Every year, operators and dispatchers at the New Orleans 911 Call Center handle thousands of calls for non-violent mental health crises — calls they say have been steadily increasing in volume since the start of the COVID-19 pandemic.
“Just my experience being in a 911 center every single day — for the last two years….I think we would probably see a 25 percent increase in the number of mental health call we get to 911,” said Tyrell Morris, director of the Orleans Parish Communications District, at a recent city council task force meeting.
And while studies show that people with serious mental illness are more likely to be killed by police, and experts warn that stress induced by lights, sirens and arrests can exacerbate crises as they are occurring, more often than not when one of these calls comes in, it’s the New Orleans Police Department that’s dispatched to respond.
Following a push from community members and advocacy organizations, officials in New Orleans Mayor LaToya Cantrell’s administration say they’re trying to change that. Beginning next summer, the city hopes to have a dedicated team of health professionals, not police, available 24/7 to respond to non-violent crisis calls.
Last week, Cantrell signed a $1.3 million contract with a nonprofit organization called Resources for Human Development (RHD) to provide an “alternative dispatch” service that will embed with the Orleans Parish Communications District — which handles 911 calls for the city — and respond to calls with a two-person behavioral health team.
The new contract comes on the heels of a mental health crisis response pilot program, announced in August 2021, that was meant to provide a similar service in several NOPD districts. Under the pilot, OPCD call-takers were supposed to route these calls to the Metropolitan Human Services District, a state agency that provides behavioral health services in Orleans, Plaquemines and St. Bernard Parishes and has long provided a non-911 crisis intervention program. According to MHSD, the pilot concluded last week when the RHD contract was signed by the city.
But the pilot appears to have been mostly a failure both in responding to crises in the way the city has envisioned moving forward, or providing useful data to inform the new city program, according to officials with MHSD and the city’s health department.
Over the course of the program, only about one hundred 911 calls were routed to MHSD, according to calls for service data, though typically many more would fit the criteria for a non-violent mental health crisis. And the director of the New Orleans Health Department, Dr. Jennifer Avegno, said that response teams were rarely — if ever — sent out to respond to calls in person.
“The pilot really — I’m not gonna say it wasn’t effective — I just don’t think that it had the intent or resources to do what we’re hoping to do,” Avegno said.
The city’s new contractor, Resources for Human Development, was also involved in that effort, as a contractor with MHSD.
Similar mobile crisis response programs have been active in cities across the country, and it is something that criminal justice reform advocates, city leaders, and healthcare professionals in New Orleans have been talking about setting up for years as a way to reduce interactions between law enforcement and people with serious mental illness.
In addition, with the NOPD’s uniformed ranks at historic lows, the city also hopes that the program could free up police resources to respond to serious crime.
Last year, several criminal justice reform organizations — led by the Orleans Parish Prison Reform Coalition — began a “Help, Not Handcuffs” campaign to hear from the community and to push the city to take action on creating a non-police response for behavioral health crisis. In June 2021, the New Orleans City Council created a 13-member Mobile Crisis Strategy Task Force in order to study the issue and provide recommendations citywide.
The group held its final meeting last week, and issued a list of recommendations for the city moving forward as the program moves — slowly — toward full implementation, a process that RHD says will take the better part of its first contract year.
Contract
The city put out a request for proposals for the mobile crisis response team in November 2021, and got four responses from prospective contractors. RHD, a Philadelphia-based national non-profit that provides a range of behavioral health services and has done work in the greater New Orleans area since 1997, received the highest score of the four from a city purchasing committee.
As part of the new agreement with the city, RHD will “provide mobile crisis outreach to individuals in behavioral health crises by meeting face-to-face with the individual in crisis anywhere in the New Orleans community,” according to the contract. “This service will be provided 24 hours a day, 7 days a week, and 365 days per year.”
RHD says they won’t be ready to actually respond to calls until June of next year — nine months into their contract. They say the time is necessary to hire and train staff, furnish an office, and coordinate with OPCD and other partners.
But because it is a one year contract, the timeline also means that the city will be forced to make a determination about whether or not to renew with very limited information regarding RHD’s actual performance.
Avegno says she hopes the timeline can be sped up, but also doesn’t want to rush the process.
“We are pushing them for earlier than June,” she said. “But I also am very mindful of the fact that we want to do this right from the beginning. Because we know it’s going to be a little bit of adjusting as we get into it. We want to make sure we have thought of everything that we can possibly think of and have a solution or a process for it.”
Each Mobile Crisis Outreach Team will consist of two people — either mental health clinician or a behavioral health specialist, and a “peer support specialist,” someone who has “lived experience with substance abuse challenges.”
According to the contract, when 911 calls come in, they will first be taken by an operator with the Orleans Parish Communications District, who will determine if the scene is “non-violent and without weapons involved.” If so, the call will be transferred to a “crisis call-taker.” That call taker will have the option of either attempting to resolve the crisis over the phone or send out the outreach team. In addition, RHD’s crisis call-takers can receive calls directly from NOPD, EMS, or the fire department.
If a team is dispatched, the contract says that it should be en route within four minutes, with the goal of arriving at the scene within 20 minutes, unless all teams are already responding to other calls.
How the teams will actually respond once they get to the scenes is not dictated in the contract beyond instructing them to “use their clinical discretion to resolve the crisis in the most appropriate, least restrictive setting.”
Avegno said that leaves open a range of possibilities, including working with people in crisis to access resources — such as medication or a psychiatrist — or transporting them to an emergency room for stabilization.
If an outreach team does transport someone to a hospital or another caretaking facility, the contract requires that team members ensure that the facility is able to take them, and provide an introduction — a process defined in the contract as a “warm handoff.”
In their recommendations, the Mobile Crisis Strategy Task Force suggested that RHD should issue quarterly reports and presentations to the City Council’s Quality of Life Committee, and that a mechanism should be developed in order to “assess whether there is a difference between services provided as they are enumerated in writing and the actual provision of services in New Orleans.”
People who are likely to rely on the services provided by RHD should be included in developing those audit mechanisms, the task force said.
Pilot program
RHD will also be required to collect a range of data, including call response times, disposition of calls, and how frequently they request back-up from either EMS or NOPD. And the group will need to meet quarterly with a community advisory committee for the “purpose of community input and oversight.”
Ideally, the city would already have such data — which will be critical to design, adjust and refine the permanent program — from the completed MHSD pilot.
But in early September, as the city was preparing to sign the RHD contract, Avegno acknowledged that they were “going to be building the plane while we’re flying it a little bit.”
The pilot appears to have produced little useful data to guide the broader implementation of emergency crisis response.
“The alternative dispatch pilot program that we have implemented allows us to be more data-driven and will overall help shape this system in a way that better suits our needs as a city,” said Mayor LaToya Cantrell in a press release last year announcing the pilot. It stated that data would be evaluated weekly “to make determinations regarding the future of the program.”
Initially, the pilot started in the NOPD’s 3rd District, but within a few months, it expanded to include the 1st, 2nd and 4th Districts as well. RHD, the current city contractor, also works with MHSD, and it was providing crisis response for the pilot program.
But very few calls were routed to MHSD in the first place. Despite the pilot ostensibly being active in half of the city’s eight police districts, fewer than 100 calls were routed to MHSD during the entirety of the 13-month pilot, according to city 911 data. Nearly all of those calls were in the first nine months of the program. Since June, only five 911 calls have been routed to MHSD.
That’s a tiny portion of potentially eligible calls. NOPD reported that in 2020, it received 2,794 calls that were classified as either a “mental disturbance” or suicide-related in the pilot districts. (It’s not clear what percentage of those calls would have been determined “low-risk” or non-violent enough to route to alternative dispatch.)
And there has been no information or analysis released regarding the ultimate outcome of those calls — including whether a team was sent out, response times, whether outreach teams requested law enforcement backup, or what sort of services were provided to those in crisis.
Tyrell Morris, OPCD’s executive director, told The Lens last month that the pilot program provided “better defined data metrics,” and that the organization was working on a “a really close up close evaluation of what happened to that call” after it was sent.
But OPCD declined to provide any of its data to The Lens, and none was presented to the Mobile Crisis Strategy Task Force.
Dr. Avegno told The Lens that she had only seen some basic information showing whether or not those calls were actually responded to in-person by a mobile crisis response team, and said that it was her impression that very few were.
“In almost no disposition — perhaps no disposition — did the team go out onto the scene,” Avegno said. “Some of it was, ‘We’ll try to talk on the phone.’ Some of it was, ‘We’ll call you back in the morning.’ It was not sort of that really warm handoff in the moment, assistance and communication that we are looking for in an alternative dispatch system and that’s become the standard of care elsewhere.”
Dr. Rochelle Dunham, executive director of Metropolitan Human Services District, said that part of the problem with the pilot was that the calls were not transferred directly from OPCD to MHSD, and instead MHSD was given information about the callers and expected to follow-up, which did not always work out.
“The identifying information that was entered into our system was not always sufficient enough for our people to back track who that person was and to make a clean connection with them so that they would get the care,” Dunham said.
She said that she did not have any data on the ultimate outcomes of the calls that were transferred from 911.
“The thing that stands out most in my mind, honestly, is the fact that that process was not sufficient enough to ensure that the person got the help they needed,” Dunham said. “And that there was a need to refine that process more, so that that was the outcome.”
Dr. Avegno said that the health department didn’t spend much time on the pilot program, and instead turned their attention to issuing an RFP and developing the broader program.
“It was pretty clear from the beginning that this was not going to be the model that we were going to utilize for alternative dispatch,” she said.