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For Mental Health 911 Calls, Dallas Found Success In Social Workers

Dallas had a disastrous history of police violence during emergency mental health calls. The RIGHT Care program shifted the power to clinicians and found success.
By Trace Miller |
Since January of 2018, a partnership between the county and the city police and fire departments has reimagined how cops respond to 911 calls involving mental illness. Called RIGHT Care, the team of a police officer, a licensed clinical social worker, a paramedic, and off-site clinicians answer between 200 and 250 calls per month, diverting thousands of patients away from the jail. In the meantime, “quality of life citations”—disorderly conduct, public intoxication, and trespassing—have dropped by 10 percent in the area the program serves. They even follow up on the patients.

RIGHT Care is in line with the sort of services that protesters are calling for as part of defunding the Dallas Police Department. This idea means divesting from the department and reallocating funds for social services, housing, and culture. Maybe cops don’t need to be calling the shots at every scene. RIGHT Care seems to have proved this out.

“I don’t think you can work in the first-responder community… in modern society without recognizing that a lot of what we do is less traditionally emergency medical calls and very often mental health calls,” says Dr. Marshal Isaacs, the medical director of Dallas Fire-Rescue and a professor of emergency medicine at UT Southwestern Medical Center. “So everyone from paramedics, firefighters, police officers, social workers, emergency doctors, to nurses have recognized for many, many years that there is a segment of the population who for many reasons aren’t getting their behavioral health needs met out in the community and deteriorate and have nowhere else to turn but the 911 system.”

In the years leading up to the creation of the RIGHT Care program, Dallas had a horrific history with regard to policing and behavioral health. In 2013, two Dallas police officers shot a man with schizophrenia and bipolar disorder after he stood up from a chair he was sitting in while holding a knife. The man did not approach the officer before being shot; the cop’s sentence was probation. In 2014, two officers shot another man who had bipolar disorder and schizophrenia after ordering him to drop a screwdriver. In 2016, five police officers smothered a schizophrenic man almost exactly like four officers smothered George Floyd almost four years later.

That victim, Tony Timpa, would likely have lived through that experience had a mental health expert been on scene.

Meanwhile, demand for mental health calls wasn’t going away for the Dallas Police Department. The city of Dallas receives 15,593 behavioral health calls per year, according to a report presented to the Public Safety and Criminal Justice Committee in 2017. At the time the report was presented, according to a study conducted by the Meadows Mental Health Policy Institute, around 17,000 people with mental illness were booked into the Lew Sterrett Justice Center each year. Of those in jail, 21 percent received psychotropic medications and 25 percent had past or current contact with the behavioral healthcare system. Even today, the jail remains the largest mental healthcare provider in the county.

All of this was foundational in the creation of RIGHT Care. A Parkland clinician, working in the 911 call center, fields behavioral health emergency calls and tries to provide resources over the phone. If that’s insufficient, the RIGHT Care team—which consists of a Parkland licensed clinical social worker, a DPD officer, and a DFR paramedic—follows four or five DPD officers to the scene. The officers arrive first and ensure the scene is secure. Then the RIGHT Care team, staged two blocks away, pulls up. With the lone RIGHT Care police officer acting as security, the other officers are free to go. The paramedic conducts a medical evaluation and the social worker conducts a behavioral health evaluation.

“Sometimes we can get them help right there at the scene,” Isaacs says. “Sometimes we can transport them to a community outpatient behavioral-health setting for them to receive further evaluation and treatment—and thereby keeping them out of jail and out of busy hospital emergency departments.”

It’s a win-win situation. Callers, receiving behavioral healthcare rather than an interaction with law enforcement, are treated as patients instead of criminals. Police officers, removed from a situation that they may not have expertise in handling, are freed up to chase criminals instead of dealing with a mentally ill individual.

The RIGHT Care program aimed to move the mental healthcare status quo from crisis response to crisis resolution, says B. J. Wagner, a senior justice fellow at Meadows who served as RIGHT Care’s general architect and its data collector and analyst for the first two years. This aim required diverting mental health crises calls not posing a risk to public safety away from public-safety responses—and not only diverting mental health crises away from jails and emergency rooms, but also plugging patients into long-term community-based care.

Working 16-hour days in DPD’s South-Central Patrol District (where most of the behavioral calls originate), the RIGHT Care team has responded to over 6,600 calls since its launch. That’s an average of 200 to 250 per month.

About 30 percent of the patients served by the RIGHT Care program have been diverted from jail or the emergency room; nearly 20 percent have been connected to mental healthcare services in the community. Fewer than 25 percent of the calls have ended in trips to busy hospitals; less than 4 percent result in bookings into the overwhelmed jail. And in the ZIP codes served by the RIGHT Care program, arrests dropped by 8 percent and quality of life citations (like, disorderly conduct, public intoxication, and trespassing) dropped by 10 percent. Meanwhile, in other nearby areas of Dallas, arrests and citations increased.

About 30 percent of the patients served by the RIGHT Care program have been diverted from jail or the emergency room; nearly 20 percent have been connected to mental healthcare services in the community

The RIGHT Care team even saves time to follow up on a quarter of its patients—checking that they got their meds when discharged from the hospital, ensuring that they’ve got a way to get to the clinic for their follow up appointment. RIGHT Care has also saved DPD time—1,083 patrol hours, to be precise. More importantly, they’ve kept the police from either treating the mentally ill like criminals or killing them.

City Manager T. C. Broadnax committed to expanding the program “to include additional teams” by October 1. Then, Assistant City Manager Jon Fortune revealed a plan to triple it. Expanding the program has been the plan for a long time, well before the protests over police brutality broke out nearly 50 days ago. But its success shows that some creative thinking can better deploy resources based on the situation, one of the many things protesters are calling for.

Kurtis Young, the director of social work for behavioral health services at Parkland, would welcome two more teams. With three teams, he said he would maintain a team in the south (where behavioral health emergency calls remain “plentiful”) and place a team in the northwest (where behavioral health emergency calls have risen the most), leaving one roaming team, which would deploy wherever depending on the day’s demands.

The important thing, Young stresses, is developing relationships wherever they operate. For example, in southern Dallas, the RIGHT Care team works with MetroCare Services, the VA Hospital, the Dallas Behavioral Hospital, Homeward Bound (a behavioral health treatment center), and Hickory Trail (a behavioral health hospital). Successfully deploying more RIGHT Care teams would require targeting resources—focusing on neighborhoods with lots of calls and community resources.

RIGHT Care presents an incomparably better, safer, more effective answer to behavioral health crises than any other response the city has previously deployed—especially police. It’s a field-tested program with an impeccable track record for which we have the blueprint and the working model. Now, the challenge for the city will be to find other opportunities to rethink policing. After all, RIGHT Care only costs $1.5 million, an expense shared by the city, Parkland, and the North Texas Behavioral Health Authority. But its impact is clear.

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