On a chilly afternoon in October 2023, a single mother stood in her living room on the North Side as her teenage daughter erupted in rage, kicking, screaming and threatening to take her own life.
The woman says that a few years earlier her daughter had been outgoing. Good in school, she loved sports and had plenty of friends. But, as an adolescent, her moods grew darker, her behavior volatile.
Amid the girl’s mental health struggles, her mother Pamela — whose last name is being withheld to protect her daughter’s identity — says she was left grasping for support.
When she previously needed help for her daughter and called 911, police officers responded. But she says that usually left her daughter shaken, with officers sometimes raising their voices, getting too close, putting their hands on the girl.
“Having the police come in and out of your house is very traumatizing to myself and, more importantly, to my child,” she says.
So this time when she called 911, she says she asked for the Crisis Assistance Response and Engagement — the program known as CARE that was begun in 2021 to offer clinical help in a mental health crisis and limit police involvement. A mental health professional, a paramedic and a police officer responded.
“When the CARE team came in, they were trained, and they knew how to calm the situation in a very professional, respectful way that my daughter was able to respond to,” Pamela says.
For her, CARE has been a lifeline, assisting her daughter, now 19, more than half a dozen times over the past four years, helping calm moments that once spiraled out of control.
“If CARE hadn’t come into our lives, I think things would have been much worse,” she says. “People with mental illness — they need help.”
But records obtained by the Medill Investigative Lab-Chicago and MindSite News show 911 personnel have been sending CARE teams to fewer mental health calls and that police still respond to most despite Mayor Brandon Johnson’s announcement last fall that the police would be removed from the program to give more responsibility to clinical responders.
Meanwhile, the federal COVID-19 recovery funding that’s paid for most of the program’s operations will run out next year.
Johnson says he remains committed to the program and city funding for it and ultimately expanding it.
The use of mobile crisis teams to respond to mental health crises became more common as the police reform movement intensified after a white Minneapolis police officer killed George Floyd, a Black man, in 2020. But they’re struggling with uncertain funding and staffing shortages.
Calls to reform Chicago’s mental health system predate the start of the CARE program, with Mayor Rahm Emanuel’s decision to close six of 12 city mental health clinics in 2012 spurring protests. City officials said the clinics would be replaced with higher-quality private care through partnerships with more than 60 clinics, saving millions of dollars.
In 2020, the Collaborative for Community Wellness — which included mental health professionals and community organizations — launched the “Treatment Not Trauma” campaign, demanding a citywide crisis-response system that didn’t rely on police.
In September 2020, Ald. Rossana Rodríguez Sánchez (33rd) proposed an ordinance calling for a move to non-police responses. She says her plan reflected demands from Black and Brown communities “that people experiencing mental health issues are met with care, not punishment.”
City Council and police union opponents called the proposal a move to “defund the police.”
CARE was Mayor Lori Lightfoot’s compromise: a two-year pilot program involving teams of police officers, paramedics and mental health clinicians. There was some opposition to having the police involved, but police Supt. David Brown said officers would provide safety.
CARE was launched in September 2021. It had just a $3.5 million budget, operating in only a handful of neighborhoods between 10:30 a.m. and 4 p.m.
When Johnson took office in 2023, he promised to reopen the closed clinics, expand CARE’s hours and phase out police involvement. Last September, his administration announced CARE was being moved from the police department to the health department.
“By directing 911 mental health calls to public health teams, we are ending the criminalization of these issues and helping to ensure people who are unhoused or experiencing a mental health challenge get the treatment and support they need,” the mayor said then.
Today, seven CARE teams — including a mental health clinician and an emergency medical technician — respond to low-risk 911 calls involving mental health issues in certain police districts, mostly on the South Side and the West Side. One team can respond citywide.
Dispatchers can send a CARE team if a call meets certain criteria, though more often the CARE teams take it upon themselves to show up after hearing calls dispatched, records show. The police also can request CARE’s assistance.
Since only the police can transport people to a hospital against their will, 911 operators often are reluctant to dispatch CARE teams. And since CARE vans operate without sirens, it takes longer for them than for the police to get to calls.
Health department logs show CARE teams responded to 37 calls in 2021, 481 in 2022 and 773 in 2023. Amid Johnson’s 2024 restructuring, the number plummeted to 276.
That was the case even as 911 dispatchers categorized more than 96,000 calls last year as potentially mental health-related. That means fewer than 1% of 911 calls regarding a possible mental health issue saw a CARE team respond.
The police are still responding to most calls the city designates as CARE calls, alone or alongside CARE clinical teams.
The mayor’s office says city officials are working to ensure “that the CARE team is dispatched more frequently to meet the need for mental health services” and developing an “action plan within the next 45 days“ to address concerns.
Current and former CARE insiders say turf battles among the city agencies involved have limited the program.
“There was a fight between the three entities” — the police, fire and health departments — says a former CARE worker who spoke on the condition of anonymity. “Who’s gonna be in charge? There was no real collaboration.”
The lack of coordination has made things difficult, according to former CARE clinician Patrick Cornelius, with interdepartmental interactions often feeling “very quid pro quo — very ‘you do me a favor, I do you a favor.’ “
In 2021, only 8% of CARE responses were initiated by 911 dispatchers — in part, CARE clinician Drake Schoeppl says, because “they didn’t want to get in trouble” if a situation became violent. That number rose to 19% in 2023 and 33% in 2024.
But after the police were removed from CARE teams last fall, the portion of CARE responses initiated by 911 dispatchers fell from 46% in September to 9% in December. The number of police calls for CARE assists also plummeted.
The health department wants 911 operators to deploy CARE teams more often, rather than the teams self-dispatching, says Dr. Jenny Hua, Chicago’s interim deputy commissioner for behavioral health.
But she says dispatchers have to be sure first that there’s no crime or medical emergency involved.
Hua says calls that have “nothing but a mental health component” and thus clearly eligible for CARE are “a needle in a haystack” of all 911 calls.
The mayor’s office says: “The 911 system must assume the worst because they don’t want emergencies missed. A person could be lying on the street because of a heart attack or an overdose or a schizophrenic episode. In a medical emergency, a paramedic is the default first responder. In a violence-related call, police is the default.”
CARE teams have responded to a wide range of settings. In one case, Schoeppl says, a woman barricaded herself inside her home because she thought the FBI was coming. Police surrounded the house for 30 minutes. Schoeppl says he stepped in, listening without challenging her delusions. Eventually, he says, she agreed to go to a hospital for help — the kind of outcome CARE aims for.
About one-quarter of CARE calls last year resulted in the person being taken to a hospital emergency department for evaluation.
Krista Murphy, a clinical social work lead in the psychiatry emergency department at Northwestern Memorial Hospital, says police officers or paramedics who bring in people with mental health symptoms “aren’t able to really speak to their clinical symptoms just because they don’t have training in mental health.”
She says the CARE teams expedite assessments, allowing the hospital staff to quickly determine whether a psychiatric admission or alternative care is needed.
In January, city officials announced the expansion of the CARE program from four police districts to six. But the federal funding that’s largely paid for it is ending.
Johnson’s office says the mayor “is committed to continued funding of the CARE program. . . . Mayor Johnson will do everything in his power to expand resources for the program,” aiming to offer the program across more of the city and around the clock.
Contributing: Rachel Yoon, Janani Janarthanan, Nicole Johnson, Tyler Williamson, Jai Indra, Nicole Johnson, Kari Lydersen
Rachel Heimann Mercader and Claire Murphy reported this story for the Medill Investigative Lab-Chicago and MindSite News, nonprofit journalism organization that reports on mental health in America.