Welfare Checks That End in Violence: Why Is Care Routed Through Force? | Rita Williams

The Call That Should Have Saved Him

In August 2020, Damian Daniels was 30 years old, a Black combat veteran, and drowning in grief. He had lost his sister, his father, and his uncle within months of each other — all during the painful isolation of the pandemic. When he began sending worrying text messages to his brother Brendan, intervention was not just necessary. It was critical. Brendan, proceeding with caution in a post-George Floyd world, chose to call the Red Cross rather than law enforcement. The Red Cross made a terrible mistake: they called 911. That welfare check was the final intervention Damian Daniels would experience.

Between 2019 and 2021, at least 178 people were killed by police responding to mental health crises, wellness checks, or reported suicide threats — calls that were supposed to bring assistance, not force. The question that lingers behind every anxious phone call, every “I don’t know what else to do” moment, is the one this piece is about: why is care still routed through violence?

The Default Response

Welfare checks account for 7% of total call volume in one large U.S. city alone — far more than calls for theft, burglar alarms, or noise complaints, and roughly as often as calls related to domestic violence. When someone contacts 911 about a family member, friend, or neighbor, the default response is armed police in uniform. Very often, welfare checks are precipitated by mental health, substance use, or medical crises — situations that most officers are not trained to address.

“Police have become the default responders to mental health calls,” wrote historian David Perry and disability expert Lawrence Carter-Long. The mechanics of this default are straightforward but devastating. An elderly relative stops returning phone calls. A neighbor hasn’t picked up their newspaper. A driver appears slumped over in a parked car. These situations rarely involve suspected crimes and far more commonly involve mental illness, physical disability, or medical crisis. Yet in most places, armed officers are who we send.

The Invisible Casualties

People With Mental Illness

At least 25% of people shot and killed by police suffer from acute mental illness at the time of their death. People with untreated mental illness are 16 times more likely to be fatally shot during a police encounter than those with their illness under control. The most common reason for a mental health-related police call is a suicidal person — 77.3% of mental health calls. Over half involve a verbal or written expression of suicide. Approximately 1 in 5 cases involves a non-suicidal mental health crisis: visual hallucinations, disoriented behavior on highways, acute psychiatric episodes. Race and presence of mental illness are strongly associated with fatal outcomes. African Americans face 2.57 times the risk of fatal shooting compared to non-Hispanic whites; presence of mental illness increases risk 7.16 times. Individuals with mental illness were more likely to be armed with a knife and more likely to have been killed at home — suggesting that more effective de-escalation might substantially reduce fatal outcomes.

People With Disabilities

In the United States, 50% of people killed by law enforcement are disabled. A Ruderman Family Foundation report found between one-third and one-half of people killed by police have disabilities. The mechanism is often perceptual: an awkward gait due to cerebral palsy is read as intoxication. An autistic person unable to maintain eye contact or repeat commands is perceived as hostile or uncooperative. An individual in mental or physical crisis who cannot communicate clearly is read as threatening. Law enforcement’s drive to control variables in a situation produces devastating results when someone is unable to respond as expected due to disability. Ethan Saylor, a 26-year-old with Down syndrome, was killed in 2013 simply trying to spend a day at the movies. LaQuan McDonald, a Black teenager acting erratically and holding a knife, was killed in a case where prosecutors charged the officer with first-degree murder, noting McDonald did not pose a lethal threat to the officers surrounding him.

The Intersection of Race and Disability

More than half of disabled African Americans have been arrested by age 28 — double the risk compared to white disabled counterparts. Black men are the demographic least likely to receive treatment for active mental health diagnoses. “You intersect all of those factors and you have Black young men who are most at risk who may not be in treatment,” explains Juan Rios, assistant professor at Seton Hall University. “And the reality is also Black men are more likely to be deemed as a threat than any other demographic.” Black people are almost three times as likely to be fatally shot by police as white people. When mental illness and Blackness intersect, the risk compounds exponentially.

The Logic of Dispatch

How did we arrive at a system where armed law enforcement became the default response to wellness concerns? The structural answer is largely historical and financial. Law enforcement has been paid to transport people suffering mental health breakdowns to hospitals. In many states, police involvement is a legal requirement for involuntary commitment — Washington state requires it “under almost all circumstances.” Oklahoma’s mental health department includes a budget line item specifically for reimbursing police to transport patients. The perception of people with mental illness as violent and dangerous reinforced the arrangement, even as evidence mounted that police presence frequently escalates rather than de-escalates these situations.

Dispatch decisions happen in seconds, often without complete information. Dispatchers must quickly assess whether a situation involves weapons, violence, or life-threatening emergencies. This sets the threshold for police involvement low and the margin for error to near zero. A wellness check becomes an armed encounter. A cry for help becomes a confrontation.

The Paradox of Protection

During mental health crises, the presence of police officers — uniforms, weapons, shouting commands — is clinically counterintuitive and too often leads to tragedy. People in mental health crises do not always respond in ways officers want or expect. Police are trained to protect public safety using interventions designed to contain someone perceived as dangerous. Mental health crises are not criminal situations. The people experiencing them are not criminals. They are usually seeking help. Yet the response involves armed strangers arriving unannounced, demanding compliance, treating distress as danger.

A 57-year-old woman with bipolar disorder was fatally shot during a welfare check involving forced entry into a locked bedroom. Michelle Cusseaux, diagnosed with schizophrenia and bipolar disorder, was killed when police came to transfer her to a mental health facility under court order. When she allegedly charged an officer with a hammer, he shot her dead. Many criticized the incident as an avoidable escalation. The paradox is stark: we send armed responders to “protect” people, and those armed responders kill the people they were sent to protect.

The Moral Reckoning

“If your family member is in pain, you should be able to pick up that phone and dial 911 and get help that is effective and safe. We need to reject this idea that you can have a safe response or a law enforcement response. We need to create a world in which you have a safe law enforcement response.”

— Christy Lopez, policing expert, Georgetown Law School

The problem runs far deeper than training or tactics. It reflects a society that has systematically defunded mental health infrastructure while expanding police budgets. When psychiatric hospitals closed, when community mental health centers lost funding, when treatment became inaccessible or unaffordable, we did not create alternative systems of care. We simply routed every crisis through 911. “Every crisis in this society always gets dumped right in front of the officer,” says Jim Cavanaugh, a former federal agent. Police become the default not because they are the best responders, but because they are the only responders we’ve funded to be available 24/7. The moral question isn’t whether individual officers are bad people. It’s whether we’ve created a system where people trained for law enforcement are being asked to provide mental health care — where guns and badges are the first response to psychological crisis, where the tools of force are applied to situations requiring compassion. When care is routed through force, we have no right to be surprised when it ends in violence.

The Path Forward: Care Without Coercion

The CAHOOTS Model

In 35 years, CAHOOTS has never had a serious injury or death attributable to its team. Ebony Morgan, a CAHOOTS crisis worker, explained her motivation: “I came into this work passionate about being part of an alternative to police response because my father died during a police encounter. So it matters to me very much.” The model has spread nationally — Denver launched Support Team Assisted Response (STAR), Olympia created the Crisis Response Unit, Portland launched Portland Street Response. After the George Floyd protests in 2020, several hundred cities requested information from CAHOOTS about implementing similar programs. In 2021, federal legislation directed $1 billion to cover 85% of expenses for Mobile Crisis Teams for three years.

Co-Responder Programs

Alternative approaches include co-responder programs pairing community-based mental health counselors with plainclothes police officers in unmarked cars for mental and behavioral health calls. New Jersey’s Arrive Together program resulted in few arrests and uses of force — only 2 cases out of 82 required force. More than 2,700 departments across the United States offer Crisis Intervention Team (CIT) training, a 40-hour specialized curriculum improving police response to individuals with mental health diagnoses or substance use problems. The Memphis Model, developed in 1987 after police fatally shot a man with mental illness threatening others with a knife, became the national CIT template.

Dispatch Protocol Reform

Dispatchers can be trained to recognize non-violent situations with behavioral health components and route those calls to alternative responders rather than police. When contacting 911 about a mental health crisis, callers should clearly state it is a mental health situation — not a criminal matter — and ask the dispatcher to repeat the information back to confirm. Some jurisdictions have developed vulnerable persons notification systems through which residents voluntarily submit information about a mental health condition or developmental disability, allowing dispatchers and officers to flag the situation and route appropriately. This requires investment in training, clear protocols, and alternative response capacity.

Systemic Investment

The fundamental solution requires investing in mental health infrastructure rather than routing all crises through law enforcement. Nearly 130 million Americans live in areas with a shortage of mental health providers. When someone acts out as a result of symptoms, the only option is often to send police — not because police are right for the situation, but because nothing else exists. The needed infrastructure includes expanding community-based mental health services, creating 24/7 crisis response teams staffed by mental health professionals, funding mobile crisis units that can respond without police, establishing crisis stabilization centers as alternatives to emergency rooms and jails, ensuring treatment is accessible and affordable, and supporting peer responders with lived experience. The Biden administration’s “Strategy to Address Our National Mental Health Crisis” promised funding for behavioral health providers, community-based mobile crisis teams, and evidence-based community mental health services. The status of those programs is in jeopardy under the current administration.

Routing Care Through Compassion

“A badge and gun should not be the first one to address a nonviolent mental health crisis call,” said Juan Rios of Seton Hall University. The statement captures the fundamental absurdity of the current system: armed law enforcement is the default response to people in pain. The consequences are measured in lives lost during welfare checks, in families traumatized by interventions meant to help, in communities that fear calling for assistance because help arrives with weapons drawn.

None of this requires demonizing police. It requires recognizing that we’ve asked law enforcement to solve problems they aren’t trained to handle, funded them as the only 24/7 crisis response system, and expressed shock when force-based interventions end in violence. CAHOOTS has operated for over 35 years handling thousands of calls with virtually no serious injuries or deaths. The model has spread to dozens of cities. We know it is possible to respond to mental health crises with care rather than coercion, with trauma-informed de-escalation rather than weapons, with people trained in crisis intervention rather than law enforcement. The question is whether we have the political will to invest in care infrastructure rather than continuing to route every crisis through police. Because when we route care through force, we cannot honestly call it welfare. We need to call it what it is: a system that treats crisis as crime, responds to pain with weapons, and too often ends calls for help with funerals. True welfare requires true care. Care should never arrive at the end of a gun.