Too often, people in crisis end up arrested, hospitalized, or tragically harmed. The problem is especially acute in rural America, where resources are scarce and communities are spread out. But in the mountains of Western North Carolina, small towns are leading a quiet revolution in rural mental health crisis response.
In North Carolina, nearly half of the prison population is estimated to need mental health treatment. Yet jails were never designed to serve as hospitals, leaving people in crisis trapped in a system that strains both individuals and the justice system itself. To break this cycle, communities in North Carolina have pioneered a new approach, embedding social workers alongside police officers. This model not only eases the burden on law enforcement but also offers valuable lessons for communities nationwide.
Why Rural Communities Struggle With Crisis Response
Cities like Denver or Seattle have piloted high-profile alternatives to traditional policing. But in places like Sylva, North Carolina, a town of fewer than 3,000 people, big-city models do not translate.
Limited Infrastructure
- No detox or treatment centers in many counties
- Few or no homeless shelters for people experiencing housing instability
- Long travel times to reach the nearest psychiatric hospital or crisis stabilization unit
Small Police Departments
Nearly 90% of police agencies nationwide have fewer than 15 officers. That means one or two calls involving mental health can overwhelm an entire shift.
Transportation Barriers
In rural regions without public transit, getting someone from crisis to care may require crossing county lines, coordinating rides, or leaning on limited nonprofit networks.
These gaps have historically left law enforcement with just one option: jail. But increasingly, rural communities are demanding better.
The Birth of the Community Care Program in Sylva
In 2021, two professors from Western Carolina University, one in social work and one in criminal justice, proposed a bold idea: place social work interns directly inside the Sylva Police Department.
At first, Police Chief Davis Hatton was skeptical. Sending students into potentially dangerous situations seemed impractical. But when one intern rode along on patrol, he saw something unexpected. The presence of a social worker transformed the encounter. Instead of defaulting to enforcement, officers and interns could together offer compassion, de-escalation, and referrals.
That pilot evolved into the Community Care Program, a model of rural mental health crisis response that has since expanded to seven police departments across Western North Carolina.
How the Rural Co-Responder Model Works
The program is built on a few simple but powerful principles:
- Embedded Social Workers – Social work interns and professionals are stationed inside police departments, making collaboration seamless.
- Joint Response to Calls – When 911 dispatch indicates a crisis involving homelessness, substance use, or mental health, officers and social workers respond together.
- De-escalation and Compassion – Officers ensure safety, while social workers engage directly with individuals in crisis, offering empathy and immediate support.
- Ongoing Follow-Up – Unlike traditional police calls, which end once the situation is contained, social workers continue working with clients, connecting them to housing, healthcare, or recovery programs.
This last piece is critical. True crisis response in rural areas is not just about the emergency moment but about building pathways to stability.
A Day in the Life: Crisis Response on the Ground
Take, for example, a call in Sylva involving a couple experiencing homelessness. A business owner called 911 after seeing them sitting outside, unsure of what to do. Traditionally, this could have led to charges for trespassing.
Instead, Community Care Coordinator Galadriel LaVere arrived alongside police. She learned the couple had significant health issues and needed transportation to a shelter in Waynesville. She arranged the ride, diffusing tension and helping them avoid criminalization.
LaVere explains that most clients face a “trifecta” of challenges: mental health conditions, substance use, and homelessness. Each is difficult on its own. Together, they require coordinated, human-centered intervention.
Barriers Unique to Rural Mental Health Crisis Response
While the Sylva program has shown promise, it also highlights the structural hurdles rural communities face:
- Lack of local services – Many towns lack even a single detox bed or psychiatric provider
- Overreliance on neighboring counties – Programs must stitch together networks across county lines
- Funding uncertainty – Smaller tax bases mean fewer resources to sustain staff and programs
- Cultural stigma – Mental illness and addiction can carry more stigma in small communities, making outreach harder
Instead of halting progress, these challenges have spurred innovation. Partnerships with nonprofits, faith-based organizations, and healthcare systems are helping fill the gaps.
Scaling the Model Across North Carolina
The Community Care Program now operates in seven rural police departments, with four more preparing to join. Other communities in North Carolina are experimenting with their own versions of alternative crisis response:
- Jacksonville’s Dix Crisis Center provides stabilization as an alternative to jails and ERs
- Hickory’s LEAD Program connects individuals to care instead of criminal charges
- Durham HEART Program deploys unarmed crisis responders for specific 911 calls
Each of these initiatives reflects a growing consensus: mental health crises are healthcare issues, not just law enforcement issues.
The Impact: Building Trust and Reducing Arrests
Around 20% of 911 calls involve a mental health or substance use crisis. Yet for decades, the default response has been to send law enforcement officers, professionals trained to enforce the law, not treat behavioral health conditions. Though still early, rural mental health crisis response programs are demonstrating measurable benefits:
- Fewer arrests – More people are being diverted to services instead of jail
- Officer relief – Police no longer feel like the only option for calls outside their expertise
- Community trust – Residents see police not just as enforcers but as partners in care
Chief Hatton puts it: “Either we have a social worker, or we are going to get a social worker. I would not want to do this job without one.”
Why Rural Mental Health Crisis Response Matters Nationally
North Carolina’s small towns are not outliers. They reflect the reality of most U.S. communities. If rural models can succeed with limited resources, they provide a roadmap for thousands of similar jurisdictions.
Key takeaways include:
- Integration is better than silos. Embedding social workers builds collaboration
- Prevention matters. Programs must look beyond emergencies to address root causes
- Flexibility is essential. Rural regions cannot copy big-city models; they must adapt locally
Conclusion: A New Vision for Crisis Response
The story of Sylva and its neighbors is about more than one program. It is about a shift in mindset: recognizing that rural mental health crisis response requires care, compassion, and creativity.
While challenges remain, including funding, infrastructure, and stigma, the progress so far offers hope. By bringing law enforcement and social workers together, rural towns are proving that crisis response does not have to end in jail. It can end in healing, stability, and stronger communities.
As policymakers, healthcare providers, and public safety leaders search for answers, North Carolina’s rural communities are quietly showing the way forward.
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