Many marginalized communities have long been distrustful of police involvement and, by extension, hesitant to call 911. To overcome the fear of a police response, jurisdictions can consider increasing access to mobile crisis responses through crisis lines, non-emergency lines, and other alternative numbers that are disconnected from traditional public safety systems. In Eugene and Springfield, Oregon, CAHOOTS, a mobile crisis intervention program, is accessible via 911, as well as via a 10-digit non-emergency line that is connected to the same communications center.²⁵ Portland Street Response (PSR) is currently only accessible via 911, but a six-month evaluation of the program included a recommendation to provide access for community members via Portland’s 311 number, 988, or another direct line.²⁶

In Rochester, New York, the Person in Crisis (PIC) team is accessible via 911 and through 211, the region’s 24/7 crisis line.²⁷ 211 operators can also make connections and referrals to all of the city’s local health and human services.²⁸ By partnering with the existing 211 system, operators can assess whether PIC is the most appropriate response, whether other community-based health and social services are more appropriate, and whether to transfer the call to 911 if there are more immediate health and safety risks.²⁹ PIC has focused on publicizing and raising awareness of 211 as the number to call for PIC because, as former Commissioner Daniele Lyman-Torres explained, “[people feel that] no matter what they do or no matter what they say, they end up with the police . . . and people don’t want the police [to respond].”³⁰

Callers may face communication barriers navigating 911 systems and crisis lines that are not tailored to serve their needs.

Daniela Hernández Chong Cuy, an immigration lawyer and mental health advocate, emphasized that communicating the nuance of a crisis situation can be very challenging for those who did not learn English as their first language: “[W]e have a particular language to speak about these mental and emotional states that, when it’s not your first language, it can be a huge issue.”³¹ Pat Strode, a leader of Crisis Intervention Team (CIT) programs and trainings in Georgia, explained that their 911 operator trainings have included a focus on navigating language barriers, “how to listen to the emotions and ask questions based on the emotions that they hear, versus sometimes the words that they hear, because people may not have the vocabulary to articulate exactly what it is they need.”³²

Advocates have also noted where gaps in technology and infrastructure can contribute to inequity in access and outcomes. For example, Toronto’s Reach Out Response Network consulted Deaf community members on how they would like to be able to access crisis response services; they recommended that services be available through multiple avenues, including text, video relay, or via an app.³³ Video relay calls establish three-way video links between 911 callers, an ASL communication assistant, and the 911 operators.³⁴ Such calls require access to the technology for the caller and training for 911 operators. Similarly, even though text-to-911 capability is expanding, there are gaps in coverage across the United States.³⁵ Importantly, advocates have successfully pushed for texting capability to be a requirement for the upcoming national implementation of 988.³⁶

Vera’s analysis of publicly available 911 call data, spanning nine cities and more than 23 million calls, suggests that an average of 19 percent of calls for service could be handled by unarmed civilian crisis response programs.³⁷

Communities that are implementing crisis response programs must define which call types their program teams should be dispatched to. Importantly, many calls that might not meet a jurisdiction’s criteria to be considered a “behavioral health crisis” might still involve an underlying behavioral health need—call types involving “disorderly behavior,” for example.³⁸ Broadening the criteria for crisis response effectively narrows the scope of police response, a common goal of civilian crisis response programs, and increases access to unarmed responders. To inform this process, jurisdictions should undertake an expansive assessment of their 911 call data. This analysis can also be used to refine the screening questions and protocols 911 operators follow.

The Community Assistance Life Liaison (CALL) program in St. Petersburg, Florida, has adopted this expansive and data-driven approach. Indeed, about 30 percent of calls the program responds to are not coded as mental health–related; rather, they are calls concerning nuisance complaints (related to issues such as panhandling and homelessness), neighborly disputes, and child/juvenile matters. These are calls that often involve an underlying mental health condition.³⁹ The chief of the St. Petersburg Police Department, Anthony Holloway, championed the decision to include a broader range of calls for service than other crisis response programs. Chief Holloway operated from the assumption that community members use 911 as a 24/7 general assistance line and may not always want or need police assistance. The department identified high-volume call types that law enforcement officers were ill-suited to address and planned for them to be diverted to CALL.⁴⁰

Identifying and triaging behavioral health–related calls is a key part of how 911 operators can contribute to more effective and equitable crisis responses. However, one recent survey of 911 call centers revealed that the majority of 911 operators do not receive specialized training to handle behavioral health crisis calls or have access to behavioral health experts.⁴¹ Of the call centers that implemented specialized crisis training, more than three-quarters were in regions where at least 75 percent of the population is white.⁴²

Call centers with embedded behavioral health experts—Harris County, Texas, and Phoenix, Arizona, for example—have seen improvements in the appropriate triaging of behavioral health–related 911 calls.⁴³ Former Commissioner Lyman-Torres, who oversaw the PIC team in Rochester, has advocated for embedding clinicians in call centers and notes that mental health professionals can play a role in defining the types of calls that are coded as “violent” in the first place, undoing the harms caused by the stigmatization of mental illness and other biases.⁴⁴

Ultimately, embedding behavioral health clinicians in call centers could drive culture change in dispatching. It would promote greater attention to the specific behaviors displayed by people in crisis rather than assessments that they are “violent” or “dangerous,” which disproportionately impact people of color.⁴⁵

911 and crisis line operators are tasked with assessing risk in all the calls they receive, including behavioral health crisis calls. Operators must assess the risk of the caller harming themselves or others on scene, including the first responders. As such, dispatching systems nationwide must create protocols that determine whether the risk of violence or harm merits sending an armed first response.⁴⁶ These considerations are critical to ensure calls are resolved as safely as possible.

Risk determinations are critical decision points that can introduce bias and inequity. Some 911 operators may be more alarmist than others when processing the same types of calls.⁴⁷ The race and class of a neighborhood or subject of a call can shape the level of risk both 911 callers and 911 operators perceive.⁴⁸ Crisis response programs, therefore, face a challenge: dispatchers may be less likely to send alternative responses to neighborhoods that are subject to an intensive police presence and that are most in need of non-police responses.⁴⁹ Screening protocols may inadvertently reproduce these inequities. For example, 911 dispatchers in St. Petersburg have implemented a series of screening questions to ensure that the calls triaged to CALL are limited to nonviolent matters and that the people involved do not have active warrants. CALL program manager Megan McGee recognizes this is most likely to affect people who are from overpoliced communities and acknowledged that it is a practice that could perpetuate racial inequities.⁵⁰ CALL has collected program data throughout its nine-month pilot and has partnered with a local university to evaluate its operations and identify processes that may contribute to inequity.⁵¹

The appropriate dispatch of calls by 911 operators has been an early implementation challenge for the B-HEARD program in New York City.⁵² Jason Hansman of the Mayor‘s Office of Community Mental Health (OCMH) explained that assessing risk of violence can be a key issue for operators: “What is your definition of violence versus someone else's definition of it?”⁵³ To support operators, OCMH is regularly reviewing call logs and dispatch decisions and providing operators with coaching, support, and re-training on how to implement protocols. Hansman notes that, while independent judgement by operators will always be a core feature of 911 triage, programs can work to identify recurring patterns in call types and situations that should receive a civilian response.⁵⁴

Many crisis response programs start as smaller-scale pilots that are restricted to specific geographic areas and/or specific times and days. Eventually, these programs may scale up their capacity to serve the entire community over a greater number of hours and days. Pilot programs often launch in neighborhoods with a high volume of behavioral health-related 911 calls. Although this is an opportunity to get resources to those most in need, it also presents logistical and management challenges. To be successful, 911 operators must have clear protocols, training, and support on how and when to dispatch crisis response teams throughout different phases of program implementation.

For example, San Francisco’s Street Crisis Response Team (SCRT) launched in November 2020 with one team available 12 hours per day in the city’s Tenderloin area. The program added a second team serving the Mission-Castro neighborhood in February 2021 and four more teams later that year to achieve city-wide and overnight coverage.⁵⁵ Each phase of SCRT’s expansion was paired with updated decision trees and protocols to guide operators in dispatching calls to the new program.⁵⁶