The dimly lit room on the top floor of the brick building in Southwest Baltimore hums with sounds of clacking keyboards and the slow, low voices of the call center operators. It’s early Monday morning and already the calls to Baltimore Crisis Response, Inc. are flowing in at a steady clip.
“Baltimore Crisis Response: here to help,” the counselors say into the phone. A team of four has settled into the first calls of their eight-hour shifts, fielding requests for assistance about a range of needs, from where callers can find substance abuse treatment programs to what they should do about their loved ones who are showing signs of harmful or erratic behavior.
The work is intense and fast-paced — and desperately needed in a city hit disproportionately hard by homicides and overdose deaths. And Baltimore officials hope BCRI eventually will evolve into an even larger force that lightens the load on law enforcement officers, too.
The crisis center, which runs the hotline as well as mobile crisis teams, substance abuse treatment and a residential treatment unit, is one year into a contract with Baltimore to provide 911 diversion services to police and fire department units that often find themselves overwhelmed with emergencies. The pilot program, launched by Mayor Brandon Scott’s administration last year, aims to reroute a small fraction of 911 calls to the crisis center: specifically, those in which callers have thoughts about committing suicide, but no weapons or concrete plans to carry out those thoughts.
In recent months, the city also has been diverting callers who express thoughts of suicide with plans to act to the center, but the city did not provide data about those calls. Dr. Benjamin Lawner, medical director for the Baltimore City Fire Department, said that data will be available “in a couple weeks.”
Data from the program’s first year paint a complicated picture of how such a service gets off the ground.
As of June 13, BCRI handled 501 incidents in a little more than a year’s time, according to the city. Of those, 207, or about 41%, required a “co-response” with police or fire units; for example, a caller uses the hotline services and expresses a time-sensitive symptom such as chest pain, which triggers another call to first responders.
Another 294 calls didn’t require a co-response. Of those, 182 were resolved using BCRI alone and 112 were returned to 911 for calls that had escalated beyond suicidal ideation.
The diversion program is one of several across the country aimed at redesigning the ways law enforcement officers respond to people with mental health disorders and interact with communities they serve. Baltimore launched its pilot program about a year after the police murder of George Floyd, a Black man in Minneapolis, which amplified a national movement that advocates for reimagined policework.
“The main premise of it is making sure that people are connected to the most appropriate resource, and is law enforcement the most appropriate resource when someone is going through a crisis?” said Alexandra Smith, senior policy advisor in the mayor’s office. “No, unless there’s also a level of violence involved, or maybe you need that type of support.”
The city points to a metric called “efficiency savings,” which measures how many hours the program saved police and fire departments to respond to other emergencies. Out of 306 total hours saved due to the diversion program, city data shows 197 hours were saved by Baltimore City Fire Department units and 109 hours were saved by Baltimore Police Department units.
Officials said the diversion volume reflects a deliberate choice by city officials to start small and scale later.
“We didn’t want to open the floodgates and do every type of behavioral health call that comes to 911 and not have the local behavioral health helpline be ready to handle that call volume,” said Adrienne Breidenstine, vice president for policy and communications at Behavioral Health System Baltimore, the city’s local behavioral health authority that oversees its mental health services. “The other major reason is because we didn’t have any new funding to expand call center services at that time. We do now.”
Those new funding sources include a public-private partnership called the Greater Baltimore Regional Integrated Crisis System, a collaboration between regional hospitals, local health authorities, community leaders and behavioral health experts in Baltimore, Howard, and Carroll counties and Baltimore City. GBRICS is investing $45 million over five years to establish a regional call center, which will place a mental health clinician in the dispatch office. The local 911 dispatch center also will soon include a mental health clinician in the office, as well, city officials said at a Thursday news conference, but didn’t specify when.
Meanwhile, later this year, callers around the country will be able to dial 988 and have their behavioral health calls reach the National Suicide Prevention Lifelines and its local outposts. Breidenstine said that change will help thousands more callers avoid law enforcement in moments of crisis.
State legislators this year created a 988 trust fund that will maintain the number as a crisis hotline as well as support call centers, mobile crisis teams and acute stabilization centers. The legislation also mandates annual funding for the centers starting in 2024.
Breidenstine said the money will allow the city to gradually increase the number and types of calls it diverts away from 911, though officials haven’t determined what category of call might come next. Smith, of the mayor’s office, said additional federal funding secured by Brandon Scott’s administration will enable the office to hire another vendor to handle diversion calls for people under 18 who aren’t currently included in the program.
“We were hoping we would be able to divert more calls, but we’re happy that we’re with the ones that we have diverted,” said Breidenstine. “The ones that we have diverted have resulted in good outcomes.”
Kathleen McAdam, a shift supervisor at BCRI who also fields calls, said that most of the diverted callers dialed 911 expecting to be taken to the hospital in an ambulance. The pilot has directed several of these callers to stabilization units — short term, community-based residential treatment facilities — rather than creating a revolving door of hospitalizations and releases, she said.
“We talk directly to the person who’s in crisis,” she said. “We try to de-escalate and provide supportive counseling: ‘What led up to this? Has this ever happened before? What kinds of coping skills and supports do you have in place that you can lean on right now?’ And if they’re willing, we can send out the mobile crisis team.”
That team includes a mental health counselor, clinician and a registered nurse, who work to bring the caller out of crisis. They visit callers on a first-come, first-served basis: Sometimes the unit can leave BCRI immediately, other times the caller’s location is added to a list of stops. Either way, callers will know within an hour approximately what time to expect the unit, McAdam said.
Diversion programs for law enforcement have become overwhelmingly popular among the public, according to a survey published last month by the National Alliance on Mental Illness, a nonprofit advocacy organization. About 86% of respondents said people experiencing behavioral health crises should receive a mental health response, not a police response. Among Black Americans, 85% said they would be afraid of police violence if they or a loved ones experienced a mental health crisis that elicited a police response; that’s an 11% increase from about six months prior and 21% higher than the general population, according to the survey results.
Kate Farinholt, executive director for NAMI Maryland, said governments and public health professionals have discussed for years alternatives to 911 dispatchers sending law enforcement officers to people experiencing crises, but those conversations across the country have been piecemeal and inconsistent. And as the nation experiences mounting mental health service requests, she said the need for safe and efficient diversions has become even more imperative.
“I don’t think everything is rosy; we’ve got a long way to go,” said Farinholt, who said jurisdictions across the country are currently wrestling with implementation and maintenance challenges. “There’s been proof, for years, that if you focus on dealing with mental health crises and you provide crisis intervention, the cost is way less than it is than if you have law enforcement engage, and possibly emergency rooms, and even more likely: jail.”
Still, the nascent programs must overcome decades-long underinvestment in behavioral and mental health services; staffing shortfalls exacerbated by the coronavirus pandemic; and competition from private firms and practices that can offer higher wages.
In Baltimore County, for example, police data showed last year that the mobile crisis teams employed by the county to respond to certain behavioral health calls failed to respond to more than half the calls for service. County officials cited capacity issues and limited resources.
In an early June interview, Scott said the city’s diversion program aligns with his administration’s goals of reducing dependency on police and funding programs to address the root causes of violence.
“We are taking [police] funds and investing in sending these calls to professionals that are prepared and trained to handle these things, taking it away from the police department, and allowing our officers to stay on patrol,” the Democrat said. “That’s an investment into an alternative method.”
He announced last month a similar initiative designed to curb the volume of calls that land with police units. Dubbed the SMART policing program, it will have some callers report non-emergencies online or over the phone, aimed to reduce the need for officers to respond in person to every call.
“That increases the hours that our police officers can actually proactively be patrolling in the city, along with the investments that we’re making in other social programs,” he said.
Another aim among city officials is to better train the law enforcement officers who do end up responding to people in distress and direct more residents to resources that exist already.
At BCRI headquarters, police officers now are receiving training from licensed social workers with the goal of improving outcomes for all participants in a crisis situation. Quinita Garrett, director of call center and system coordination at BCRI, said the mobile crisis teams also are effective at improving outcomes; there are nine teams of two, with seven teams operating throughout a given day.
Some days, Garrett said only three callers will want to connect with the mobile teams. Other days, more than a dozen requests for an in-person response will come in by morning.
“We could always use more,” Garrett said.