For generations, “Call 911” has been the mantra for any perceived crisis. In the U.S., approximately 240 million calls are placed to 911 annually, an average of almost 675,000 per day. Unfortunately, too frequently, 911 calls include those which require a mental health response, but police officers are dispatched alone to handle them. A model that is showing great promise is 911 call diversion.
Across the country, cities are transforming the 911 system to improve public health and safety and ensure that the correct responders are sent to crisis situations. Rather than defaulting to law enforcement, public health and mental health practitioners are deployed alongside, or in place of, police and emergency medical services.
The diversion approach aims to reduce unnecessary law enforcement contact by connecting individuals who have dialed 911 because of a mental health need to mental health professionals.
911 call diversion initiatives vary across the country. For example, some communities have embedded clinicians within the 911 system who divert people not at imminent risk away from police and toward more appropriate care.
Other programs use telehealth options to transfer mental health calls to skilled professionals, who can help to de-escalate individuals before police involvement. No matter which type of program a community decides to use, it’s essential to understand the 911 Call Diversion Initiative and how it works for mental health calls. In this article, we will examine the following elements of 911 call diversion models:
- Co-Location
- Community Responder Teams
- Call Matrix
Co-Location of Mental Health Partners in 911 Call Centers
Studies involving the co-location model of mental health partners in 911 call centers have revealed some exciting benefits. These benefits include faster response times, greater trust between partners, and more person-centered language toward call takers.
In Austin, Texas, when someone dials 911, they will hear the following: “Are you calling for police, fire, EMS, or mental health services?” When the call has a mental health component, the person can immediately be connected to a mental health specialist. The clinician can then quickly de-escalate the situation and decide the most appropriate response.
Marisa Aguilar, LPC, practice manager of the team, has stated: “The EMCOT clinicians are accessible for rapid impromptu dialogue, going over calls…answering questions. We’re just steps away, and they know they can come over and chat with us.”
Aguilar has also noticed a shift to more person-centered language from call takers as they hear how EMCOT members speak to individuals in crisis or their families. They have become increasingly aware of what happens to a person physiologically during a crisis and have learned to use empathetic language. For example, rather than asking someone: “Are you bipolar?” they are asking: “Do you have a diagnosis of bipolar disorder?”
The Community Safety Department in Durham, North Carolina, has recently launched its Community Response Team initiative, which consists of unarmed three-person teams made up of a clinician, a peer support specialist, and an EMT. Based on specific questions asked by 911 call takers, individuals will be routed to the appropriate responder – police, fire, EMT, or mental health. Durham is using Julota’s software platform, which provides data sharing without permitting access to information protected under HIPAA laws.
In discussing Julota’s functionality, Director Ryan Smith stated: “One of the features that Julota has is you can build relationships with other providers…and send out a text message or email about the person.” In addition, responders can track calls on their tablets or other devices in real-time and use 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,” said Smith.
Using Community Responder Teams in 911 Call Diversion
As protestors gather across the country and call for reducing police presence in communities, alternative crisis team initiatives are becoming more commonplace. For example, using community responder teams in 911 call diversion programs can keep encounters from escalating into violence and divert people away from jail toward other services.
It can also free police resources to focus on more serious crimes. In 2020 the Law Enforcement Action Partnership (LEAP) and the Center for American Progress (CAP) conducted an analysis of 911 calls from eight cities. They proposed that cities establish a new branch of civilian first responders, known as “Community Responders.”
The purpose of these teams would be to reduce the need for police response and improve outcomes for the community. Recent polling indicates that approximately 68% of voters support this initiative. Their vision outlined two specific categories of calls for service that these teams would address.
They include lower-risk 911 calls related to mental health, addiction, and homelessness. Other calls include disturbances, suspicious persons, trespassing, and lower-risk neighborhood conflicts.
The report referenced the example of the CAHOOTS program in Eugene, Oregon, which has been operating successfully since 1989 and now handles around 20% of 911 calls. CAHOOTS dispatches nurses or EMTs alongside experienced mental health workers in calls regarding mental health, substance use disorders, or suicide ideation.
The program emphasizes hiring people with lived experience of mental illness, poverty, and the justice system. Many cities are using the CAHOOTS program as an example for their program.
In Olympia, Washington, a former police chief who had worked in Eugene helped to establish their program, which launched in April 2019. The Crisis Response Unit offers various services, including crisis counseling, harm reduction, conflict resolution and mediation, and referral to additional support services.
They frequently provide problem-solving services for individuals with few options: the woman with mental illness convinced a motel manager had stolen her things; the kid who continues to get kicked out of treatment; the older woman with dementia who keeps trying to leave her shelter. Olympia also has a “familiar faces” program that pairs peer support specialists with those who have frequent encounters with law enforcement, connecting them to housing, treatment, and other services.
Development of Call Matrix for 911 Call Diversion
Appropriate coding and classification of calls are vital to a successful 911 call diversion program. The proper classification of these calls can mean the difference between a successful encounter and tragedy.
Nationwide, communities are developing 911 call matrixes for mental health and substance use disorder calls. The list includes Los Angeles County, California, Tucson, Arizona, Harrison County, Texas, and the state of Virginia.
Los Angeles County and the state of Virginia have incorporated four risk levels into their programs. In Virginia, the levels are labeled as: Level 1 – routine, Level 2 – moderate, Level 3 – urgent, and Level 4 – emergent. Levels 1 and 2 are triaged to regional call centers or mobile crisis hubs. Level 3 incorporates specialized teams such as children’s mobile crisis or teams for people with developmental disabilities.
Per Alexandria Robinson-Jones, Behavioral Health Program and Training Coordinator: “Incorporating specialized teams helps ensure that people have the response they need, and that law enforcement isn’t automatically dispatched.”
Los Angeles County’s risk levels vary slightly from Virginia’s: Level 1 – no crisis/resolved/not immediate risk, Level 2 – immediate remote help, Level 3 – moderate, requires in-person help, and Level 4 – immediate risk to public safety. Level 1 – 3 calls are immediately diverted by 911 call takers to Didi Hirsch Mental Health Services. Individuals will be connected to the LA County Department of Mental Health if an in-person response is needed. A level 3 call will result in a response from a mobile crisis team or a co-responder team for a level 4 call. Captain John Gannon with the LA County Sheriff’s Office stated: “The goal is to minimize co-response when possible and maximize the efficiency of teams out in the field.”
In its document entitled: “Tips for Successfully Implementing a 911 Dispatch Diversion Program,” the Council of State Governments recommends a regular review of the diverted calls and those not diverted. An analysis of this data through Julota’s robust reporting capabilities can help to determine if the diversion approach is working. These data-driven insights are essential to show communities and elected officials that the program is effective. In addition, they can be a powerful tool for needed changes. Its cloud-based platform can also make tracking contacts between agencies and follow-up contacts easier.
Conclusion
In this article, we have looked at the various elements of the 911 Call Diversion Model and how it works for mental health calls. Whether a community opts for the colocation of 911 call centers and mental health professionals or community response teams, research thus far shows great promise for the model. In addition, this country’s cultural shift indicates that law enforcement is not always the correct response for a person in a mental health crisis.
Implementing the call diversion method could lead to more comprehensive solutions involving treatment and healing. In the words of Tiffany Lace Clark, chief operating officer of Behavioral Health Response in St. Louis: “This program has really helped people see the humanity in others and remember that this is about saving lives.”