How one city integrated mental health response into 911 dispatch systems

Each year, the Austin, Texas, Police Department (APD) call center diverts more than 80% of its calls to mental health clinicians, freeing police officers to focus on “hot calls,” such as life-threatening situations and robberies in progress.  

Since 2019, Integral Care, the city’s Local Mental Health and Intellectual and Developmental Disability Authority, has been integrated into APD’s computer-aided dispatch (CAD) system. This means that when APD operators take a 911 call, they ask if the caller needs police, fire, emergency medical services (EMS) or mental health response.

“They do their initial triage, and then depending on what information they’re taking in, they have the ability to within the CAD system to transfer to the most appropriate first responder system or our clinicians,” said Marisa Aguilar, crisis services administrator at Integral Care.

Integral Care clinicians are trained on APD’s phone systems and have modified views of the CAD so they can see in real time what’s happening and seamlessly transfer to police or EMS. Mental health calls that don’t pose a public safety threat go to a clinician, who can support the caller and provide referrals and resources for additional help, collaborate with the 911 call-taker to determine if mental health services are appropriate, provide information to inform officers en route to an incident and de-escalate callers while responders head to the scene.

According to Austin’s Crisis Call Diversion Program Data, about 48,000 calls were identified as a potential or confirmed mental health crisis in 2021. Nearly 5,700 calls were transferred to the crisis clinicians, who can also deploy Integral Care’s Expanded Mobile Crisis Outreach Team.

“Of the ones that we are not able to divert, about half are because the person chooses not to have a mental health response and is still requesting public safety response,” Aguilar said.

“The efficiencies of getting the calls to the right place the first time is really important,” said David Zolet, chief executive officer at CentralSquare Technologies.

CentralSquare provides CAD and records management solutions to APD, which recently went live with CAD-to-CAD. That lets neighboring public safety agencies connect and share resources during an emergency.

Integral Care and APD are currently looking for lessons learned from their integration that they can apply to the rollout of 988, the National Suicide Prevention Lifeline phone number that goes live nationally on July 16.

“For 988 to be really effective, it needs to operate like we do in Austin, where it’s integrated into the emergency response,” Zolet said. “It’s the automatic fourth option [after police, fire or EMS], where you don’t have to press 4, but it goes through our systems so we can rapidly respond in an appropriate manner.”

Integral Care has been coordinating with APD on response for many years. The city has had a round-the-clock crisis help line since the 1980s, but when officials realized that police officers were responding to many calls involving mental health crises – Zolet said 15% of calls are mental health-related – they saw an opportunity to intercept those calls and ensure that people were getting the right care at the right time.

Officers are “provided with [mental health response] training from our department, but it’s not necessarily their expertise to do that,” Aguilar said. 

In 2006, Integral Care launched a mobile crisis outreach team that activated based on referrals that community members called in to the help line. A few years later, first responders called in requests themselves through the CAD. 

“We then would respond, and our goal was to clear the officer or paramedic from the scene within 15 minutes in the absence of a medical emergency or public safety issue,” Aguilar said.

Being integrated directly into the systems was a natural next step. Initially, the clinicians had their own system and no access to CAD. 

“We quickly learned that this was not efficient, and when people got transferred, there were dropped calls,” Aguilar said. “Who wants to be put on hold when they’ve called 911?... It was very difficult for our clinicians to get a hold of someone when we’re trying to call them back.”

Programs targeting 911 callers in need of mental health services are increasing. For instance, Durham, North Carolina, is launching four pilot tests of intervention methods.

“Crisis is dynamic and things can change very quickly,” Aguilar said. “We want first responders to be there as quickly as possible to help that person. So just being integrated into the technology has allowed better efficiency for our entities and collaboration and ensuring that we’re getting the most appropriate entity, whether that be an officer, a paramedic or a mental health counselor out into the community as quickly as possible.”

Stephanie Kanowitz is a freelance writer based in northern Virginia.