In one North Carolina community, mental health workers respond to 911 calls

CNN
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In an emergency, everyone is taught to call 911, an alert for the fire department, emergency medical services or police to help. But what if the caller doesn’t need help because of a fire, accident or crime?

As one recent caller to the 911 center in Durham, North Carolina, said: “I feel kind of dangerous to myself. Not anybody else. I would like to go to the hospital. I do not have any way of getting there.”

Leigh Mazur was the one who picked up the call, but she isn’t a typical 911 responder.

“When you mention that you’re having thoughts, that you’re having thoughts about being dangerous to yourself, have you ever tried to hurt yourself or kill yourself before?” Mazur asked.

She’s a licensed clinical social worker and one of a handful of mental health professionals working with the city’s Holistic Empathetic Assistance Response Team, or HEART, a pilot program that hopes to better match 911 responses to callers’ actual needs by putting mental health professionals in the call center itself.

“We as clinicians have more training in mental health and just assessing people who are struggling with that,” said Jordan Hyler, a licensed mental health clinician and a member of HEART. She spoke with CNN Chief Medical Correspondent Dr. Sanjay Gupta, who recently visited with the team to report on their unique approach.

“I think we’re able to ask those specific questions to kind of determine if this is something they’ve been dealing with for a long time and just assessing the risk of harm for themselves or somebody else,” Hyler said.

In the case of Mazur’s caller, the HEART team was able to get them to a hospital. But Hyler told Gupta that the callers can vary in need; some may be calling for help with self-harm or suicide, but others may be struggling with family violence and abuse. Other calls may be for reports of loitering and trespassing – one of the team’s most commonly handled calls. It’s often linked to someone who is unhoused and dealing with substance use and mental health problems.

National surveys estimate that 19% to 38% of 911 calls are related to these kinds of issues – and they don’t necessarily require a response from armed police.

From an initial 911 call, Hyler and her colleagues can determine how to defuse the situation and whether it needs followup, either by their unarmed community response team – which includes a mental health clinician, a peer support specialist and an emergency medical technician – or by a co-response team of a clinician and a law enforcement officer.

According to a new survey from CNN and the Kaiser Family Foundation, about 1 in 5 Americans have called 911 because they or a loved one was having a mental or behavioral health crisis.

But more than 1 in 4 people surveyed think that calling the emergency line would actually make these situations worse.

The most significant concern: a lack of training and awareness from police on how to deal with mental health issues. Among this group, 10% were specifically worried that it would result in a potential arrest or hospitalization.

Views on calling 911 were similar across racial and ethnic lines, but views on the effectiveness of the number differed by age, with 44% of adults under 30 skeptical that calling the number would help while more than half of older adults thought it could be beneficial.

The KFF CNN Mental Health Survey was conducted by SSRS from July 28 through August 9 among a random national sample of 2,004 adults. The poll includes 1,603 adults who were surveyed online after being recruited using probability-based methods and 401 adults who were selected by random digit dialing and reached on landlines or cellphones by a live interviewer. Results for the full sample have a margin of sampling error of plus or minus 3 percentage points.

In 2017, the nonprofit Treatment Advocacy Center surveyed 355 law enforcement agencies across the country and found that they spent about 20% of on-the-job time responding and dealing with people with mental illness. In most states, the center found more people with mental illness are held in jails or prisons than in the largest psychiatric hospitals.

“The concern about police being responders is that their involvement can cause serious harm,” explained Daniela Gilbert of the Vera Institute, a criminal justice reform advocacy group. “The tragic killings by police of people who are experiencing mental health crises are the worst-case scenario in that regard.”

According to the Treatment Advocacy Center, at least 1 in 4 fatal police shootings involves someone with a mental illness.

These are the outcomes that programs like HEART are trying to prevent by connecting neighbors with resources. “If we can divert somebody from getting incarcerated, then we would like to do that,” Hyler told Gupta.

The HEART program not only tries to defuse the situation in the moment, it tries to aid with larger issues at hand.

“Peer support specialists are trained to really meet a neighbor where he or she is at and kind of be that voice to help pull someone up and recommend resources, recommend advice and really even sometimes to be a shoulder to cry on,” said one specialist, Christopher Loritts.

Mental health already carries a stigma, and the presence of law enforcement officers in marked cars can add to that. About 7% of CNN/KFF poll participants who thought calling 911 would worsen a situation were worried about stigma and embarrassment. It’s something the HEART team is acutely aware of, so its followup teams ride in white vans with the team’s green and purple heart logo, rather than patrol cars.

“Even when officers are trained in de-escalation, the presence of armed responders can intensify feelings of distress,” Gilbert said.

Meera, who responded to the CNN/KFF survey, says she called 911 in the early 2000s when she was depressed and took too much acetaminophen.

“I just wanted all the pain to stop,” said Meera, who asked that only her first name be used to protect her privacy.

It was already a difficult time for her personally, she said, but the response made the situation worse. “They called the police, the fire department, everyone. The troops come in,” she remembered. “It’s like come on, a little discretion, please?”

Another of the HEART team’s methods is that they call everyone they work with “neighbors.”

“They’re not subjects. They’re not patients or clients,” team member Abena Bediako said. “It could be me that you all may have to help one day. It could be you.”

Connecting people with services, driving in unassuming white vans, simply being a shoulder to lean on – these may not sound like revolutionary steps, but they appear to be making a difference. In the first eight weeks HEART was in operation, the team says they were able to resolve 68% of neighbor calls on-scene and divert 82% of the calls they received away from law enforcement.

Ryan Smith, director of Durham’s Community Safety Department, says the added hands from HEART are appreciated in a city like his, which already has a police shortage. He thinks of the team like a fourth branch of first responders: “Police, fire, EMS and now HEART.”

The program covers only part of the city and has limited hours, but officials hope to expand it.

Cities across the country – including Eugene, Oregon; Denver; and Olympia, Washington – have begun to utilize programs similar to HEART.

There have been increasing calls from criminal justice reform advocates for changes in policing and the use of force, especially after the killing of George Floyd by police in 2020 after a 911 caller reported that he used a counterfeit $20 bill to buy cigarettes. There’s even interest in these community responder programs from the federal Bureau of Justice Assistance.

Bediako is reminded of Floyd in the calls she takes and the neighbors she visits. “The types of calls we get, I think, would have been similar calls that came for George Floyd,” she said.

She sees her role not only to help connect her neighbors to services but to serve as a voice for them.

“Sometimes, neighbors don’t know how to advocate for themselves. They don’t know how to approach situations,” Bediako said. “If we can be there for them, even in that brief moment, it could save a life.”