When 911 calls require a mental health response

As the Durham, North Carolina, Community Safety Department (DCSD) prepares for changes to its computer-aided dispatch (CAD) system, it launched four pilot programs that could change how the city responds to emergency calls involving mental health crises.

A study of emergency response in Durham by research firm RTI International found that police officers estimate that up to 90% of crisis response calls are related to mental health, but the a tiny fraction – about 1% to 2%, said Brian Aagaard, a research analyst at RTI’s Policing Research Program – are coded that way in the CAD.

A mental health crisis often gets categorized as another type of call, DCSD Director Ryan Smith said. “If it is a call of a person who is unhoused who is sleeping in the doorway of a business, that is going to be a trespass call in our system. Even if there are underlying mental health needs associated with that, that is not going to get a ‘crisis’ call.”

With RTI and other partners, Durham is launching four year-long tests of new response methods:

• Crisis Call Diversion (CCD), in which the city will embed licensed mental health professionals into the 911 call center to triage, assess and respond remotely.
• Community Response Teams, which are unarmed three-person teams made up of a clinician, a peer-support specialist and an emergency medical technician.
• Care Navigation, which focuses on providing follow-up within 48 hours of an encounter with a first responder to connect callers to the community-based care they need and want. 
• Co-Response, which will pair clinicians with crisis intervention-trained police officers.

The first three will launch in June, with CCD available citywide and the others in eight police beats because of staffing constraints, and the fourth will start later in the summer. The department selected the eight locations because they have the highest number of the types of 911 calls eligible for the pilots.

“A lot of this is about being able to make better use of officer time, to reallocate towards higher-priority needs around violent crime and homicides,” Smith said. “We can put more resources and time but still meet these other important safety needs through other types of responses.”

To conduct the tests, the city has had to integrate the new responses into its 911 system and train call-takers and dispatchers. Based on how callers answer the call-taker’s predefined script of questions, the system generates more than 1,000 call types and then recommends the appropriate type of first responder – police, fire, emergency medical services and now mental health – to the call-taker.

DCSD is using Julota clinical management software, which allows for data sharing without permitting access to all notes or any information protected under the Health Insurance Portability and Accountability Act that police officers don’t need to see, Smith said.

Additionally, Julota can facilitate the referral process, he added. For instance, if a call comes in about an unhoused person sleeping in a business’s doorway and the owner wants them to leave, the dispatcher will send an unarmed response. If the person is interested in connecting to food or shelter resources for the night, the responder can coordinate that on the scene.

“One of the features that Julota has is you can build relationships with other providers in the area, and you can, in one step, send out a text message or email to all the local food banks or to all the different housing providers about this person, Smith said.  After an agency says it’s willing to provide that service, the loop is closed so there won’t be any duplication. 

Julota can integrate with Microsoft Power BI, which DCSD will use starting in August to publish monthly public dashboards that will show the number of calls responded to by type, average response time, percent of callers who were connected to the care they needed and wanted, and the number of eligible calls that were not responded to because of staffing levels.

Police officers will also be able to track the calls on tablets in their vehicles where they can access the CAD. They can see calls as they come in, review notes from call-takers and take the tablets with them to conduct assessments. “Dispatch will always know where they’re at, which is an important additional safety feature and one of the benefits of integrating through 911,” Smith said.

RTI and the University of North Carolina’s Center for Health Equity Research will evaluate each pilot. They will look at four main buckets of data, Aagaard said: demographics, resources callers can be connected to, officers’ perception of the interaction and outcome, and data about the interaction, such as its nature.

“Our hypothesis going into it is that all four of these are needed,” Smith added. “The plan is to go where the data leads us.”

The idea is to determine the success of pursuing a case management system that captures information on callers while tying into the CAD, which is “just a system that’s built to deploy resources. It’s not a system that’s meant to collect information about individuals in crisis,” Aagaard said.

For the study, RTI looked at emergency response in other North Carolina cities – Burlington, Cary, Greensboro, Raleigh and Winston-Salem – plus Rock Hill, S.C. Each has stood up its own pilot projects. For instance, Raleigh initiated “Addressing Crises through Outreach, Referrals, Networking, and Service,” or ACORNS. It uses a “care and safety first, enforcement last” approach.

Programs that emphasize mental health in emergency response are growing nationwide. Virginia launched a 911 call diversion matrix that has four risk levels. Call centers triage the first two to regional 988 call centers. That number is the new National Suicide Prevention Lifeline, which goes into effect nationwide on July 16.

In March, Los Angeles County announced a similar matrix to send 911 behavioral health calls to Didi Hirsch Mental Health Services, and in April 2019, Pima County, Arizona, embedded behavioral health crisis professionals at the Tucson Police Department’s 911 call center.

Additionally, Integral Care, Austin, Texas’s Local Mental Health and Intellectual and Developmental Disability Authority, has been integrated with the city’s police department and CAD for the past two years. Between December 2019 and June 2021, clinicians diverted 81% of calls that needed medical attention from police response.

Stephanie Kanowitz is a freelance writer based in northern Virginia.