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This program sends a social worker on 911 calls about mental health

A pilot program in Dallas found a better way of helping people who call 911 for mental health emergencies than simply putting them in jail or dropping them off at the ER.

This program sends a social worker on 911 calls about mental health
[Photo: Franck-Boston/iStock]

If you call 911 in certain neighborhoods in Dallas, a licensed specialist at the dispatch center will determine if the call relates to a mental health crisis. If it does, it won’t just be the police that respond to the call. Instead, a team led by a mental health professional will show up and try to defuse the situation, hopefully leading to an outcome that doesn’t result in violence, incarceration, or unnecessary hospitalization.

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Started in a single district of the city, the program, called the RIGHT (Rapid Integrated Group Healthcare Team) Care program, diverts emergency 911 calls that are evidently mental health-related from the police to social workers and paramedics, is soon to expand citywide, given its success in reducing unnecessary arrests and freeing up resources for overrun hospitals.

At its core, the program allows individuals with mental health problems to be treated as patients, rather than suspects. “Mental healthcare is a medical need, not a law enforcement issue,” says B.J. Wagner, senior director of smart justice at Dallas’s Meadows Mental Health Policy Institute, which created the program, based on a similar one in Colorado Springs, Colorado. “But we had not yet crafted a solution that embraced that.”

Previously, the police would respond to all 911 calls, often to the detriment of those reaching out with mental health emergencies. “When a police officer is on scene, he’s trained to do two things,” Wagner says, “make an arrest or take somebody to a hospital.” That meant that chronically mentally ill people were just going to jail or to the ER, to the point where the hospitals were over capacity and didn’t have enough resources to care for them. And repeat calls for the same person were endemic. The quick fix wasn’t helping these people in the long term.

For RIGHT Care to happen, it needed buy-in from different entities. After a full year of research, and a grant from the W.W. Caruth Foundation, Meadows got approval from Parkland, the Dallas County hospital, as well as the Dallas police and fire rescue departments, and it launched in January 2018. Each entity is represented in the program: each RIGHT Care team consists of a social worker from Parkland, a police officer, and a paramedic (in Dallas, the fire department is the paramedic authority). “To get three of the largest agencies in the county together to agree and to work on this program together, it took some very good coordination,” says Kurtis Young, Parkland’s director of social work.

When a licensed clinician at the dispatch center assesses that there’s a mental health emergency, the “mobile mental healthcare unit” of three responders is sent to the scene to respond accordingly. The police officer is on scene for safety purposes, and the paramedic to check for physical injuries. But the scene is the social worker’s jurisdiction, and they decide the best form of treatment. She may decide to check up with the individual’s case worker, then take them to the pharmacy to refill a prescription, to a food pantry for a meal, or to a same-day appointment at a hospital—”and be home for dinner that night with their family, instead of confined involuntarily to a hospital,” Wagner says.

Whatever the case, the decision is made by a licensed worker who has years of experience—which police don’t have. Wagner is a former police officer, but she is also a mental health clinician with a master’s in clinical neuropsychology. She received 3,600 hours of classroom instruction on the topic; a police officer might have taken a 40-hour crash course. “He should not be giving mental health advice, he should not be making treatment or diagnostic decisions,” she says. “I wouldn’t want a police officer making that decision for my loved one.”

Since its launch in 2018, the program has specifically served South Central Dallas, an area whose population is predominantly black and has high levels of unemployed and uninsured people. It’s a particular hotspot for repeat mental health calls, the highest in Dallas. “When you meet a vulnerable population, and find out what keeps them calling 911 [over and over], and you address that, entire worlds can change,” Wagner says. The team also does follow-ups, to ensure people are on the mend, and that they’ve been taking their prescribed medicines—and to try and find financial or access solutions if not.

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The data shows the progress: Between pre-launch and 2019, admittance to the ER decreased by 9% in the targeted zip codes, while it increased in the rest of the city. Arrests dropped by 8%, while they went up in neighboring ones of a similar socioeconomic status. Just 2% of the RIGHT Care calls led to arrests, and the repeat call rate is less than 7%.

The grant ended May 31, but it’s a testament to the program’s success that it is continuing, with plans to expand to the entire city of Dallas. (The expansion was planned for this month, but that’s been hampered by coronavirus.)

In the current context of policing reform and alternatives, the program could serve as a model for the departments around the country. Both Abilene, Texas, and Tulsa, Oklahoma, have now started their own version of the programs. And other cities are taking lessons from it while trying different tactics: Houston, for example, has installed clinicians in 911 dispatch and is aiming to solve mental health calls virtually, without the need to deploy an officer.

“Why are we tied to this fascination of delivering mental healthcare through a law enforcement officer?” Wagner asks. “There is no dignity in that, and people living with chronic mental healthcare needs deserve better.”
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