In March in a McDonald's parking lot off a busy Baltimore street, mental health clinician Michala Williams met a 38-year-old woman in a car.
"So, you called the police for help?" Williams asked the woman, who was sobbing uncontrollably and said she sometimes thinks about harming herself.
She told Williams she has children ranging from age 2 to 22, she was dealing with health issues, and that her fiancé had recently been jailed. She felt so overwhelmed she couldn't eat.
The woman, who asked not to be named so that she could freely discuss her mental health, explained she'd tried to get help the previous month by driving to the hospital but got pulled over on the way because her car registration had expired.
"I don't care if I get pulled over," she said. "But I was saying, 'I don't know what to do. I just want to go to the hospital.'"
The officer arrested her for acting erratically, so instead of going to the hospital she went to jail.
"I had to sit inside of a cold cell. I couldn't use the bathroom or anything," the woman said.
On the day she met Williams, she'd decided to call 911. The dispatcher recognized the woman didn't need a police response but instead needed one of Baltimore's mobile crisis teams, which send a clinician and a peer counselor to meet people in mental health distress.
By the end of an hourlong conversation, Williams set the woman up with referrals to a psychiatrist, a therapist, legal help, and a case manager to determine if her child with autism was eligible for government services.
"She's been through a lot of trauma, and no one is going to deny that," Williams said. "But I now have to take all of that and decide, 'OK, here's steps 1, 2, and 3,' because we got to find a little bit of sliver of something to give her some hope that there's help out here."
Problem solving 24/7, without badges, guns or handcuffs
For years, the mobile crisis teams, which are overseen by Behavioral Health System Baltimore, a nonprofit that acts as the city's mental health department, have diverted calls from police to mental health professionals. However, the units have a limited scope, focused on people in mental health crises.
Now Baltimore is tapping into some of the roughly $400 million it has received from opioid-related legal settlements to build out a broader service to operate around the clock and respond to other kinds of crises when police aren't needed.
Baltimore logged 1.68 million calls to 911 in 2024, but tens of thousands of them didn't require traditional emergency services, like police, firefighters, or EMTs, according to Tahir Duckett, an expert in community safety at Georgetown Law.
Instead, the calls were about, for example, a homeless person who fell asleep in a store, a person who seemed confused in a public park, and someone who was yelling at passersby on the street.
Such calls "don't require a badge, a gun, and handcuffs to resolve," Duckett said.
Often those people end up in jail instead of getting the help they need, he said.
A study recently found that when a non-law enforcement team responded to 911 calls in Durham, North Carolina, it resulted in fewer arrests than when police responded — especially for callers who were Black, men, or ages 25-39.
Police responses can also lead to trauma for that person or a less satisfactory outcome than another community service response would produce, Duckett said.
The idea behind the Baltimore mobile crisis teams — and the new service — is to find out what people in crisis may need and how to connect them to those resources instead of arresting them.
How a legal windfall will pay for expanded 911
From 2021 to 2025, Baltimore's homicide rate decreased by 60%, setting records for the drop in violence. But at the same time, drug overdoses made national records, as about 1,000 people here died of an overdose each year from 2020 to 2023.
In 2018, Baltimore opted out of a global settlement that other jurisdictions made with opioid makers and distributors and instead sued them independently.
As these opioid-related lawsuits settled, city officials decided that the settlement awards it receives must be spent on drug-related harms — or on services that help prevent addiction such as housing support, healthcare, and education.
One new program seeks to directly address overdoses by placing boxes of the overdose reversal drug naloxone at every subway stop.
Expanding 911 services is part of a larger strategy to beef up city services, with $15 million in settlement funds allocated so far, according to Sara Whaley, Baltimore's director of overdose response.
Whaley hopes the expansion will help the city think differently about how it responds to residents in crisis — regardless of why they're calling 911.
She views the calls as an opportunity to help solve a problem rather than be punitive. "What are the wraparound services and support that can help prevent them from being involved in this, in that emergency system?" she said.
For example, the person falling asleep in a store may need connection to community housing. The goal is to reduce violence, get people proper resources, and avoid the cycle of incarcerating people dealing with poverty, addiction, and mental health.
'The right response at the right time'
Rebecca Neusteter, executive director of the Health Lab at the University of Chicago, studies the impacts of services like these. She said they offer peace of mind for callers that "they're going to be met with the right response at the right time."
"We also see responders themselves feeling like they have a better toolbox in their ability to pursue actual resolution to these calls," she said.
To expand its system, Baltimore looked to cities — including Durham — that have adopted similar models to reroute callers who don't need emergency responders.
Durham's diversion program is called the Holistic Empathetic Assistance Response Team, or HEART. The program estimates it has diverted more than 12,000 calls in four years. It said police backup was needed for only 0.02% of those calls and that response times have improved for all types of 911 calls.
Durham has collected descriptions of the HEART calls, showing that nonpolice responders in Durham have helped with everything from finding housing for a woman fleeing domestic violence to setting up medical appointments for a homeless veteran.
In one case, a hotel manager called 911 asking for help finding a blind man housing for the night, since the hotel didn't have accessible rooms available. The HEART responders booked him a room and the next day provided a ride to meet with an organization that could help secure housing.
This story comes from NPR's health reporting partnership with WYPR and KFF Health News.
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