Editor’s note: This story mentions suicide and mental health issues.
Raleigh has made some big changes to how it handles 911 calls and mental health emergencies.
When a Raleigh resident calls 911, a telecommunicator inside the city’s emergency communications center asks them a series of screening questions over the phone.
Up until very recently, the main goal of those questions was to determine whether a crime had been committed and whether to dispatch police or EMS to the scene, according to emergency communications director Dominick Nutter.
Now, for the first time, 911 call-takers are also paying attention to whether the caller might be experiencing a mental health crisis. They’re assessing whether police officers are best equipped to respond to the situation, or if a mental health professional should intervene instead.
“We’re refocusing,” Nutter said.
The reason for the change? Raleigh is piloting a crisis call diversion program: a team of licensed mental health clinicians embedded within the 911 call center who are trained to de-escalate mental and behavioral health crises and connect people with long-term support.
The crisis call diversion program debuted in November and is one component of Raleigh CARES (Crisis Alternative Response for Empathy and Support), the city’s answer to community members’ desire for more compassionate and specialized alternatives to policing.
In developing CARES, the city took inspiration from programs like CAHOOTS (Crisis Assistance Helping Out On The Streets) in Springfield, Oregon, STAR (Support Team Assisted Response) in Denver, Colorado, and HEART (Holistic Empathetic Assistance Response Teams) in Durham. Each of these programs includes a crisis call diversion component to redirect mental health and substance use-related 911 calls to mental health professionals instead of police.
Similar to CAHOOTS, Raleigh is working with a private health care provider, Alliance Health, to staff the crisis call diversion program. At this stage, three Alliance mental health counselors—Meg Hill, James Pearce, and Ashley Wilson—work out of the 911 call center Monday through Friday from 9 a.m. until 5 p.m. City leaders plan to expand the service in the future.
The INDY spoke with the counselors, Nutter, and Raleigh chief of staff Michele Mallette, one of the chief architects of the CARES program, about the crisis call diversion program.
INDY: When and why did Raleigh decide to pilot the crisis call diversion line?
Mallette: One of our former police chiefs, Cassandra Deck-Brown, recognized that there was a growing need—not just from community concern, but from a police resource standpoint—for an alternative for the community that was experiencing mental health crises. We decided we would embark on developing our crisis called diversion line. Our wonderful director over at emergency communications jumped on board.
Nutter: One of the big things is, as we divert calls over to the clinicians, it helps with our improved response time. If responders aren’t going to those calls, they can focus on other calls where the public needs them, and it’s going to reduce the time it takes us to get there. Additionally, with the clinicians, we now have experts handling the calls, so we enhance the service that we provide. We also have continuity of care, [Alliance Health] can provide follow-on care. That is the one thing that our program has and other places don’t.
What share of 911 calls qualify for this type of diversion? How many mental health calls are coming in on a given day?
Nutter: It’s hard to formalize and give you a hard and fast number, because prior to us having a crisis call diversion, we didn’t necessarily focus as much on it. Now we’re refocusing and taking that additional look. Raleigh Police are also doing the same as they go out and respond. So if you ask me that same question in about four months, I think we could properly frame that for you.
Mallette: I stress the importance of making sure our officers are trained through what’s called Crisis and Invention Training. That CIT training helps them know when they are out and interfacing with someone, “Does this person actually need law enforcement, or does this person actually need care from a mental health standpoint?” They’re collecting data in the community to help us assess when to deploy other resources, in particular [Raleigh’s police and social worker co-response unit] ACORNS.
Tell me how it works when someone calls 911 and how it gets filtered to the clinicians. What kind of questions are asked to make sure people get connected to the right call-taker?
Nutter: A 911 call comes in and we have our standard case entry questions. We’re going to ask their location, their number, their name, and then we’re going to say, ‘Tell me exactly what happened.’ As they start explaining the situation, our team will start listening and decide if it’s something that is appropriate for crisis call diversion. The big thing is, does the person have a weapon and is there any danger? In that case, then [diversion] wouldn’t be appropriate. If it’s something that’s appropriate for crisis call diversion, then the call is transferred to a counselor. One of our telecommunicators will talk to the counselor first so the counselor is aware of the situation, and then they will bring in the caller.
Meg, James, and Ashley, tell me a bit about your portion of the job and how a call might go.
James Pearce: We have a list of screening questions. We’re screening for suicidality, homicidality, psychosis—are they seeing things, hearing things—also … substance abuse. The answers they give us determine their risk level, [which] is going to determine our response.
Meg Hill: Very often, people who call 911 in a mental health crisis may already be members of Alliance Health, because [it] serves people with severe, persistent mental health challenges or intellectual developmental disabilities. When they are a member, we’re able to follow up and make sure there’s support in place to help that person. Often we are helping people access resources like behavioral health urgent care, crisis assessment, or mobile crisis, a service that comes to people’s homes and helps them figure out the best next steps for them, while assessing that it’s a safe step.
Ashley Wilson: In the history of mental health, people usually don’t have power of choice. A lot of times when someone was having a mental health crisis, they were treated like a criminal and put in the back of a police car and transported to whatever hospital was available. With us, we give choices. There’s individuals that may need police or EMS to come out, but we talk to them about options: “If you didn’t like going to Triangle Springs, no problem. There’s Holly Hill, there’s Raleigh Oaks.” We give people choices because, maybe they went to a doctor or provider who was not helpful. So why go back there?
Could you share some examples from the past couple months of successful crisis call diversion?
Pearce: I have a great example of a call that came in from a young teenage man. He was suicidal, and I spoke with him, deescalated him. It was about a 15-minute call. He did not like police, so it was good that I was able to speak with him, and that we were able to divert that. By the end of the call, he was doing a lot better. He was linking with a support of his.
Wilson: I have one individual I think about often. He called 911, he wasn’t doing well. His provider had told him to go to Monarch Behavioral Health Urgent Care [in Raleigh], and he went to a different location that was not an urgent care, and he was upset. We deemed it was safe for him to drive, and I gave him a list of options of different places. He said he wanted to go to the Wake Recovery Response Center; I said, “That’s wonderful, when do you think you’ll be there?” I called him about the time he said he was going to arrive, and he was checking himself in, and he was happy.
He found himself in a situation where he wasn’t getting the help he thought he was going to get. He reached out for help. It could have easily escalated to police needing to be involved. But because he was transferred to a counselor, we were able to get him where he needed to be. It’s not just throwing him out in the wind and hoping that he got there. I made sure he was safe and got what he needed.
Hill: I’m thinking of a family I spoke to with an adult who was experiencing hallucinations. She wasn’t wanting to hurt herself or anyone else, but she was having a hard time. [The family] ended up deciding for [Alliance Health’s mobile crisis service] to come to their home. The mobile crisis responder comes in plain clothes, and it’s a very family-friendly way to help when someone’s at a lower level of risk. Sometimes people just say, “I just need someone to come and talk to me, to help me with strategies to get through the night.”
Going forward, do you see a demand to expand this pilot program with more counselors or longer hours?
Nutter: We’re using the word pilot, but [the program] will not go away. This is just the first implementation. There is a demand. This initial iteration helps us to get an understanding of how we can make things flow better as we bring on additional counselors.
Is there anything else Raleigh residents should know about this service or the people behind it?
Nutter: There are other services, there’s [the suicide and crisis hotline] 988. However, 988 is a regional service, and if there’s a problem with the call, they’re going to have to call us.
Here the advantage is, since [the counselors] are part of [our local] team, we can easily work together to find a common solution. Even if it’s a bad situation and police are on scene, the counselors can still play a part to ensure that we have a more positive outcome. A counselor can intervene on the phone … and reduce the chances of a negative outcome.
Pearce: Combined, we have over three decades of clinical experience. We’re very skilled in crisis intervention work in a variety of different settings and populations. We’re here, and equipped, to help.
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