A New Model for Mental Health Calls

Current rates of mental illness and drug addiction raise the likelihood of emergency calls involving related crises. Research from the Pew Charitable Trusts shows 9-1-1 call centers lack the resources and training needed to dispatch tailored responses. Law enforcement officers are often sent to manage situations that require specialized services related to health, mental health, and housing.  

New research from the Meadows Mental Health Policy Institute in partnership with the Pew Charitable Trusts shows a Dallas-based program may serve as a blueprint for policy-makers looking to move their crisis response systems toward a health-centered approach instead of relying solely on police.

Established in 2018, the Rapid Integrated Group Healthcare Team (RIGHT) is a multidisciplinary model that brings together teams of mental health professionals, paramedics, and specialized law enforcement officers who can better direct people in distress to community-based care and services. 

The program is called RIGHT Care, and an analysis of its 6,679 calls from January 29, 2018 to June 7, 2020 found 62% resulted in a connection to care such as community service or voluntary or involuntary hospitalization. Forty percent resulted in a connection like a referral to health or housing services. Twenty-nine percent were resolved on scene with no further services needed, and only 14% resulted in emergency detention. Eight percent resulted in a person being taken to a hospital or psychiatric facility. Only 2% resulted in arrests for new offenses.

While mental health visits to the city’s Parkland Hospital emergency room increased by 30% from 2017 to 2019, areas served by RIGHT Care saw a 20% decrease in mental health-related admissions.

‘Decriminalizing’ Mental Illness

Tabitha D. Castillo, MPA, is the RIGHT Care program manager in the city’s Office of Integrated Public Safety Solutions. Several factors led to the program’s development, she notes. They include the number of behavioral health calls received through the 9-1-1 call center; past examples of use-of-force incidents that occurred during 9-1-1 calls that involved residents experiencing mental health crises; and the number of first responder resources required to respond to a single call for service.

Dallas receives more than 13,000 behavioral health calls a year.

“After studying this challenge, the city recognized that 20% of people in the local jails had a prior history of mental health conditions,” Castillo says. “Systemically, law enforcement officers were the primary first responders for people experiencing crisis, which typically resulted in arrest or hospitalization.”

When RIGHT Care was established as a pilot program in January 2018, it was stationed in the South-Central Division, a division known for violent crime and a high volume of behavioral health calls, notes Castillo.

“The pilot program was embraced by the community, local government, and healthcare,” she says.

The impact of the program has been positive enough to allow for expansion beyond the initial pilot project. 

“Six additional RIGHT Care teams have been added to address the large demand of mental health calls and ensure patients are being connected to the proper services,” Castillo says. “Without RIGHT Care, four Dallas police patrol officers and a Dallas Fire-Rescue ambulance would respond to mental health calls. These calls average 65 minutes, keeping these emergency resources out of service. The RIGHT Care program allows first responders to answer higher-priority emergency calls.”

From 2017 to 2019, the RIGHT Care program in the South-Central Division led to a 29.5% reduction in mental health calls to 9-1-1 that required an ambulance.

“The RIGHT Care program decriminalizes mental illness,” Castillo says. “Prior to the pilot program, Dallas police officers had few options other than to arrest individuals in crisis. Prior to RIGHT Care in 2017, 1,675 arrests were made. After RIGHT care in 2020, 659 arrests were made.”

In 2021 the RIGHT Care program expanded to include six additional teams, giving the city a total of seven teams at each police substation. Leaders are still working to include additional rover teams and overnight teams.

A Model That Works

RIGHT Care continues to respond to more than 1,000 calls for service per month. The average officer on a RIGHT Care call clears the scene 10 minutes faster than on non-RIGHT Care calls, Castillo notes. 

“For the month of November 2021, the RIGHT Care team answered about 53% of all behavioral health calls,” Castillo says. “As we add more teams, we expect this number to increase.” 

Operations include a field team composed of a Dallas Police Department officer, a Dallas Fire-Rescue paramedic, and a behavioral health clinician. The dispatch team has a behavioral health clinician in the call center. Hours of operation are from 7 a.m. to 11 p.m. Officers wear polo shirts and khaki pants and travel in unmarked police SUVs.

RIGHT Care calls end with an APOWW (apprehension by a police officer without a warrant) less frequently than non-RIGHT Care calls, she adds.

“The average officer is on scene of a RIGHT Care APOWW 20 minutes less than a patrol APOWW,” says Castillo. “Twenty percent of our mental health calls take place overnight, between 11 p.m. and 7 a.m. Therefore, our team is working on staffing and launching overnight teams to meet that need.”

In advising other municipalities on creating a similar program, Castillo notes there are many formats to alternative-response teams. 

“The RIGHT Care program consists of a coresponse model,” she points out. “The coresponse model works best for Dallas, as [it helps] ensure residents receive the most proper response on scene: security, medical evaluation, and mental health assessment.”

Challenges in implementation have been ensuring that all members of the police department are informed and aware of the services the city’s team can provide. 

Castillo advises municipalities looking to implement a similar program to follow the U.S. Department of Justice Programs’ Police Mental Health collaborations tool kit, which can be found at https://bja.ojp.gov/program/pmhc.  

Carol Brzozowski is a freelance journalist and former daily newspaper reporter in South Florida. Her work has been published in more than 200 media outlets.