911 Fails People in Mental Health Crises. Here’s a Plan to Fix It.

Dan Gorenstein (DG): When people talk about the dangers faced by someone in a mental health crisis, a lot of focus turns, understandably, to law enforcement.

Police killed more than 2,000 people in a mental health crisis between 2015 and 2024, one of every five police killings in that time.

But one of the country’s leading public safety researchers argues that we need to pay just as much attention to 911, which sends cops to many of those deadly calls.

Rebecca Neusteter (RN): The system is actually doing exactly what it was designed to do. And the question is, is that what we want 911 to do? 

DG: Today, we talk with that researcher and a sheriff about how 911 has harmed people with mental illness, and what a better system could look like. 

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein. This is Tradeoffs.

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DG: More than half a million calls, on average, come into 911 every day. 

Research shows only a small fraction involve violence.

But police are the main response for at least 65% of calls, including for mental health crises, where cops have limited training.

This weighs a lot on Ed Gonzalez. He’s sheriff of Harris County, Texas, which includes Houston. 

Ed Gonzales (EG): We signed up to do this job because, at the end of the day, we want to help and serve people. And sometimes I think we have to ask ourselves, did we really accomplish that today?

DG: Ed remembers a time earlier this year when a call came into 911. A desperate mother was seeking help for her 19-year-old son. 

EG: Her son, was off medications, had become, uh, verbally aggressive, a bit combative.

DG: He’d been like this for days. He’d used knives to carve holes in the walls. He’d talked about wanting to harm himself. His mom was scared for him.

EG: Therefore, she called 911.

DG: Around 11 p.m. on a Saturday night, two deputies were dispatched to the home.

They found the young man walking in the neighborhood.

EG: As they approach him, a tussle ensues between the deputy and the individual. He breaks away, he’s becoming combative. They give chase again.The deputy has to then use force against the individual to contain him and bring them under control.

DG: In the struggle, the man and the officers fall to the ground. 

The young man scratches one of the officer’s arms, and the deputy punches the man in the face. 

Eventually, they get him in handcuffs and force him into the car.

EG: We’re trained to gain control of the situation immediately. There had been reports that this person may have had some weapons at some point. And so we immediately look through a lens of safety, right? Things just escalate instead of things getting resolved. And it’s just tough on everybody.

DG: The man was charged with assault on a peace officer, and booked in jail.

EG: Now he has a felony that’s filed against him. It now becomes a criminal matter instead of really putting it where it needs to be, which is a public health issue. 

DG: This story, Ed, is really a textbook example of why people worry about law enforcement responding to mental health crises. And I’d like you to help us understand the connection between what happened here and the 911 call that started it.

Can you walk me through the role 911 plays in situations like this?

EG: Yes when we receive a call for service, it could come from a family member or from bystanders in the area. And of course, everybody knows instinctively, call 911. it’s just ingrained in us that that’s the go to system for everything.

So when you’re given a limited number of options police, fire and ambulance, the decision will be made of what response are we sending? You know, immediately it’s like thinking safety, right? Somebody may be a danger to themselves or others. Like, they say when you have a hammer, everything appears to be a nail. And so now an officer is on the scene or a deputy is on the scene. 

DG: You talk about this hammer and nail. And I think what you’re saying to me is, so often 911 dispatchers are used to things being crime related that the default assumption is let’s send the cops. 

EG: Correct. And I think that even sometimes we even leave it to the person making the call to actually determine what response they want because they’ll ask you: Police, fire and ambulance. And a person doesn’t know. They’re not trained in any of this, you’re just somebody trying to help because they see something happening and they’re just going to say, well, police, you know, and, and there we go. 

DG: I want to bring in our second guest now, Rebecca Neusteter.

Rebecca, you’ve spent much of the past 30 years studying the public safety problems Ed is describing here.

You’re the executive director of the health lab at University of Chicago Harris School of Public Policy and the author of the new book – 911, What’s Your Emergency? The Promise and Peril of Crisis Response.

Beyond who we send out on these calls. In the book, you describe three key structural challenges with 911. The first: the majority of 911 call centers are run by law enforcement.

Two, 911 call takers lack adequate training and support.

And three, 911 is underfunded.

And you make the case that if we address these issues, we could meaningfully decrease the number of people in a mental health crisis killed by law enforcement. I’d like you to walk us through each of these structural challenges at a high level. And I’d like to start with the call centers based on your work. What’s problematic that some 60% of these call centers are overseen by law enforcement? 

RN: When law enforcement governs 911, the default answer to every 911 call is going to be a law enforcement response. And that’s a design that shapes the outcome before the 911 calls even come in. It’s not about individual officers or 911 professionals making bad decisions, in many of these instances. It’s more about a structural design choice that’s been baked into the founding of 911 and the structures that predated 911.

In the 1960s when 911 was first developed. It was developed in direct response to trying to give police control in the civil rights movement. And that sort of structure has remained today and allows law enforcement to be the default response, but also to govern 911 response. It puts all of our first responders in an untenable situation, and it doesn’t serve the needs of callers.

DG: Let’s briefly talk about this second challenge, Rebecca: lack of training and support.

You write that there are no national standards for training 911 professionals in general – let alone, for handling mental health calls.

RN: Yeah, 911 professionals themselves tell us the calls that they feel least equipped to deal with are calls that involve mental health crises, despite the fact that we know that it’s a regular occurrence.

And I think the other piece of this that’s very challenging for 911 professionals, is that they often don’t have available to them what they might see as the appropriate resource to deploy in these situations. And so they lack support when they know that they are incapable of providing the kinds of resources that community members expect and need to resolve these underlying crises. 

DG: Final structural challenge. Rebecca: funding.  Most communities finance 911 through user fees, a small amount added to everyone’s phone bills, which you argue in the book is woefully inadequate to pay for the kind of 911 system we need. How do you see insufficient funding contributing to the problem of preventable harm?

RN: Funding is a difficult conversation, especially in this moment in time when budgets and communities are strapped. That being said, you know, the problems with 911 cannot be fundamentally solved without some investment of resources.

Most 911 centers have such high vacancy rates that they’ve been forced over the past number of years to work mandatory and forced overtime. Those things contribute then to 911 professionals burning out and greater levels of attrition.

The lack of funding prevents 911 professionals in most places from knowing exactly where callers are calling from, so they have to spend an inordinate amount of what is a pretty short time on a phone call just trying to figure out where somebody is rather than understand what the issues are.

That’s a really frustrating situation for 911 professionals and callers that your, you know, average pizza delivery app is more likely to be able to find you than 911. That is entirely a funding issue. And frankly, I think some of those resources need to be coming from a national set of dollars.

DG: Any ballpark estimate, Rebecca, How much funding would need to increase to have 911 more fully funded. Are we talking about $2 billion, $200 billion? 

RN: Well, just the estimates to bring 911 technology nationally to where it should be is, you know, in the ranges of, you know, billions of dollars in the two digits.

DG: You mean north of at least $10 billion?

RN: That’s right. So, you know, we’re not talking about an insignificant amount of money, but the reality is that people are dying literally because first responders can’t find them. 911 professionals are committing suicide. There are really extreme adverse outcomes by the system being underfunded in the way that it is that I don’t think we can put a price tag to.

DG: When we come back, we’ll explore what a more robust 911 system could look like, and what it could take to get us there.

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DG: Welcome back. We’re talking with 911 researcher Rebecca Neusteter and Harris County, Texas, Sheriff Ed Gonzalez.

In the second half of the show, I want to turn to solutions and what it would take to make 911 work better for people in mental health crises.

In the last few years, hundreds of communities, including many of the country’s largest, have started sending social workers and other health care professionals to certain 911 calls that involve mental or behavioral health crises. 

Sometimes they’re paired with law enforcement, sometimes it’s just the unarmed health care workers.

As you know, Ed, Harris County, where Houston is, launched its version of this in 2022, called HART. 

Those teams of unarmed mental health and medical experts have handled more than 33,000 calls that otherwise would have deployed an armed officer and a patrol car.

Is there a story that stands out to you that shows the impact of giving 911 the option to send different responders in Harris County?

EG: Yes, absolutely. We had an example a couple years back where an older adult, that was living in squalor, unhealthy conditions. Did not really want assistance even though she was in serious need of medical attention. We had received over 200 calls for service to law enforcement, to that residence for welfare checks.

DG: Just for this one person.

EG: Just for that one person. To finally build the trust necessary to get her to help and potentially save her life. Our partners at HART took 14 hours. Our deputies would never have had that kind of time. That required almost a two day response to spend eight hours in the first shift. And then the next day they came for the follow up, and it was on that second six hours where they finally got her the help she needed.

And I mentioned 200 calls for service before. We haven’t had a call for service since in years past it would have been, you know, a deputy just scratching their head like, what do I do? I can’t force this person to leave their home.  and it would have just continued. It’s not really what law enforcement was intended to respond to.

DG: Rebecca, I’m really curious in your mind if every community in America adopted teams like HART in Harris County. And yet the same structural challenges you’ve identified in 911 were to remain, would this new class of first responders go most of the way in helping realize safer outcomes for people in crisis.

RN: Absolutely. We’re already seeing it. The Harris County, Texas HART program works in direct coordination with the 911 center that still falls under the law enforcement agency. I think that making those structural changes will take all of these programs to the next level.

But we have absolutely seen tremendous progress. We see reduced escalation, better outcomes for people in crisis and relief for first responders, community members who were unwilling and scared to call 911 are now calling 911 because we have decoupled enforcement from care in these places and ultimately have taken away the conflation of when you call 911 that you’re calling the police, and instead you’re calling 911 to access care and well-being.

DG: In the book, Rebecca, you talk about these reforms, these series of reforms, they’re going to cost money. You as well as anybody knows, the current fiscal political climate, that these are not shovel ready projects for anybody, really. What do you hope in the most realistic way is going to come as a result of ginning up this conversation that your book gins up? 

RN: Yeah. Well, first off, I’ll just disagree. I think there are a lot of shovel ready projects in this space and some things that don’t have hefty price tags. Some of it, frankly, is the culture and the leadership, like Sheriff Gonzalez is, is demonstrating. And there are some very simple remedies that can take us far.

DG: For example?

RN: For example, making sure that there are opportunities for advancement for 911 professionals to become supervisors and leaders within their own jurisdictions, which, you know, is often not the case when it’s under uniformed leadership.

There are opportunities to create peer support programs for 911 professionals that really cost nothing. There are also things that cost money, but what we also have to recognize is that the current system and its failures is costing us immensely.

Success to me means that we are no longer creating sort of patchwork remedies in order to solve around 911, but instead are confronting the problems within it. If I’m not able to pay my phone bill, guess what? I can still call 911 and seek access to services and support. That’s phenomenal. We need to use that access and that delivery in a way that proves itself to solve problems in communities.

DG: Ed, what does success look like?

EG: I want to see more conversations about this. How we could all do better, how we could reimagine how calls for service are dispatched, and matching the right service to the response.

Too often, my colleagues and others, we talk about the crisis of mental health, but we never talk about how those calls are dispatched to begin with, you know, at the end of the day, we return back to where we started. It’s ultimately about helping people and let’s remove egos and let’s align budgets where they belong.

More people need to be informed and we simply can’t afford to continue to invest the way we’ve been investing. 

DG: Rebecca and Ed, thank you both so much for taking the time to talk to us on Tradeoffs. 

RN: Thank you, Dan.

EG: Thank you.

DG: I’m Dan Gorenstein, this is Tradeoffs.