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911 Services That Dispatch Mental Health Counselors, Gain Traction

Above photo: The Austin-based mental health clinic Integral Care partners with the city’s police and EMS departments to dispatch mental health counselors to nonviolent, psychiatric 911 calls. The clinic’s Expanded Mobile Crisis Outreach Team is among the models now gaining national interest, but the program isn’t a panacea for ableist police violence. Candice Bernd.

Austin-Travis County Emergency Medical Services (EMS) Capt. Jason Castleberry grabbed his shoulder radio, responding to a dispatcher from his office at Austin EMS’s Station 5, “Chip 100, chip 1, are you calling me?” “Yes, we’ve got a confirmed psych call. Are you available?” “Yes, we’ll get moving.”

Castleberry helps oversee the city’s Community Health Paramedic team, abbreviated as CHP, or “chip,” and this was just the type of call I had come to the station that morning to witness. We hopped into the station’s marked SUV, and rolled. “Normally for these, I would go lights and sirens. The reason we’re not is I can tell medic 3 is already on scene,” he tells me, pointing to his monitor.

The monitor also showed that mental health counselors with Integral Care’s Expanded Mobile Crisis Outreach Team (EMCOT) had been dispatched; it didn’t show police among the responders at or heading to the scene. I was hoping to observe and document both CHP and EMCOT’s work and coordination to de-escalate a mental health crisis, but the call was canceled en route.

Still, even the canceled call gave me insight into how Austin’s first-response system works when it comes to “psych calls,” as Captain Castleberry calls them. This model has been in place since 2014, when the city’s EMS first partnered with the mental health center Integral Care.

EMCOT, alongside programs in Eugene, Oregon, and Denver, Colorado, is one of the few services that existed in the U.S. prior to the murder of George Floyd that send mental health counselors directly to nonviolent, mental health-related 911 calls.

Now, such models are rapidly expanding, especially as roughly half of police-perpetrated killings involve someone living with mental illness or disability. San Francisco, Albuquerque and Los Angeles are all moving to introduce similar systems to replace cops with trained, unarmed professionals to respond to noncriminal emergency calls. Even the insubstantial executive order focused on procedural reform signed by President Trump on Tuesday provides more resources for social workers to accompany police on calls involving mental health and substance abuse.

Mental Crisis First Responders

Austin’s City Council provided additional funds for EMCOT last year to add four counselors to the city’s 911 call center to provide a fourth option beyond EMS, fire and police. Currently, when an Austin resident dials 911, they are still given the standard three options. The determination to transfer a caller to EMCOT, though, remains in the hands of EMS and police, who often show up in tandem.

EMS and police can also request EMCOT directly to the scene of a mental health crisis, but an EMCOT counselor can release other first responders from the scene if everyone determines that’s best.

Last fiscal year, the expanded crisis team dispatched 3,182 times, says Integral Care Practice Administrator Laura Wilson-Slocum, mostly to communities of color on the city’s east side. Last fiscal year, 29 percent of people EMCOT served were those experiencing homelessness.

As long as there’s no weapon present and no sense of “imminent death or harm to self or others,” Wilson-Slocum says, 911 callers can be transferred from the Austin police to the crisis team. EMCOT is automatically dispatched to psych calls that are determined to be Priority 5 or lower.

Last year’s funding boost has also made it possible for EMCOT counselors to take video calls from paramedics or clinicians in the field. The program’s budget for fiscal year 2020 is a little over $2.3 million, funding 28 positions.

About 85.5 percent of the calls that get transferred to the crisis team are ultimately diverted away from a police response, with many calls being handled directly by a mental health counselor over the phone. When calls are diverted back to police, it’s mostly because the caller is insistent about having a cop present at the scene, Wilson-Slocum says.

EMCOT’s rate is similar, between 75 to 80 percent, in terms of keeping the patient on scene, rather than transporting them to a clinic. The team is able to follow up with and serve patients for up to 90 days after a precipitating crisis event, linking them with longer-term social services.

“We want to prevent the unnecessary dispatch of an ambulance and the unnecessary dispatch of police,” Wilson-Slocum says. “We want to make sure that we are preventing the misuse and overuse of jails, psychiatric commitments, hospitalization and emergency department admissions when someone is experiencing a crisis. Those are the most restrictive types of interventions; they are the most costly types of intervention.”

Moreover, she says, people experiencing a mental crisis already feel very unstable and out of control. “To have police officers come on scene, it can feel very jarring and very destabilizing. If you’ve had poor experiences with law enforcement, it can really escalate the crisis.”

Community Health Paramedics

The crisis team works alongside CHP paramedics like Captain Castleberry to provide services to reduce the residents’ reliance on the 911 system. CHP’s goal is to connect residents with the social and medical services they need to prevent reliance on hospital emergency rooms as primary care providers.

After the canceled psych call, Captain Castleberry’s next tasks were to check in with a confirmed positive COVID-19 case to assess any potential need for hospitalization, and then do a follow-up visit with a longtime opiate user who had recently overdosed, assisting in the patient’s detoxing process. These types of opiate responses, Castleberry says, only started about two years ago.

According to Andy Hofmeister, an assistant chief with Austin EMS, the service currently has 15 staffers, and has funding to bring on three more positions, but the COVID-19 pandemic has slowed the hiring process in recent months.

On the Monday morning I arrived at Station 5, Castleberry was the only one there. Mondays, he explained, are one of CHP’s “light staffing” days because of reassignments due to the pandemic. “There’s always the ability to do more,” Castleberry said when I asked him if he thought the program was adequately funded. “We’ve been able to develop a triage system for the referrals that come in,” he says, but the pandemic has hit the program hard. The demand for both CHP paramedics and EMCOT counselors “definitely outstrips the supply,” he says.

Last year, Austin City Council also gave CHP a funding boost: providing nearly $2.4 million to the service, which served 1,164 individuals in fiscal year 2019.

“When you work in EMS for any length of time, it becomes pretty evident pretty quick that we’re very much a safety net for a lot of things,” Hofmeister told Truthout. The department recognized that by addressing the root cause of many residents’ issues early on, they could free up much of the department’s resources.

Community health paramedics don’t work on the ambulance as a regular assignment; instead, they work autonomously to engage patients, identify gaps in their care, and connect them with services to fill those gaps. Many specialize in working with residents experiencing homelessness.

“One of the things that we try and do is educate people on appropriate uses of the ER but also give them the means to connect to alternative resources, so it’s not just us going once and saying, ‘You don’t need to go to the ER for this,’ but getting them connected with a place so that they truly have long-term medical care,” Castleberry says. “We have a much more holistic goal.”

Programs Are Reform, Not Panacea

Austin City Council members voted unanimously last week in favor of resolutions to limit the police department’s budget by eliminating money for new hires and filling vacant positions in the next fiscal year, as well as restricting officers’ use of deadly force. The money will instead fund mental health services, including EMCOT and CHP. The details are still being worked out ahead of next month’s budget discussions.

The eventual goal, said City Council Member Greg Casar, is to expand EMCOT’s hours from 8 am to 10 pm Monday through Friday so that it becomes available around-the-clock, and for residents to have an automatic, fourth option when they initially dial 911. Things are already shifting quickly: Next month, the service will become available until midnight on weekdays.

According to the council’s resolution, from December 16, 2019, to June 4, 2020, the city received 23,333 calls with a mental health component, but only 291 were transferred to a mental health counselor. Mental health accounted for about 7 percent of the roughly 146,000 911 calls the city received from 2014 through 2017.

“Clearly, we are not even close to where we need to be as far as addressing mental health issues with treatment and care rather than policing,” Casar told Truthout. “So the hope is that this year we can divert millions of dollars from policing to other forms of community safety and response, and I think one of the most obvious places to do that is mental health calls.”

Casar pushed to reduce funding for a few police positions to instead fund EMCOT last year, and “didn’t have even close to majority support” from the council. Now, he says, the council is united about replacing dozens of police positions to fund the response model, “So it just goes to show how much the movement has changed hearts and minds,” he says.

Locally, activists are calling for Police Chief Brian Manley to resign and for city leaders to defund the department by $100 million after police fired beanbag rounds at protesters, fracturing 20-year-old, Black college student Justin Howell’s skull and leaving him with permanent brain damage. Organizers are also demanding accountability and answers in the police-perpetrated killings of Mike Ramos and Javier Ambler.

Many of those activists say the city’s programs haven’t even made a dent in Austin’s racist and ableist policing. The programs’ current budgets are a drop in the bucket compared to the police department’s record $375.6 million in funds. Ultimately, they say, police have to choose to use the programs, which they often fail to do.

By the city’s own account, activists are right: A 2018 city audit found that of the 15 most populous cities in the U.S., Austin had the highest per capita rate of fatal mental health-related police-perpetrated shootings. More than a third of the 24 people killed in police shootings in Austin from 2010 through 2016 had mental health conditions.

The data underscores the debate around how effective even the most dramatic police reform and alternative first-response efforts have been thus far. How much of a difference City Council’s planned funding increases can ultimately make, however, remains an open question.

Casar says discussions are ongoing in regard to how the 911 dispatch system should work moving forward, and the degree to which police should have control over routing calls.

One case from last year remains instructive: Instead of requesting EMCOT, Austin police responded to a 911 caller requesting EMS for Tania Silva, an undocumented student diagnosed with schizophrenia who was off her medication. Video obtained by the Texas Observer shows how police escalated the situation after they arrived. They charged Silva with felony assault and took her to jail, where Immigration and Customs Enforcement placed a detainer on her.

In another case from 2017, police were dispatched to a mental health call in which the caller, Richard Munroe, was explicit about not wanting contact with police. When Munroe emerged from his house with a BB gun, officers fired 23 bullets, six of which struck and killed him. Police requested a helicopter fly over Munroe’s neighborhood but never called for EMCOT.

“In the past, this has been thought of as a supplementary program and an accessory, useful resource that exists, rather than as its own alternative emergency response,” Casar told Truthout. “I think this is the year for our city and lots of other cities to make that philosophical shift: that this isn’t an additional resource available for policing, but instead that this is a more compassionate and more effective response that should have its own decision making and be prioritized in its own right.”

Toward Abolition

More than 1,000 miles up Interstate 35E, city council members in Minneapolis, Minnesota, are looking to such programs after a veto-proof majority pledged to disband the city’s police force and envision a new system of public safety after national uprisings over the murder of George Floyd.

The main first-response model being discussed there, though, is White Bird Clinic’s “Crisis Assistance Helping Out On The Streets” (CAHOOTS) program in Eugene, Oregon. I recognized the program’s significance as a first-response system that minimized contact with police early on, reporting on the program in a 2015 story that was later compiled for Truthout’s Haymarket anthology Who Do You Serve, Who Do You Protect?

CAHOOTS is a mobile intervention service that is designed to provide an alternative to police action whenever possible. It handles significantly more call volumes, however, independently responding to 20 percent of all public safety calls.

“A lot of citizens that I think would otherwise not be calling and getting support because they’d be afraid of the type of responses they might get, I think feel more comfortable calling us because they know that we’re a human service response,” Benjamin Brubaker, a CAHOOTS team crisis worker, told me in 2015.

In fact, Austin EMS staffers themselves are looking to the CAHOOTS model, traveling to Eugene in late February to meet and ride along with White Bird Clinic’s field staff to see firsthand how the service works. Casar is likewise organizing a public meeting with CAHOOTS staffers toward the end of the month so that city leaders can understand the model before heading into budget deliberations.

Oluchi Omeoga, a co-creator and organizer with Black Visions Collective in Minneapolis, says the collective is working with a number of organizations that don’t partner with police, including the Minneapolis Sex Workers Outreach Project and the Minneapolis chapter of Men Against Destruction to build networks focused on both crisis response and prevention. Two of the collective’s members, Omeoga says, were 911 dispatchers and “know the ins and outs of the system.”

It’s this kind of organizing and investment in community-driven models that Omeoga hopes can ultimately lead the city’s transformation of its public safety system in ways truly unlike what has come before. Organizers there are not interested in simply repeating CAHOOTS or the “community policing” structure put in place in Camden, New Jersey, after the police department was disbanded, he says.

Even while remaining fiercely optimistic, the one thing Omeoga does say he fears is “that people are not going to be motivated enough to actually contribute to the system we want to see.” In order to truly abolish police, a much deeper kind of revolution must first take place.

“Abolition of police in the current moment that we’re talking about, around defunding the police, does not get rid of other systems of oppression that people face,” Omeoga says. “As much as we can reinvest in our communities, we still live under a capitalist and imperialist state.”

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