From the moment Mayor Bill de Blasio took office in 2014, he’s been convening task forces and announcing initiatives to improve the way people with mental health issues interact with the criminal justice system. "For far too long, our city's jails have acted as de facto mental health facilities,” he said in announcing his Mayor’s Task Force on Behavioral Health and the Criminal Justice System in June of that year.

Yet, for the most part, the new mental health resources the administration has invested in are not currently linked to 911—the number most people call in case of an emergency. As a result, in the nearly 180,000 cases in which someone called 911 last year to report an “emotionally disturbed person,” police and/or Emergency Medical Services (EMS) remained the default first responders, with no guarantee they had special mental health training.

For New Yorkers who live with a mental illness, that’s a problem: They say it can be humiliating to have police cars and ambulances show up at their homes, they complain that too often the only response available is a trip to the emergency room or the police precinct, and—most disturbingly—they fear they will be added to the growing tally of people with mental illnesses who have been fatally shot by police officers.

When a mental health–related call comes in to 911, for example, the dispatcher does not specifically send out police officers who have gone through the city’s crisis intervention training, which teaches officers how to de-escalate situations involving someone in a mental health crisis (although each precinct can opt to send out a trained officer for backup). Nor can the 911 dispatcher send a mobile crisis team staffed by mental health professionals. Those teams—as well as the city’s co-response teams, which pair police officers with a mental health professional—can be sent out in response to calls to the city’s dedicated mental health hotline, NYC Well, but not via 911.

But all that may be poised to change. The city is beginning to experiment with creating more options for triaging mental health calls that come through 911; it’s just moving very cautiously.

Between late July 2018 and April 2019, the NYPD and FDNY quietly conducted a pilot on Staten Island in which some calls to 911 were rerouted to NYC Well. The hotline can provide phone counseling and referrals to treatment, in addition to sending out teams of mental health professionals to check on someone in person (although these can take up to two days to arrive).

During the pilot, approximately 4,500 calls were made to 911 involving emotionally disturbed persons on Staten Island. Of those, the EMS operators determining referrals decided that some 150—just 3 percent—could be handled by NYC Well.

The low number of calls that were redirected appears to be largely by design. “The factors for connecting callers to NYC Well included that they be indoors, in a quiet place, in a private location conducive to important conversations,” explained an NYPD spokesperson via email. He added that for a call to be redirected, the person in need of assistance—not just the person calling on their behalf—had to be able to speak directly to an NYC Well counselor.

“For inherently dangerous events located outside, in public areas, or involving violence, weapons, or touching on the issue of suicide, the NYPD and EMS responded,” the spokesperson said.

It’s possible that more calls could be directed to NYC Well if the pilot is expanded. “My understanding is that conversations are ongoing about what types of calls should be diverted,” says Susan Herman, director of the city’s ThriveNYC office, which was familiar with but not directly involved in the pilot.

As the city explores more options for triaging mental health-related 911 calls, it will be a test of how willing the de Blasio administration is to heed the pleas of those in the mental health community who have called for minimizing the role of police and empowering alternative mental health responders. The Crisis Prevention and Response Task Force the mayor convened last year is, after a months-long delay, now scheduled to release its recommendations in the coming weeks.

One of the task force’s recommendations, according to Herman, will be to have co-response teams composed of both police officers and mental health professionals respond to mental health situations that are deemed to be emergencies, rather than police alone. Before considering a change citywide, the city will roll out pilot programs in one or two precincts in which 911 will be able to directly deploy co-response teams to respond to mental health calls.

“One goal of co-response responding to 911 calls would be more voluntary compliance on the part of the person you're responding to,” Herman tells Gothamist. “And if they're already in treatment or have been to a particular hospital, it would be more likely they would be connected to their health care provider.”

In the three years since the city created its co-response program, it has been used sparingly. Since co-response teams are not currently linked to 911, they are instead referred to cases by other police officers, or less commonly, NYC Well.

“In some cases, teams were able to connect people to housing, re-connect them to family, or connect to ongoing treatment, leading to many fewer interactions with police and increasing stability in their lives,” a spokesperson for the health department told Gothamist in an email.

Much of the existing literature that exists on co-response teams focuses on describing how the model works in different cities, rather than measuring results. However, the research that is available suggests that co-response teams can reduce arrests and emergency room visits as well as repeat calls for service.

But mental health advocates in New York are seeking to move the needle on what’s considered progressive. In supporting co-response teams as first responders, the de Blasio administration is set to clash with Communities for Crisis Intervention Teams in NYC, a coalition of about 70 organizations serving people with behavioral health issues. The group previously pushed for the city to adopt crisis intervention training and supported co-response teams, but has recently shifted its platform to reject any response involving police.

“The fact is that just the sight of a police officer scares some people in the mental health community,” says Carla Rabinowitz, advocacy coordinator at the mental health nonprofit Community Access and an organizer with CCITNYC.

When the NYPD was facing scrutiny from the city council in 2017 over a rash of incidents in which police fatally shot people with mental illnesses, Herman pointed out that only about one percent of mental health-related 911 calls resulted in any use of force. But those incidents have demonstrated the extent to which police can escalate an already tense situation, and have put many people with mental illnesses and their families on edge.

Moving forward, Herman says, the city is aiming to build up its capacity for “health-only” responses to mental health calls. But she adds that certain types of situations will always trigger a police response.

"If a person is deemed to be in an emergency situation in which they are likely to hurt themselves or someone else, it's very likely there will be a police officer involved in that,” Herman says. “If it's not an emergency situation, but it's urgent and not violent, then it's likely we will have more calls answered by health-only teams [in the future].”

There’s no agreed-upon definition of what constitutes an emergency situation in which someone is “likely to hurt themselves or someone else.”

Even among those within the mental health community who acknowledge that police officers are generally not the best equipped to handle mental health situations, there is little consensus about when it’s appropriate for them to get involved. Some say the authority officers wield makes it possible for them to defuse situations that non-police responders might not be able to.

Alice, a peer specialist in a community center for people with mental illnesses, says that her colleagues have called police on rare occasions when they’re unable to de-escalate a disruptive situation. “Mostly, the police get called when somebody is belligerent or breaking things or screaming and cursing,” she said. “We don’t have those situations so often, because most people have been in recovery for a long time. But if someone presents as being a danger and we’re not able to get the situation under control, we definitely would call 911.”

Alice, who declined to use her real name because she isn’t authorized to speak to press, added, “We can’t put our hands on anyone and force them to leave, so the police have more authority in that respect. People will listen to them more because people are scared of police and scared of getting arrested.”

Still, Alice, who has bipolar disorder, says she agrees that police shouldn’t be the go-to response for mental health situations. When her mom called 911 a few years ago to have police check on Alice at home because she sounded suicidal, “it was really humiliating,” she says.

“I went outside with them and we talked on a street corner, but everyone in the building is so nosy,” Alice recalls. Police officers, she says, are “not equipped to assess someone’s mental health.”

In seeking out a model that does more to empower non-police responders, CCITNYC has pointed to CAHOOTS (Crisis Assistance Helping Out on the Street), a program that has operated in Eugene, Oregon, for 30 years. CAHOOTS has gained more national attention of late as cities across the country have sought to reform their responses to mental health calls.

Each CAHOOTS team consists of a medic and a mental health counselor, providing more leeway in the types of situations they can handle. (New York’s mobile crisis teams are staffed only by mental health professionals.) CAHOOTS teams travel in a van that’s designed to accommodate a quiet counseling session, or if necessary to transport someone to the hospital or another location—say, a pharmacy to refill a prescription—while mobile crisis has to call 911 if someone needs to go to the hospital. And CAHOOTS teams can be dispatched by 911.

CAHOOTS has achieved this level of empowerment not by isolating itself from police, but rather by developing a close working relationship with them over the years, says Chelsea Swift, a crisis worker at the nonhierarchical organization who also does outreach and education on the model to other cities. In fact, the name was originally chosen as a nod to the fact that the self-described “hippies” staffing the vans were willing to collaborate with the cops. CAHOOTS workers are in frequent contact with the police, using earbuds instead of radios in order to appear more approachable. Sometimes, Swift says, a police team will respond to a 911 call first to ensure the situation is not dangerous, calling on a CAHOOTS team to be stationed nearby so they can take over once the scene is cleared.

Swift says she understands some activists’ desire to create a mental health response system that’s totally separate from police. “But because we’re embedded like we are, that lets us limit the scope of police work,” she says.

There is no magic bullet, though. CAHOOTS, for its part, has not completely eliminated fatal encounters between police and people with mental illnesses in the communities in which it operates. The best any mental health team can do, says Swift, is try to divert as many calls for help as possible.