For years, systems have attempted to respond through individual programs: crisis teams, outpatient providers, courts, law enforcement, and hospitals. Each program may perform well on its own. Yet without coordination, even the best interventions struggle to achieve lasting stability for those who repeatedly cycle through emergency services.
Across many jurisdictions, a more effective approach is emerging. By combining multidisciplinary co-responder teams with Assisted Outpatient Treatment (AOT), communities are seeing meaningful reductions in 911 calls, hospitalizations, arrests, and system costs—while improving outcomes for individuals with the most complex needs.
This integrated approach does not rely on a single solution. Instead, it aligns outreach, treatment, and accountability into a coordinated continuum that follows the person, not the silo.
Understanding the high-utilizer population
Individuals who frequently use emergency services often share overlapping characteristics:
- Serious mental illness, frequently psychotic disorders
- Co-occurring substance use
- Unstable or nonexistent housing
- Limited income or access to benefits
- Repeated emergency detentions or hospitalizations
- Difficulty engaging consistently with outpatient care
These individuals often cycle through the same system repeatedly. A crisis leads to a 911 call. Police or EMS respond. An emergency detention occurs. The person is evaluated and stabilized briefly in a hospital. Within days, they are discharged back into the community, often to the same conditions that contributed to the crisis.
The cycle repeats.
The challenge is not simply access to services. In many cases, services exist. The challenge is continuity, coordination, and engagement for people who may not voluntarily seek or maintain treatment.
Why traditional systems struggle
Mental health and public safety systems have historically been structured in silos. Crisis teams operate separately from courts. Hospitals operate separately from law enforcement. Case managers may not know when a client is detained. Courts may not know when someone stops engaging. Outreach teams may not know when someone reappears in an emergency department.
Even within the same organization, programs can operate independently. A person may qualify for multiple services but still fall through the cracks because no single entity has full visibility into them.
This fragmentation creates gaps in care. When someone disengages, the system may not notice until the next crisis. By then, stabilization can take weeks or months rather than days.
Reducing repeat crises requires more than adding services. It requires connecting them.
The role of multidisciplinary co-responder teams
Co-responder models have expanded rapidly in response to the growing number of behavioral health calls handled by law enforcement. Officers are frequently asked to manage complex mental health situations, often without the specialized clinical training or support needed.
Multidisciplinary co-responder teams address this gap by pairing law enforcement with behavioral health clinicians, paramedics, or other specialists. These teams respond to crises together and often provide ongoing follow-up for individuals who repeatedly contact emergency services.
Key features of effective co-responder teams include:
- Immediate clinical expertise on scene
- De-escalation and assessment support for officers
- Rapid linkage to services
- Persistent outreach and follow-up
- Coordination across agencies
For high-utilizing individuals, co-responder teams often function as intensive case management units. They meet people where they are—in shelters, encampments, hospitals, or homes—and maintain consistent contact over time. By showing up repeatedly, they build trust with individuals who may initially resist services.
Not every person responds to the same professional. Some may distrust clinicians but engage with a familiar officer. Others may open up to a paramedic or case worker. A multidisciplinary team increases the likelihood that someone will connect with at least one trusted figure, creating a bridge to broader care.
How Assisted Outpatient Treatment adds structure
Assisted Outpatient Treatment is a civil court-ordered intervention designed for individuals with a history of treatment non-adherence and repeated hospitalizations. AOT does not criminalize mental illness. Instead, it establishes a structured expectation that the individual will participate in treatment while living in the community.
AOT typically includes:
- A time-limited court order requiring treatment engagement
- Regular monitoring of compliance
- Rapid intervention if someone begins to deteriorate
- Coordination between courts, clinicians, and case managers
One of AOT’s most significant benefits is the clarity it provides. Families and providers are no longer solely responsible for enforcing treatment adherence. The court’s involvement provides structure and accountability while remaining focused on stabilization and recovery.
Many individuals respond to this structure. Even those experiencing severe symptoms often recognize the seriousness of a court order and engage more often when the process is respectful and supportive.
AOT is not a universal solution. Some individuals will still struggle to engage. However, it often serves as a critical turning point for people who have not responded to voluntary services alone.
Why combining these approaches works
Assisted Outpatient Treatment and co-responder teams frequently serve the same population: individuals with repeated emergency detentions, hospitalizations, and difficulty maintaining treatment engagement.
When these two approaches operate independently, each has limitations.
Co-responder teams may spend years conducting outreach without achieving consistent treatment adherence. They can connect individuals to services, but without structure, some clients disengage repeatedly.
AOT provides structure and accountability, but can struggle to locate individuals, maintain frequent contact, or respond quickly when someone disappears from care.
When combined, the strengths of each model address the other’s gaps.
Co-responder teams provide real-time visibility and field engagement. They can quickly locate individuals, respond to crises, and maintain consistent contact. AOT provides a formal structure that enables rapid re-engagement and reinforces expectations around treatment.
Together, they create a coordinated system that reduces the likelihood that individuals will fall out of care unnoticed.
Impact on public safety and healthcare systems
Jurisdictions implementing coordinated co-responder and AOT strategies have reported meaningful improvements across several metrics:
- Reduced 911 calls for behavioral health crises
- Fewer emergency detentions
- Decreased emergency department visits
- Reduced hospitalizations
- Fewer arrests
- Lower use-of-force incidents
- Improved treatment engagement
- Increased housing stability
Financial impact is also significant. Emergency department visits and hospitalizations are costly, particularly for individuals without insurance. Even modest reductions in utilization can generate substantial system savings.
Investing in proactive outreach and coordinated care is often more cost-effective than repeatedly absorbing the cost of crisis-driven responses.
Addressing housing, substance use, and social needs
Stabilizing high-utilizing individuals requires more than medication or therapy. Housing, benefits, and substance use treatment are critical components of success.
Many individuals cannot engage consistently in treatment until basic needs are addressed. Without stable housing or income, even well-designed treatment plans may fail. Effective programs prioritize:
- Securing benefits and insurance coverage
- Connecting individuals to housing resources
- Coordinating substance use treatment
- Addressing transportation barriers
- Supporting daily living skills
These interventions take time. Persistent outreach and coordination across agencies are essential.
When additional support is needed
For some individuals, even coordinated outreach and court-ordered treatment may not be sufficient. Severe cognitive impairment, lack of executive functioning, or profound instability may require additional supports such as guardianship.
Guardianship should not be viewed as a primary solution or a replacement for outreach and treatment. Instead, it can be one component of a broader continuum for individuals who cannot manage essential decisions independently. When combined, Assisted Outpatient Treatment and co-responder teams may help stabilize those with the most complex needs.
Breaking down silos
Perhaps the most important lesson from jurisdictions that have implemented these models is the need to break down organizational silos. Agencies often serve the same individuals without fully coordinating efforts.
Effective systems prioritize:
- Shared communication channels
- Real-time data visibility when possible
- Cross-agency protocols
- Joint case reviews
- Collaborative funding strategies
The goal is not to merge all programs into one. It is to ensure they operate as parts of a coordinated continuum.
Measuring success
Communities seeking to implement or expand these approaches should track metrics that reflect both individual outcomes and system impact:
- Number of 911 calls per enrolled individual
- Emergency detentions
- Emergency department visits
- Hospital admissions
- Arrests
- Housing placements
- Treatment adherence
- Use-of-force incidents
- Net cost impact
Tracking these measures helps demonstrate effectiveness and sustain funding.
Looking ahead
There is no single intervention that will resolve the challenges posed by high-utilizing individuals with serious behavioral health needs. But coordinated systems that combine multidisciplinary outreach with structured accountability show strong promise.
Co-responder teams provide consistent presence, relationship-building, and rapid response. Assisted Outpatient Treatment provides structure and a framework for sustained engagement. Together, they create a model that better supports individuals while reducing strain on emergency services, hospitals, and law enforcement.
The path forward is not about choosing one program over another. It is about aligning resources, sharing responsibility, and building systems that respond to complexity with coordination rather than fragmentation.
Communities willing to integrate these approaches are finding that when outreach, treatment, and accountability work together, the cycle of repeat crises can finally begin to break.
