The day after Christmas 2015, Chicago police responded to a call from the father of a 19-year-old college student, Quintonio LeGrier, who was at his Austin home wielding a baseball bat, apparently in mental distress. LeGrier himself had called 911 three times that morning asking for help.

But he never got it. An officer who arrived at the scene, Robert Rialmo, wound up fatally shooting LeGrier outside his father’s home. In the process, Rialmo accidentally killed a neighbor, Bettie Jones. Prosecutors declined to press charges against the officer, saying LeGrier had moved toward him with the bat above his head.

Rialmo was later fired. But that’s little solace for the woman who lost her son. “He called for help — to get shot?” LeGrier’s mother told the press. “I don’t understand that.”

Would LeGrier and Jones still be alive if a mental health professional rather than an armed officer had responded to that call? That’s the theory behind the initiative Treatment Not Trauma, a linchpin of Brandon Johnson’s mayoral campaign that he hopes to put in place now that he’s in office.

Already, Chicago is running a small pilot program known as Crisis Assistance Response and Engagement, created when Lori Lightfoot was mayor. In June 2022, two teams of paramedics and mental health clinicians started covering the Southwest Side neighborhoods of West Elsdon, West Lawn, Chicago Lawn, Gage Park, and West Englewood. The Loop and Near South Side were added last March. As of October, CARE had responded to 391 calls, according to the Chicago Department of Public Health.

Expanding the program citywide won’t be easy. The biggest challenge, of course, is money. Alderperson Rossana Rodriguez Sanchez introduced a resolution in 2020, in the wake of George Floyd’s killing, that called for diverting funds from police to pay for such responses. That was a political nonstarter. Lightfoot opposed it, and the measure never got a hearing in the City Council. But an ordinance that passed on October 4 created a mental health systems working group that will shape Treatment Not Trauma’s implementation by studying both nonpolice response to such crises and city-run mental health resources.

Johnson’s 2024 budget includes more than $15 million for such services, which he said will allow “expanding 911 response teams by almost 75 percent” and increasing staffing in public mental health clinics. Matt Richards, the Chicago Department of Public Health’s deputy commissioner of behavioral health, said the department plans to double the geographic size of the CARE program and expand it to evening hours. That, however, would cover only a small portion of the city’s neighborhoods, and the teams would not necessarily be able to respond to all eligible emergencies even in their territory.

“People tend to forget that social workers have been doing this community-based work for generations, responding to all sorts of crises and chaotic situations.”

— Jason Lerner, U. of C. Health Lab

Just as critical to making the Treatment Not Trauma approach work are the 911 call takers. They will need to make judgments on the fly about whether emergencies require mental health experts or police presence, often based on short conversations from people in chaotic situations. The city has recognized this challenge, and the public health department is now training 911 staffers and supervisors. Richards said 550 — about half — have received such instruction “to actually change the way we screen for these calls, posing questions in a way that’s more consistent with how you would ask them in a clinical setting.”

Rebecca Neusteter, executive director of the Health Lab at the University of Chicago Urban Labs, which is formally evaluating the CARE pilot, says the biggest implementation hiccups are often mundane ones — “even basic questions like procuring vehicles and making sure people’s schedules align” — products of melding teams of first responders from different city agencies, with their own workplace cultures and systems.

Then there’s this vital consideration: What if it had been a social worker, not a police officer, facing a bat-wielding Quintonio LeGrier? Are unarmed mental health professionals equipped to handle potentially violent situations? Jason Lerner, a senior director at the U. of C. Health Lab and a former social worker himself, insists they are. “People tend to forget that social workers have been doing this community-based work for generations, maybe not formally responding to a crisis call for 911 but certainly responding to all sorts of crises and chaotic situations,” he says. “Make no mistake, they are trained, and people who sign up to do this are more than capable.”

Denver, which started a similar program in 2020, deploys police along with medical professionals in situations deemed to be potentially dangerous. “It’s a spectrum of care with behavioral health crises,” Chris Richardson, who helped found Denver’s Support Team Assisted Response Program, told NPR. “Some of it is really low level. No threats, no safety concerns, no legal issues.” Atlanta, New York, and Houston also have nonpolice response or co-response programs.

The next question is where to take those in need of further care. That’s been a sticking point. The city lacks mental health resources, especially for lower-income communities of color, and especially after Mayor Rahm Emanuel closed six public clinics in 2012. Johnson says he is “committed” to reopening all six, though his current budget doesn’t allow for that. And a $538 million budget gap may prevent it from happening at all in his first term. He has cleared one obstacle, though: Lightfoot’s public health commissioner, Allison Arwady, was opposed to the reopenings, arguing that city-run clinics are less efficient and effective than those operated by nonprofits. Johnson fired her in August.

Whatever the challenges to its implementation, advocates say Treatment Not Trauma represents a shift in 911 response that needs to happen, both to reduce the burden on police and to protect people with mental health issues. “When officers are involved, the use of force is this ever-present risk because their tactics might lead to a response that could escalate the situation,” says Northwestern University Pritzker School of Law professor Jamelia Morgan, who directs the school’s Center for Racial and Disability Justice. “It’s a pathway to police violence, even if that’s not the intention.”