BALTIMORE -- Around 8:30 p.m. one Thursday last fall, a phone rang.
“C3, Pam speaking,” a woman answered.
For a few seconds, she nodded as she scribbled on a sticky note in front of her. Then she paused her note taking and spoke again into her headset.
“Hey, I understand you have a tense situation out there tonight,” she said, her tone gentle. “Officers are getting sent out. I’m going to talk with you in the meantime.”
For the next roughly 10 minutes, the “C3″ — call center clinician — spoke to members of a Baltimore County family who’d called 911, collecting information about the conflict and calming the situation, all from a small room adjacent to the county’s 911 call center.
It’s a common occurrence for the center’s clinician program, a pilot project that’s put licensed mental health clinicians alongside dispatchers to defuse and divert some of the area’s emergency calls.
The clinician and program manager, Pam Wellman, who The Baltimore Sun shadowed on a 4 p.m.-to-midnight shift, said placing a mental health professional in the center offers a chance for earlier intervention by someone trained assessing and aiding a person in crisis.
So far, interventions have included both clinicians resolving calls without first responders being dispatched and clinicians de-escalating a crisis by 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 to have, and offered to listen to each family member’s perspective.
At times she was quiet, or just murmuring: “Aw.” At others, she guided the conversation, asking, “How often do you have conflict like this with your family?” or acknowledging, “You’ve identified something really hard for teens.”
As officers arrived at the home, Wellman wrapped up the call, making sure the family had the county’s crisis hotline number for future reference. Then she hung up, began to file case notes and hoped her guidance had helped ease tensions.
Calls that Wellman and her team field have ranged from 90 seconds to an hour, and can involve anything from family conflicts to mental illness and substance use. The interactions, however brief, ideally create safer situations for the caller, the person who might need care and the first responders who might arrive on scene.
There are high hopes for the experiment, meant to complement existing county efforts in ensuring appropriate responses for residents in mental or behavioral health crises. The county’s Crisis Response System in February also boosted its mobile crisis teams from six per day to eight, hoping to increase the number of calls to which a two-person team of a clinician and a police officer respond.
Democratic County Executive Johnny Olszewski Jr. has cast the pilot and mobile crisis team increase as a “step forward” to help “better provide those in crisis with the help they need.”
The pilot and expansion were made possible through an injection of funding from the county’s portion of 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 funneling certain types of 911 calls to a mental health hotline, and some have created new first-responder teams of clinicians, medics and other professionals who are not police officers.
“A crisis can be a catalyst for change,” said Allison Paladino, director of the Baltimore County Crisis Response System. “That’s an opportunity to help [people] re-look at what’s going on, and to engage them with appropriate resources.”
‘When they see someone in crisis, they’re calling 911′
Baltimore County has long embraced the co-responder approach that puts a mental health clinician alongside a police officer.
Supporters of the program, first launched in 2001 as a pilot in Dundalk, note that it places a clinician “front and center” in the early stage of a response, creating better outcomes for clients and widening officers’ understanding of mental health. It also allows clinicians to respond more quickly and to calls with higher “acuity,” or intensity.
Paladino said she firmly believes that pairing a clinician with an officer leads to more client interactions for the mental health professionals and more opportunities to help.
“It increases the amount of people that get into the mental health system through these interactions,” she said, “because community members, when they see someone in crisis, they’re calling 911.”
The mobile crisis teams seek to divert clients from emergency rooms and the criminal justice system. That can take a number of forms: transportation to a shelter or substance-use treatment, connection to behavioral health professionals, even links to a food pantry or eviction prevention service.
In the fiscal year that ended June 30, county crisis teams prevented people from entering the criminal justice system on about 60% of calls where it was a possible outcome, and from a hospital emergency department on about 44% of calls, according to the Santé Group, the behavioral health services vendor that the county contracts with for its crisis response system.
About 58% of calls that could have resulted in an emergency petition — Maryland’s legal process for immediate, involuntary psychiatric evaluation — were resolved without one.
But for years, the crisis teams haven’t been able to respond to all of the hundreds of calls for service a month that are related to behavioral health. That left patrol officers to handle 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 average total countywide behavioral health-coded calls for service, according to statistics provided by the county police.
It’s an imperfect metric — some crisis team calls have other codes, and it’s debatable whether crisis teams should handle 100% of the calls coded as being about a behavioral health issue — but it helped reinforce the idea the county was ready to expand.
The mobile crisis teams saw a slight uptick in the number of behavioral health calls in 2022.
Through November, teams responded to an average of 240 per month, or 43%, of the county’s total behavioral health calls. Since the start of March, the first full month with two extra teams per day, they’ve been to an average of 247 per month, or 44%.
The expansion, together with the call center clinician pilot, was funded by 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 money must be spent by the end of 2026, leaving the long-term future of the crisis team expansion and call center clinician pilot unclear.
Leaders of the county’s crisis response system say their “pie in the sky” dream would be a crisis stabilization center, a location where someone could be taken instead of a hospital or jail. They could cool down and be assessed without requiring an inpatient hospital setting. Paladino said such a space would “round out” the county’s offerings.
“We can have hundreds of [mobile crisis] teams,” said Lt. J. Bryan Shanks, who commands the police department’s Behavioral Assessment Unit, including mobile crisis teams. “Even if we did that, where do you take folks who are so in need of psychiatric care?”
‘First first responder’
Wellman, the pilot program manager, explained that crises can come from a “fight or flight” mentality — a state that is potentially helpful at times, but also can kick in when something else might be better.
The goal for crisis response is to help get a client’s “brain back online, and out of crisis.”
The licensed clinical social worker spent years working with the county’s mobile crisis teams, which she said was helpful in understanding how the overall system works and how calls are triaged.
The response over the phone is very different from in person, though.
“You don’t know as much,” Wellman said. “The moment of crisis can be screaming or confusion, and you don’t have other senses available, not being present, like the smell of gas or what their living environment looks like.”
The 911 call taker is the “first first responder,” offering an even earlier window into the crisis a client is undergoing, Wellman said.
From July through November, the program took about 101 calls, or an average of 20 per month, according to figures provided by Santé Group.
Of those, 36 were resolved over the phone and 62 were de-escalated while first responders were on the way.
Wellman also hopes to increase staff for the call center clinician program and continue exploring what calls are safe for her team to handle, with or without dispatching police.
It’s a work in progress as the pilot project gets off the ground, Wellman said: “We’re building a plane while we’re flying it.”
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