Dr Chris Maylea is a social worker, lawyer, and Professor of Law at La Trobe University. He has practice experience in mental health services as a social worker and manager, provides advice to government and policy reform bodies.
Dr Panos Karanikolas is a Postdoctoral Fellow at the La Trobe Law School and an Honorary Fellow at the Melbourne Social Equity Institute, at the University of Melbourne. Panos has a background in law and has expertise across fields of disability and mental health law, policing and criminal legal processes.
Police have become the default first responders to mental distress. Major service gaps across social service systems leave few options for people in crisis. We have co-produced research with people who have been apprehended by police under mental health powers. Participants described police attendance as frequently intimidating, escalating and, too often, traumatic. People who anticipate force, humiliation, or being treated as a public threat will avoid calling for support, even when they are frightened, distressed and wanting support.
Both police departments and governments want fewer mental health-related police call outs. As part of the Royal Commission into Victoria’s Mental Health System, the Victorian Government has committed to sending ambulances instead, something we have also seen overseas. Transport matters, but it is not the core problem. A care-led response requires relationships, choice, and somewhere safe to go other than an emergency department. Emergency department have become the main contact point for people experiencing mental health crises. Currently, there are very few peer-run alternatives to hospital emergency departments for people experiencing acute distress.
Participants consistently described wanting a response that feels human, not tactical. That means a calm approach, clear communication, and genuine support options. Many expressed a preference for police not to attend at all. People want police to play a limited safety role, while health and peer responders lead the interaction.
Just as important, people want alternatives to the narrow pathway of apprehension, transport and emergency department triage. They described wanting peer support in the moment, not as an afterthought. Peer workers bring mutuality and practical understanding that can de-escalate distress without turning it into a law enforcement encounter.
From control to ecosystems of care
In our work we use the language of psychiatric carcerality to describe how mental health and justice systems can become linked sites of control, moving people through apprehension, locked transport, emergency departments, involuntary treatment, seclusion and restraint. Participants generally did not experience police and mental health services as separate systems. Many described a continuous arc of coercion, beginning at the front door, and continuing after arrival at hospital.
Shifting away from this circuit requires an ecosystem of care that makes voluntary support easy to access before crisis, during crisis, and after crisis. That includes culturally safe responses, and a strong family violence lens. Participants described being taken into police custody in the context of acute mental distress caused by family violence. Including various instances where police misidentified the person experiencing distress as the ‘primary aggressor’. Any credible alternative model must recognise how systems can be weaponised, and how police responses intersect with gender, race, disability and social disadvantage.
Peer support
Peer support and prevention are sometimes treated as “nice to have” features once the acute response is fixed. Our findings suggest the opposite. People described deteriorating for long periods while trying to access help, then reaching crisis because services were unavailable, inaccessible, or offered only hospital-based options. Prevention in this context means practical access to early support, timely community-based care, and rapid follow-up after a crisis contact.
If governments want fewer police call-outs, we need to make it easier to get help before someone reaches breaking point. This requires a rethinking of how we run our mental health system.
However, reimagining the mental health system is not enough on its own. Genuine change also depends on strong leadership, cross-sector collaboration and sustained commitment from all levels of government. Without these, even well-designed reforms risk stalling or failing to be implemented. To move forward, it’s critical that leaders prioritise action, foster partnerships across health, justice and community sectors, and remain accountable for delivering the reforms people need.
What makes alternative responses effective
There is no single model that will work everywhere, but several design elements recur across the alternatives people described and the reforms we have argued for.
- A presumption of non-police attendance, with clear thresholds for when police involvement is genuinely necessary.
- A workforce mix that includes peers alongside clinicians, with peer roles embedded in governance, training, dispatch and evaluation, not confined to “support” tasks.
- Real destinations other than emergency departments, including peer-led crisis respite and sub-acute options, so that “getting help” does not automatically mean hospital.
- Genuine choice mechanisms, including advance statements and pathways that respect a person’s preferences.
- Independent evaluation and long-term funding, so pilots do not remain small, time-limited and unequally available. Evaluation should measure what people value: dignity, trauma reduction, perceived safety, fewer repeat crises, fewer uses of force, and effective follow-up, and feature lived experience leadership within evaluation teams.
If we could nominate one courageous change, it would be this: legislate and fund a state-wide, peer-inclusive crisis response system, that is responsive 24/7.
In practice, that requires dispatch reform, workforce investment, and service capacity. This also requires accountability when services cause harm, because systems that do not acknowledge harm will inevitably repeat it.
