Behavioral Health 9-1-1 Diversion
Behavioral Health 9-1-1 Diversion Pilot Overview
In June 2021, Baltimore launched the Behavioral Health 9-1-1 Diversion Pilot Program with the goal of diverting certain behavioral health-related 9-1-1 calls from law enforcement to experienced mental health professionals through the Here2Help hotline. The pilot program began by diverting two suicidal ideation call types, and through the quality assurance process, in April 2022, the program expanded to include a third similar call type. Housed within the city’s emergency response network, When 9-1-1 call takers identify a call as appropriate for diversion they transfer the call to the Here2Help line, a mental health services line operated by Baltimore Crisis Response, Inc. (BCRI) and staffed by trained mental health clinicians. Here2Help can resolve calls over the phone or dispatch a team of clinician responders.
The central mission of this pilot program is to match individuals to the most appropriate and available resources when they call for assistance and reduce unnecessary police encounters with people in behavioral crises. This approach aligns with federal guidance, evolving best practices, and the requirements of our consent decree and demonstrates a commitment to addressing gaps in our public behavioral health system. A “successful” diversion occurs when an individual in need (who meets inclusion criteria) is linked to the Here2Help crisis hotline. The hotline is then able to close the encounter without response from police or fire/EMS resources. Co-notification occurs when patients are connected to the crisis line and there is some degree of response by police or fire department resources.
Secondary outcomes of the behavioral health diversion project include:
- Reduced police response
- Reduced utilization of 911 resources (fire and EMS)
- Raising awareness about available behavioral health resources and promoting linkage between EMS, BCRI, and other crisis-oriented resources (stabilization center, de-escalation training, etc)
Diverting calls that come in through 9-1-1 that do not necessitate a police response to a non-police behavioral health or crisis response will benefit everyone with these identified outcomes and best practices:
- community-based, people-centered, trauma-informed response that promotes an individuals’ dignity, autonomy, self-determination, and resiliency,
- harm reduction model,
- a more appropriate response which connects residents with services,
- uncoupling medical crisis from unnecessary police contact, decriminalizes mental illness and behavioral health crises, and
- lower cost response to non-criminal, non-violent emergency calls,
- improve police/community relationships by reducing negative interactions.
Over the next year, through a federal investment, the partnership will expand the behavioral health diversion pilot program to have a non-police response to more behavioral health calls that come in through 9-1-1 by:
- Adding youth under the age of 18 as eligible for diversion by creating youth-focused mobile crisis teams, and;
- Co-locating a behavioral health clinician in the 9-1-1 call center to support 9-1-1 call takers in de-escalating crises and conducting screening to determine the most appropriate response.
The behavioral health diversion is currently limited to those aged 18 and older. This provision is due to the gaps in crisis services for children and youth in Baltimore City. Creating child and youth-focused mobile crisis teams will allow the pilot to expand capacity so that calls received by 9-1-1 from youth and families can be safely diverted to mobile response teams that can serve any child in the City. Expanding to include youth in the program has been a priority identified by community members and stakeholders such as the Collaborative Planning and Implementation Committee (CPIC). Given the complexity of these calls, the high-pressure nature of handling 9-1-1 calls, and the limited training call-takers receive in behavioral health; there is a need for real-time support to call-takers with making the appropriate classification and linking callers to the necessary resources. Co-locating a behavioral health clinician in the 9-1-1 call center is a practice that has been adopted in several communities across the country. The primary role of the clinicians will be to support 9-1-1 call takers in de-escalating crises and conducting screening to determine the most appropriate response. As the local behavioral health authority for the city, Behavioral Health System Baltimore (BHSB) will partner with the city and oversee the planning and implementation of this expansion.
An internal working group, which includes a data analyst and the Baltimore City Fire Department’s medical director, continues to provide quality assurance. Through the data fellows program, housed within the Mayor’s Office of Performance and Innovation, a public facing dashboard has been developed and is now available for residents to follow progress and impact of the behavioral health diversion pilot.
This diversion pilot program is one aspect of the city’s Behavioral Health Gap Analysis Implementation Plan. The City developed the implementation plan to address the recommendations identified within the Public Behavioral Health System Gap Analysis Report published in 2019.
One section of the consent decree deals specifically with response to behavioral health crises, whereby the City agreed “to conduct an assessment to identify gaps in the behavioral health service system, recommend solutions, and assist with implementing the recommendations as appropriate.” In response to this recommendation, the City has developed a multi-year approach to reducing unnecessary police encounters with people in crisis and is committed to implementing the non-enforcement measures to bridge the gaps that lead to these unnecessary interactions.