findings demonstrate consistent overarching themes and associated subthemes involved in this restructuring and provide insight into how these teams have begun to respond to the legacies of sanism and racism within mental healthcare systems. We suggest areas looking to establish civilian-led crisis response teams consider the pathways to restructuring presented here.\u003c/p\u003e \u003cp\u003eTo better advance civilian-led crisis teams as transformative healthcare models, we suggest that funding provision follow a divestment and reinvestment approach, such that funding is taken from policing and allocated toward non-police crisis teams. This approach is in line with prison industrial complex abolitionist principles and represents an intentional step to creating transformative worlds. At the practice level, we recommend civilian-led teams establish transparent, clear guidelines about their ties to police (i.e., when police will be involved, what their relationship to police looks like), as well as look to better define what constitutes \u0026lsquo;non-emergency\u0026rsquo; or \u0026lsquo;non-violent\u0026rsquo; situations, ensuring that human distress is not being conflated with violence, particularly along sites of race.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eA systematic review and meta-analysis were not possible due to the limited availability of empirical research on civilian-led crisis teams (Cumpston et al., 2019). Restricting the review to English reports limited the search scope. Due to the diverse language used to describe civilian-led teams, some articles may have been missed despite our multifaceted search strategy. In addition, we did not include anti-carceral crisis lines (e.g., Walls Down Collective, Trans Lifeline) as these services typically do not offer in-person intervention, and therefore did not meet our eligibility criteria for a civilian-led crisis response team.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eAreas for Future Research\u003c/h2\u003e \u003cp\u003eFuture research programs can explore the comparative effectiveness (i.e., service user experiences, linkage to resources), operational dynamics (e.g., number of calls received/responded to, time from call to response, length of intervention), and community perceptions between co-responder and civilian-led crisis response teams. Examining how these teams interact, differ in their approaches, and influence crisis outcomes could provide valuable insights into the strengths and limitations of each model, as well as inform best practices for scaling civilian-led crisis response. Further, exploring entirely anti-carceral crisis response teams (i.e., ones that have a strict, transparent policy against involving police) remains an important area for future research. Anti-carceral, peer-led care work offers insight into crisis intervention strategies that do not rely on law enforcement at any stage, demonstrating that entirely anti-carceral care is possible.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe growing recognition of the harms of policing mental health within mainstream discourse has generated calls for alternative, non-police crisis response programs in form of civilian-led teams. This review provides a synthesis of the existing literature on civilian-led crisis teams and outlines the overarching themes associated with restructuring crisis models into civilian-led teams. It also examines how these teams have begun responding to the legacies of sanism, racism, and colonialism in policing mental health. In sum, this review brings together existing literature on civilian-led models, providing a foundation by which local leaders, policymakers, and communities can build off in exploring civilian-led crisis models.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePTMF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePower Threat Meaning Framework (Johnstone \u0026amp; Boyle\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e2018)\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e Data and materials from this review are available on Borealis at https://doi.org/10.5683/SP3/OXKHUZ\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Insight Development Grant, Social Sciences and Humanities Research Council (SSHRC #430-2024-00241). The funder had no role in the review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Thank you to Kelly Montgomery and Henytha Uthayakumar for assistance with this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAnene, E., Nallajerla, M., Bath, E. P. J., \u0026amp; Castillo, E. G. (2023). Revisiting Research Safety Protocols: The Urgency for Alternatives to Law Enforcement in Crisis Intervention. \u003cem\u003ePsychiatric Services\u003c/em\u003e, \u003cem\u003e74\u003c/em\u003e(3), 325\u0026ndash;328. https://doi.org/10.1176/appi.ps.20220084\u003c/li\u003e\n \u003cli\u003eAntojado, D. 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(2023). \u003cem\u003e2023 Update on the Toronto Community Crisis Service and Proposed\u0026nbsp;\u003c/em\u003e\u003cem\u003eExpansion Plan\u003c/em\u003e. City of Toronto Social Development, Finance \u0026amp; Administration Division. https://www.toronto.ca/wp-content/uploads/2023/10/90a4-2023-Update-on-the-Toronto-Community-Crisis-Service-and-Proposed-Expansion-Plan.pdf\u003c/li\u003e\n \u003cli\u003eCanady, V. A. (2021). Emerging 988 crisis hotline expected to transform BH care. \u003cem\u003eMental Health\u0026nbsp;\u003c/em\u003e\u003cem\u003eWeekly, 31\u003c/em\u003e(21), 3\u0026ndash;5. https://doi.org/10.1002/mhw.32810\u003c/li\u003e\n \u003cli\u003eChalabi, A. (2019, March 6). \u003cem\u003e\u0026ldquo;Social will\u0026rdquo; as important as political will for implementing\u0026nbsp;\u003c/em\u003e\u003cem\u003ehuman rights\u003c/em\u003e. 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(2023, June 5). \u003cem\u003eCity of New Orleans rolls out non-police 911 mental health response.\u003c/em\u003e The Louisiana Weekly. https://www.louisianaweekly.com/city-of-new-orleans-rolls-out-non-police-911-mental-health-response/\u003c/li\u003e\n \u003cli\u003eChryssogelos, A. (2024, May 17). \u003cem\u003eNational conservatism is the new paradigm of conservative politics\u003c/em\u003e. LSE British Politics and Policy. https://blogs.lse.ac.uk/politicsandpolicy/national-conservatism-is-the-new-paradigm-of-conservative-politics-80766-2/\u003c/li\u003e\n \u003cli\u003eCityNews Staff. (2021, June 24). \u003cem\u003eToronto police pilot program will see mental health calls\u0026nbsp;\u003c/em\u003e\u003cem\u003ediverted to crisis centre\u003c/em\u003e. City News\u003cem\u003e.\u0026nbsp;\u003c/em\u003ehttps://toronto.citynews.ca/2021/06/24/toronto-police-pilot-program-will-see-mental-health-calls-diverted-to-crisis-centre/\u003c/li\u003e\n \u003cli\u003eCotton, D., \u0026amp; Coleman, T. G. (2010). Canadian police agencies and their interactions with persons with a mental illness: A systems approach. \u003cem\u003ePolice Practice and\u003c/em\u003e \u003cem\u003eResearch, 11\u003c/em\u003e(4), 301-314. https://doi.org/10.1080/15614261003701665\u003c/li\u003e\n \u003cli\u003eCSG Justice Center. (2021, December). \u003cem\u003eOverview of First Responder Programs.\u0026nbsp;\u003c/em\u003ehttps://csgjusticecenter.org/publications/expanding-first-response/the-toolkit/ \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDavis, A. (2000).\u003cem\u003e\u0026nbsp;Are prisons obsolete?\u003c/em\u003e Seven Stories Press.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDeLaus, M. 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C., \u0026amp; Fleming, P. J. (2023). Police violence: reducing the harms of policing through public health-informed alternative response program. \u003cem\u003eAM J Public Health, 113\u003c/em\u003e(51), 537-542. https://doi.org./10.2105/AJPH.2022.307107.\u003c/li\u003e\n \u003cli\u003eTaheri, S. A. (2016). Do Crisis Intervention Teams reduce arrest and improve officer safety? A systematic review and meta-analysis. \u003cem\u003eCriminal Justice Policy Review\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(1), 76-96.\u0026nbsp;https://doi.org/10.1177/0887403414556289\u003c/li\u003e\n \u003cli\u003eTowles, A. G. (2021a). \u003cem\u003eThree ways state leaders can support community responder programs.\u0026nbsp;\u003c/em\u003eJustice Center: The Council of State Governments. https://csgjusticecenter.org/2021/09/07/three-ways-state-leaders-can-support-community-responder-programs/\u003c/li\u003e\n \u003cli\u003eTowles, A. G. (2021b). \u003cem\u003eExplainer: A Breakdown of Community Responder program staff models\u0026nbsp;\u003c/em\u003e\u003cem\u003eand structures\u003c/em\u003e. CSG Justice Center. https://csgjusticecenter.org/2021/09/07/explainer-a-breakdown-of-community-responder-program-staff-models-and-structures/\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTownsend, T. G., Dillard-Wright, J., Prestwich, K., Alapatt, V., Kouame, G., Kubicki, J. M., Johnson, K. F., \u0026amp; Williams, C. D. (2023). Public safety redefined: Mitigating trauma by centering the community in community mental health. \u003cem\u003eAmerican Psychologist\u003c/em\u003e, \u003cem\u003e78(2)\u003c/em\u003e, 227\u0026ndash;243. https://doi.org/10.1037/amp0001081\u003c/li\u003e\n \u003cli\u003evan Lier, P. (2021, July 21).\u003cem\u003e\u0026nbsp;Reimagining public safety in Cleveland\u003c/em\u003e. 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Between the Lines.\u003c/li\u003e\n \u003cli\u003eWatson, A.C., \u0026amp; El-Sabawi, T. (2023). Expansion of the police role in responding to mental health crises over the past fifty years: driving factors, race inequities and the need to rebalance roles. \u003cem\u003eLaw and Contemporary Problem, 86\u003c/em\u003e(1), 1-28.\u003c/li\u003e\n \u003cli\u003eWellborn, J. (1999). Responding to individuals with mental illness.\u003cem\u003e\u0026nbsp;FBI Law Enforcement\u0026nbsp;\u003c/em\u003e\u003cem\u003eBulletin\u003c/em\u003e, \u003cem\u003e68\u003c/em\u003e(11), 6-8. https://www.thefreelibrary.com/Responding-to-individuals-with-mental-illness-a058177901.\u003c/li\u003e\n \u003cli\u003eWinters, S., Magalhaes, L., \u0026amp; Kinsella, E. A. (2015). Interprofessional collaboration in mental health crisis response systems: a scoping review. \u003cem\u003eDisability and\u003c/em\u003e \u003cem\u003eRehabilitation, 37\u003c/em\u003e(23), 2212\u0026ndash;2224. https://doi.org/10.3109/09638288.2014.1002576\u003c/li\u003e\n \u003cli\u003eWyton, M. (2022, Nov 25). \u003cem\u003eA new model for responding to mental health crises\u003c/em\u003e. The Tyee. https://thetyee.ca/News/2022/11/24/New-Model-Responding-Mental-Health-Crises/\u003c/li\u003e\n \u003cli\u003eYee, K. (2022). \u003cem\u003eIndigenous resurgence in colonial urban parks: Possibilities and\u003c/em\u003e\u003cem\u003epotential for urban Indigenous land-based practices\u003c/em\u003e [Master\u0026rsquo;s thesis, University of Toronto]. TSpace.\u003c/li\u003e\n \u003cli\u003eYousif, N. (2020, September 17). Toronto moves forward on consultations to create a non-police mental health crisis response team\u003cem\u003e.\u003c/em\u003e \u003cem\u003eToronto Star\u003c/em\u003e. https://www.thestar.com/news/gta/toronto-moves-forward-on-consultations-to-create-a-non-police-mental-health-crisis-response-team/article_a69b69ca-7bc2-5ed2-a8e3-9cb6aefac021.html\u003c/li\u003e\n \u003cli\u003eYousif, N. (2022a, January). Toronto\u0026rsquo;s first-ever mental healthcrisis response teams \u0026mdash; without police\u0026mdash; to launch in March.\u003cem\u003e\u0026nbsp;Toronto Star.\u0026nbsp;\u003c/em\u003ehttps://www.thestar.com/news/gta/toronto-s-fi rst-ever-mental-health-crisis-response-teams-withoutpolice-\u003cbr\u003e\u0026nbsp;to-launch-in-march/article_fbd429c1-46a6-57b6-9727-e93b9fda39d7.html\u003c/li\u003e\n \u003cli\u003eYousif, N. (2022b, October 17). Toronto approved a non-police crisis response team. This woman is trying to build them. \u003cem\u003eToronto Star\u003c/em\u003e. https://www.thestar.com/news/gta/toronto-approved-non-police-crisis-response-teams-this-woman-is-trying-to-build-them/article_5cbd7130-c4f9-5bf7-b4f1-cb067caad97d.html\u003c/li\u003e\n \u003cli\u003eZiafati, N. (2022, March 24). \u0026lsquo;\u003cem\u003eTime for change\u0026apos;: Toronto launching services to respond to mental\u0026nbsp;\u003c/em\u003e\u003cem\u003ehealth crisis\u003c/em\u003e. The Canadian Press. https://www.ctvnews.ca/toronto/article/time-for-change-toronto-launching-service-to-respond-to-mental-health-crisis-calls/\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Supplementary Material","content":"\u003cp\u003eThe Supplementary Material file is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Civilian-led crisis response, non-police crisis response, alternative crisis response teams, mental health","lastPublishedDoi":"10.21203/rs.3.rs-6674129/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6674129/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCivilian-led crisis response teams provide emergency mental healthcare for acute distress in community settings, without the involvement of police at first response. Civilian-led teams are relatively new, diverse in team composition and scope, and a promising alternative to police-led crisis teams. This scoping review synthesizes the key processes of civilian-led crisis response programs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIncluded reports discussed: the development, need, potential, implementation, and outcomes of civilian-led crisis response models. Covidence software was utilized by two independent reviewers to search 11 databases, with a third reviewer resolving conflicts. A dataset of 46 reports were then analyzed with thematic content analysis by a multidisciplinary team using critical social theories to offer an exploration of how civilian-led crisis teams have begun to address the harms of policing mental health.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn exploring the key processes for civilian-led crisis response teams, three themes emerged. The first theme, \u003cem\u003eDecentering Police\u003c/em\u003e, explores the growing collective awareness of the harms associated with policing mental health and the corresponding need for alternative approaches, alongside efforts to establish a team composition that is intentionally distinct. The second theme, \u003cem\u003eTeam Scope of Practice\u003c/em\u003e, explores the subthemes of dispatch logistics and defining criteria for response. \u003cem\u003eTeam Sustainability\u003c/em\u003e is the third theme and explores how social and political will to introduce how alternative crisis response teams shape the uptake and long-term sustainability of civilian-led crisis programs, as well as efforts to resource these teams.\u003c/p\u003e","manuscriptTitle":"Restructuring Crisis Response Programs as Civilian-Led: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-29 12:21:29","doi":"10.21203/rs.3.rs-6674129/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b1c3b47-51bf-43ac-a1c7-016d3b13bcba","owner":[],"postedDate":"May 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-30T19:01:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-29 12:21:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6674129","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6674129","identity":"rs-6674129","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}