Baltimore, MD

911 Diversion Pilot – Baltimore, MD

October 11, 2022

In June 2021, the city of Baltimore, MD, launched the Behavioral health 911 Diversion Pilot Program, with the goal of diverting certain mental health-related 911 calls from law enforcement to experienced mental health specialists through the three-digit 988 crisis line (formerly named the Here2Help hotline). The program is housed within the city’s emergency response network and is a partnership between Behavioral Health System Baltimore (BHSB) and Baltimore Crisis Response, Inc. (BCRI).

Unlike some other community responder programs, Baltimore’s 911 diversion program is not a singular organization, but an expansion of its existing crisis services. Through the pilot program, mental health specialists that already provide crisis assistance through the 988 hotline now respond to three additional 911 call types, providing de-escalation assistance, crisis aid, and referrals to additional resources. Mobile crisis teams employed by BCRI can also be dispatched to provide in-person aid should the BCRI clinician determine that response is necessary.

The following information outlines Baltimore’s 911 diversion program efforts since it began; it follows the sections of the toolkit. Readers can connect to other parts of the toolkit by clicking the headers for more details.

 

Photo credit: Baltimore Crisis Response, Inc

 

Community Engagement and Collaboration

• Baltimore established the Collaborative Planning and Implementation Committee (CPIC) to assist in evaluating the 911 diversion program’s outcomes and making recommendations for improvement. The CPIC is made up of people and organizations representing a wide range of disciplines, such as community members, service providers, behavioral health advocates, and other city partners, who work to improve interactions between law enforcement and people with behavioral health needs.
• The vision of CPIC is that Baltimore will develop a system of care that:
  • Treats all people with dignity and respect,
  • Prevents people from having unnecessary contact with the police,
  • Diverts people away from the criminal justice system into services that will meet the needs of the individual and their families, and
  • De-escalates crisis situations with minimal or no use of force.
• Read the CPIC charter to learn more about its guiding principles and core components.

Needs Assessment

• After the 2015 death of Freddie Gray while in police custody in Baltimore, city officials asked for the U.S. Department of Justice to conduct an investigation into patterns and practices of the Baltimore police department. This led to a 2017 consent decree, under which, the city agreed “to conduct an assessment to identify gaps in the behavioral health service system, recommend solutions, and assist with implementation of the recommendations as appropriate.”
  • • The goal of the assessment was to analyze a sample of police interactions with people who have behavioral health conditions and to identify systemic barriers and solutions. Baltimore’s Public Behavioral Health System (PBHS) was also tasked with identifying gaps in behavioral health services, problems with the existing services, and other issues that could lead to justice system involvement. Baltimore published its findings in December 2019 in the Public Behavioral Health System Gap Analysis Report.
    • Following the release of the Gap Analysis Report, the city developed the Gap Analysis Implementation Plan to address the analysis report’s recommendations, outlining a multi-year approach to reduce unnecessary police encounters with people in crisis. The report and plan both highlight the non-enforcement measures the city committed to in order to bridge the gaps that lead to these unnecessary interactions, one of which was the pilot program already being developed.

Call Triaging

• Calls are dispatched via 911. If 911 call takers identify a call as appropriate for diversion, they will transfer the call to the 988 hotline, which is a mental health services line operated by BCRI and staffed by trained mental health specialists. The 988 hotline can also be called directly.
• Staff who answer 988 calls can resolve them over the phone or dispatch a team of clinician responders. In June 2021, as part of the pilot program, Baltimore’s 911 center started forwarding two suicidal ideation call types to the hotline for phone or in-person response. And in April 2022, Baltimore expanded eligibility for the diversion pilot program to include a third call type related to suicidal ideation.

Program Staffing

• The BCRI mobile crisis teams includes mental health professionals—psychiatrists, social workers, and nurses—who provide immediate assessment, intervention, and treatment. If residential treatment is necessary, the team immediately transports the client to their facility. There are currently eight teams operating 24/7.
• The 988 hotline is available 24 hours a day, 7 days a week, and staffed by the same mental health specialists who participate in the pilot program.
• Officials expect to increase capacity of the currently operating mobile crisis teams, fund a youth-specific mobile crisis provider, and pilot embedding a specialist within the 911 call center.

Use of Data to Inform Decision Making

• An internal working group—including data fellows, the Baltimore City Fire Department’s medical director, and stakeholders from the Baltimore police department, emergency medical services, 911, and others—provides weekly quality assurance. This includes examining incidents when calls were diverted to figure out what worked and what did not work, as well as assessing incidents that could have been diverted and were not.
• As a result of these weekly meetings, city officials added a third call type for the pilot program to respond to and were able to receive funding for a clinician in the call center to help the specialists divert more calls.

Financial Sustainability

• The program is financed through state funding and grants allocated to BCRI.
• Earlier this year, the city of Baltimore received an award of $2 million in federally earmarked funds to support expansion of the 911 diversion pilot. The grant funding will last for 36 months, starting October 2022.
• The Greater Baltimore Regional Integrated Crisis System (GBRICS) is investing $45 million over 5 years to expand mobile crisis teams and community-based providers in Baltimore City, Baltimore County, Carroll County, and Howard County, including for Baltimore’s pilot 911 diversion program.

Legislative Strategies

• HB 108 allows the awarding of grants under the Behavioral Health Crisis Response Grant Program and created the 988 Trust Fund to help fund the 988 hotline. This bill allocates $5,000,000 each year in fiscal years 2023-2025 to maintain the fund, as well as allocates at least one-third of this appropriation be used for mobile crisis teams. Since the pilot program uses 988 staff and call triaging, it also benefits from this funding.