(TNS) — Around 8:30 p.m. one Thursday last fall, a phone rang.
A woman replied, “C3, Pam speaking.”
For a few seconds, she nodded as she scribbled on the sticky note in front of her. Then she stopped taking her notes and spoke again into her headset.
“Hi, I understand you have a tense situation tonight,” she said in a gentle tone of voice. Officers are sent. I’ll talk to you in the meantime.”
For about the next 10 minutes, “C3″—the call center physician—talked to the Baltimore County family members who had called 911, gathering information about the conflict and de-escalating the situation, all from a small room adjacent to the county’s 911 call center.
It’s common for the physician-at-the-center program, a pilot project that puts licensed mental health physicians alongside dispatchers to defuse and divert some of the area’s emergency calls.
Placing a mental health professional at the center provides an opportunity for early intervention by someone trained to evaluate and assist a person in crisis, said the physician and program director, Pam Willman, who kept The Baltimore Sun on shift from 4 p.m. to midnight.
To date, interventions have included clinicians resolving calls without dispatching first responders, and clinicians avoiding escalating the crisis over the phone while police or other first responders are on their way.
On the phone with the 911 caller, Wellman explained that she knew this wasn’t the night anyone wanted, and offered to listen to each family member’s perspective.
Sometimes she was quiet, or just mumbled: “Excuse me.” In other cases, she directed the conversation, asking, “How often do you have conflict like this with your family?” or acknowledging, “You’ve identified something that’s really difficult for teens.”
When the officers arrived at the home, Wellman hung up, making sure the family had the county’s crisis hotline number for future reference. Then she hung up, began giving case notes, and hoped her guidance would help ease tensions.
The calls reported by Wellman and her team ranged from 90 seconds to an hour, and could include anything from family conflicts to mental illness and substance abuse. Interactions, however brief, ideally create safer situations for the caller, the person who may need care, and the first responders who may arrive on the scene.
There are high hopes for this trial, which is intended to complement the county’s existing efforts in ensuring appropriate responses for residents in mental health or behavioral crises. The county’s crisis response system in February also boosted mobile crisis teams from six a day to eight, hoping to increase the number of calls a two-person team of a doctor and a police officer responds to.
Democratic County Executive Director Johnny Olszewski Jr. considered the surge of the pilot team and mobile crisis team a “step forward” to help “better deliver the help they need.”
The pilot and expansion were made possible by an injection of funding from the county’s portion of the Federal American Rescue Plan Act. They come as Baltimore County, and cities and counties across the country, grapple with how best to respond to mental health and other types of nonviolent emergencies. Some areas, including Baltimore City, have moved toward Diverting certain types of 911 calls to a mental health hotlineand some created new teams of first responders of physicians, Paramedics and other professionals who are not police officers.
“A crisis can be a catalyst for change,” said Allison Palladino, director of the Baltimore County Crisis Response System. “This is an opportunity to help [people] Reconsider what is going on, and engage them with appropriate resources.”
When they see someone in crisis, they call 911
Baltimore County has long embraced a co-responder approach that places a mental health physician alongside a police officer.
Supporters of the programme, which was first launched in 2001 as a pilot in Dundalk, note that it puts the clinician “front and center” in the early phase of response, leading to better client outcomes and broadening officers’ understanding of mental health. It also allows clinicians to respond more quickly and to calls with a higher “pitched” or intensity.
Paladino said she firmly believes that pairing a clinician with an officer leads to more client interactions for mental health professionals and more opportunities for help.
“It increases the number of people entering the mental health system through these interactions, because community members, when they see someone in crisis, call 911,” she said.
Mobile Crisis Teams seek to divert clients from emergency rooms and the criminal justice system. This can take a number of forms: transportation to a shelter or substance abuse treatment, contact with behavioral health professionals, or even links to a food pantry or eviction prevention service.
In the fiscal year that ended June 30, county crisis teams denied people entry to the criminal justice system on about 60% of calls that were a possible outcome, and from the hospital emergency department on about 44% of calls, according to health groupthe county’s contracted behavioral health vendor of the Crisis Response System.
About 58% of the calls that could have resulted in emergency petition – Maryland’s legal procedures for compulsory immediate psychiatric evaluation have been resolved – without a single procedure.
But for years, crisis teams have been unable to respond to all of the hundreds of calls to service per month that relate to behavioral health. That left the patrol officers dealing with them alone more than half the time.
In 2020 and 2021, mobile crisis teams responded to an average of 205 and 215 behavioral health calls per month, respectively — representing 42% and 41% of the average countywide behavioral health coded calls for the service, according to statistics provided by the county police.
It’s an imperfect measure — some crisis team calls have other codes, and it’s debatable whether crisis teams should treat 100% of coded calls as having to do with a behavioral health issue — but it helped reinforce the idea that the county was ready to expand.
Mobile crisis teams saw an uptick in behavioral health calls in 2022.
Through November, teams responded to an average of 240 calls per month, or 43% of all behavioral health calls in the county. Since the beginning of March, their first full month with two more teams per day, they’ve averaged 247 per month, or 44%.
The expansion was funded, along with the call center’s clinical pilot, with a one-time $1.6 million investment from the American Rescue Plan Act. Budget documents show the police department received $521,000 and the health department $1.1 million.
ARPA funds must be spent by the end of 2026, leaving the long-term future of the expansion of the crisis team and the call center clinical pilot unclear.
Leaders of the county’s crisis response system say their dream “pie in the sky” would be a crisis stabilization center, a place where someone could be taken instead of a hospital or prison. Chills can be evaluated without the need for an inpatient hospital setting. Such a space would “complement” the county’s offerings, Paladino said.
We can get hundreds [mobile crisis] Said Lieutenant J. Brian Shanks, Chief of the Police Department behavioral assessment unit, including mobile crisis teams. “Even if we did, where would you take people who are in desperate need of psychiatric care?”
Wellman, director of the pilot program, explained that crises can come from a “fight or flight” mentality—a state that can be beneficial at times, but that can also set in when something else is better.
The goal of crisis response is to help get the customer’s “mind back online and out of the crisis”.
The licensed clinical social worker has spent years working with mobile crisis teams in the county, which she says has been instrumental in understanding how the public system works and how calls are triaged.
However, the response over the phone is very different from the response in person.
“You don’t know much,” Wellman said. “The moment of crisis can be screaming or confusion, not having other senses available, or not being present, like the smell of gas or the look of their living environment.”
The recipient of a 911 call is the “first responder,” Wellman said, providing an early window into the crisis a customer is going through.
From July to November, the program received about 101 calls, or an average of 20 a month, according to figures provided by the Santé Group.
Of those, 36 were resolved by phone and 62 were de-escalated while first responders were en route.
Wellman also hopes to increase staffing for the call center physician program and continue to explore safe calls for its team to handle, with or without police being dispatched.
It’s a work in progress as the pilot project gets under way, Wellman said: “We’re building an airplane while it’s in flight.”
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