Social workers and clinicians will soon play key roles in all emergency mental health calls placed in the city of Dallas. It has been happening for the past three years in southern Dallas, through a pilot project between Parkland Health and Hospital System, Dallas Fire Rescue, and the Dallas Police Department. They combine to respond to mental health crises, giving off-site clinicians the power to take the calls and deploying social workers alongside police officers. After arriving and securing the scene, the cops back off and offer support.
The collaboration proves city and county resources can in fact play nice together.
The group is called RIGHT (Rapid Integrated Group Healthcare Team) Care and includes a police officer, a licensed clinical social worker, a paramedic, and off-site clinicians who connect residents with community resources rather than send them to jail. Expanding the program was a key piece of City Manager T.C. Broadnax’s last budget.
When a mental health-related call comes to the 911 dispatch, the team is deployed. If the scene is safe when they arrive, and if the patient has no history of aggression or violence, the social worker engages instead of the police officer.
Between 2017 and 2019, psychiatric visits to Parkland’s emergency department grew by 30 percent. That wasn’t the story where RIGHT Care was operating. Those ZIP codes saw a 20 percent overall decrease in psychiatric admissions. Several individual ZIP codes saw a decline of more than 30 percent. Arrests from the three southern patrol divisions were lower during the first half of 2020 compared to 2019, which police say is because more mental health patients are getting the services they really need.
“With the success of that pilot program, it only makes sense to look at expanding it to other areas of the city,” says Dr. Marshal Isaacs, the medical director for Dallas Fire-Rescue and the RIGHT Care team.
For fiscal year 2021, there will be five RIGHT Care teams, which include individuals to cover a day shift and a night shift. By April, there will be five teams that will cover the entire city, with each team covering a specific subdivision (South Central, Southeast, Northeast/North Central, Northwest/Central and Southwest). For fiscal year 2022, which begins in October, there will be 10 teams to provide even more coverage for the city. It will also mean that the organizations will need to expand their partnerships throughout the city to connect patients to resources, rather than send them across town for housing, a pharmacy, or a mental health resource.
The additional five teams for 2022 will be in next year’s budget, so the cost has yet to be determined, but the City of Dallas budgeted $2,192,998 for the expansion to five RIGHT Care teams this year.
“We’re talking about better resource matching,” Isaacs says. “We are determining what the patient experiencing a behavioral health emergency might need and trying to provide it where they are, where they live, where they’re housed, out in the community in a better setting than we would find in a police car, an ambulance, jail, or an emergency department.”
It will follow the metrics to report to the city and the county. The team measures the diversion rate from the emergency room and jails. It is focused even more on connecting patients with appropriate resources rather than diverting them from high-cost settings like the emergency room. If the resident does not have a significant medical issue, they will be connected with counseling, housing, pharmacies, or other resources that can better address their needs. The social worker helps decide what would be the most impactful for the patient.
Partners in southern Dallas have responded. With additional mental health referrals in certain areas, providers like MetroCare and other urgent care clinics are expanding hours to meet the need.
“We’ve built some strong partnerships, and people have stepped up to the table,” says Kurtis Young, the director of social work for Parkland’s behavioral health services. “We’ve seen an expansion of services since RIGHT Care has been here, and that’s helped us a lot.”
In a city where city and county leaders can’t figure out a way to work together for the city’s good, the RIGHT Care team is doing so with aplomb. “We have to make sure that all the bureaucracy and red tape is going well and that we’re all communicating and properly,” Young says. “It’s putting a standard operating procedure in place to make sure that everything goes the way we need it to, and communicating when it doesn’t, and being flexible enough to to make those changes.”
“We are marrying three distinct organizations, all with slightly different cultures,” says Isaacs. “The good news is we have a long, proud history of collaboration between DPD, DFR, Parkland, and the city of Dallas. Many obstacles that we have encountered are worked out collaboratively, and we’re very fortunate to have those relationships in place.”