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


In an emergency, everyone learns to call 911, an alert for firefighters, emergency medical services or the police. But what if the caller doesn’t need help due to a fire, accident or crime?

As a recent caller to the 911 center in Durham, North Carolina said, “I feel a little dangerous to myself. Not anyone else. I would like to go to the hospital. I have no way to get there.

Leigh Mazur is the one who picked up the call, but she’s not a typical 911 responder.

“When you mention having thoughts that you think are dangerous to yourself, have you ever tried to harm yourself or kill yourself before?” Mazur asked.

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

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

“I think we’re able to ask those specific questions to kind of figure out if this is an issue that they’ve been dealing with for a long time and just assess the risk of harm to themselves or someone. else,” Hyler said.

In the case of the caller from Mazur, the HEART team was able to get them to the hospital. But Hyler told Gupta that callers may have different needs; some may call for help to self-harm or commit suicide, but others may struggle with domestic violence and abuse. Other calls may relate to vagrancy and intrusion reports – one of the most common calls handled by the team. It is often linked to someone who is homeless and struggling with addiction and mental health issues.

National polls 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 his colleagues can determine how to de-escalate the situation and whether it requires follow-up, either by their unarmed community response team – which includes a mental health clinician, support specialist by peers and an emergency medical technician – or by a co-response team consisting 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 is having a mental or behavioral health crisis.

But more than 1 in 4 people think calling the hotline would actually make these situations worse.

The biggest concern: a lack of police training and awareness on how to deal with mental health issues. Of this group, 10% specifically feared it would lead to potential arrest or hospitalization.

Opinions on calling 911 were similar across races and ethnicities, but opinions on the number’s effectiveness differed by age, with 44% of adults under 30 skeptical of using the number calling the number, while more than half of older adults thought it might be beneficial. .

The KFF CNN Mental Health Survey was conducted by SSRS from July 28 to August 9 among a random national sample of 2,004 adults. The survey includes 1,603 adults who were interviewed online after being recruited using probability-based methods and 401 adults who were selected by random dialing and contacted on landlines or mobile phones by an online interviewer. direct. Results for the full sample have a 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 their work time responding to and dealing with people with mental illness. In most states, the center has found that more people with mental illness are held in jails or jails than in the largest psychiatric hospitals.

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

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

These are the results that programs like HEART attempt to prevent by connecting neighbors to resources. “If we can save someone from being incarcerated, we’d like to do that,” Hyler told Gupta.

The HEART program not only tries to defuse the situation in the moment, but it also tries to solve bigger problems.

“Peer Support Specialists are trained to really meet a neighbor where they are and kind of be that voice to help pull someone up and recommend resources, recommend advice and sometimes even be a shoulder to cry on,” said a specialist. , Christophe Loritts.

Mental health is already stigmatized, and the presence of law enforcement officers in marked cars may add to that. About 7% of CNN/KFF poll participants who thought calling 911 would make a situation worse worried about stigma and embarrassment. This is something Team HEART is acutely aware of, so its tracking teams drive around 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 heighten feelings of distress,” Gilbert said.

Meera, who responded to the CNN/KFF survey, said she called 911 in the early 2000s when she was depressed and taking 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 says, but the response made it worse. “They called the police, the fire brigade, everyone. The troops are coming,” she recalls. “Is it like come on, a little discretion, please?”

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

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

Connecting people to services, driving around in unassuming white vans, just being a shoulder to lean on – it might not sound groundbreaking, but it looks like it’s making a difference. In the first eight weeks of HEART’s operation, the team claims to have been able to resolve 68% of calls from neighbors on-site and divert 82% of calls received from law enforcement.

Ryan Smith, director of Durham’s Community Safety Department, says HEART’s extra hands are appreciated in a town like his, which already suffers from a police shortage. He sees the team as a fourth branch of first responders: “Police, Fire, EMS and now HEART.”

The program only covers 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 – started using programs similar to HEART.

There have been growing calls from criminal justice reform advocates for changes to policing and the use of force, particularly after the police killing of George Floyd. police in 2020 after a 911 caller reported he used a fake $20 bill to buy cigarettes. There’s even interest in these community outreach programs from the Federal Office of Justice Support.

Bediako remembers Floyd in the calls she takes and the neighbors she visits. “The types of calls we’re getting, I think, would have been calls similar to George Floyd’s,” she said.

She sees her role not only to help connect her neighbors to services, but also to serve as their spokesperson.

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

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