What Is the Fourth 911 and Why Is it Critical for Community Safety?

The city of Austin implemented mental health services as a fourth option for emergency calls. When a citizen calls 9-1-1, the caller hears, “Austin 9-1-1, do you need police, fire, EMS, or mental health services?”

Although some cities have adopted the practice of integrating mental into 911 response, there are still barriers that block citizens from receiving the help they need.

Lack of access to proper mental health services, few alternatives to calling 911 for emergency response and inadequate training for first responders are just some of the contributing factors that affect citizens who need mental health services as an option for emergency response.

In a nationwide survey of 2,400 senior law enforcement officials, 84% of the respondents said that mental health-related calls have increased during their careers. Another 63% reported that the time spent on mental health calls has increased, primarily due to the inability to provide the proper support for mental health cases.

The National Alliance on Mental Illness reports that people experiencing mental health crises are more likely to end up in confrontations with law enforcement, rather than receive medical treatment. The result is more citizens in the criminal justice system, as opposed to the health care system.

When mental health is prioritized as a 911 option, law enforcement can better serve the community and keep people safe, while citizens receive the critical resources they need.

Implementation in Austin, TX

In February 2021, the city of Austin began offering mental health services as an option when someone calls 9-1-1. The goal is to resolve mental health crises without involving police when appropriate.

Although every mental health call may not be considered a threat to public safety, it is still a medical emergency and deserves a health care response. For mental health calls that do not pose a threat to public safety, 911 telecommunicators are able to transfer the calls to a Center Crisis Clinician.

These trained clinicians provide support to the caller through three primary support services.

1. Call diversion: The clinician provides support to the caller during their crisis, conducts planning and provides resources and referrals to help for a future related mental health crisis.
2. Call Consult: The clinician collaborates with the 911 telecommunicator to determine whether mental health care is appropriate, and they provide additional information for situational awareness for the first responders.
3. Call De-escalation: If there is a threat to public safety and officers are dispatched to the scene, the crisis clinician will attempt to de-escalate the caller. De-escalation support leads to better results and safety for the caller and officers.

According to the city of Austin’s Crisis Call Diversion Program Data, there were approximately 48,000 calls that were identified as a potential or confirmed mental health crisis in 2021. Nearly 5,700 calls were transferred to the crisis clinicians.

Research demonstrates the rates of arrest and use of force are lower when officers respond to situations where a caller initially requested mental health services, as opposed to cases where mental components were later identified.

Implementing mental health as a fourth 911 option in the city of Austin allows emergency responders to increase public health and safety, reduce barriers to mental health services and prevent over-use and misuse of emergency departments, psychiatric hospitalizations and unnecessary law enforcement involvement.

Their approach is “right care, right place, right time.”

Best Practices to Integrate Mental Health and Emergency Response

While your agency may not have a fully implemented mental health emergency response program, there are effective methods for serving community members who experience mental health crises.

Crisis Intervention Training

An effective method for training police departments and 911 telecommunicators is using the expertise of mental health professionals such as psychologists and crisis clinicians. Effective methods for training can include knowing how to identify if the caller is suffering from mental health issues, learning how to de-escalate incidents that involve mental health as well as utilizing intervention techniques to avoid arrest and use of force.

Non-Law Enforcement Crisis Teams

In 1989, the city of Eugene, OR developed the community-based public safety system called CAHOOTS. This system uses a team consisting of a medic and crisis professional who are equipped to handle mental health-related cases. They do not carry weapons to ensure a non-violent resolution.

Many police departments look to this model as a guide to develop similar programs for mental health response. Using a model such as CAHOOTS not only helps keep people who suffer from mental health issues out of incarceration, but this model also saves costly resources such as ambulance transport and hospitalization.

Co-Responder Model

Through the co-responder model, both police officers and mental health professionals work together to respond to an emergency. While police officer provides the assurance of public safety, the mental health worker works to de-escalate the crisis, prevent injuries and provide the appropriate services.

The trained mental health worker will conduct an assessment as a method to avoid an unnecessary arrest or need for additional medical treatment.

Mental Health Is Public Safety

Having mental health services incorporated into your emergency response plan benefits the entire community. Adopting crisis intervention plans and creating alternatives to making arrests can have lasting effects. Community members are safer, costly emergency resources are not over-utilized and police departments experience less stress trying to handle mental health emergencies without the proper means.

Whether or not your agency is prepared, you will experience mental health emergency crises.

Begin today by assessing your crisis intervention, identifying any gaps in your ability to respond and creating a plan to implement in your community.

Mental Health Resources for Law Enforcement

CentralSquare has partnered with the National Law Enforcement Museum, Caron Center, and others to provide mental health resources for law enforcement professionals.

Learn more about these mental health resources.