When a call to 911 is a call for compassion

Two years ago, Julius Graves, a homeless man who had long struggled with paranoid schizophrenia, started having a  psychotic episode while at a St. Louis bus stop, according to news reports that cited the police and family members. Police later reported he was acting irrationally and, when officers arrived, they couldn’t deescalate the situation by talking to him. Officers then stunned him with Tasers three times. Paramedics  gave Graves a sedative and antipsychotic medication.

He was immediately taken to a hospital when his pulse and breathing faltered.

Four days later, Graves died in a St. Louis hospital at 43. “He was just sick, he wasn’t a threat to anyone else,” says Tiffany Lacy Clark, chief operating officer of Behavioral Health Response (BHR), a nonprofit that provides crisis support, telephone counseling and mental health resources for Missourians. She had worked with Graves when he was a client at her previous job in mental health services. “It was an unnecessary loss.”

Now, Lacy Clark and her team are working with St. Louis officials and police on a new mental health initiative they hope will prevent similar tragedies. Through the city’s 911 diversion call program, dispatchers are trained to recognize behavioral health crises or traumatic events. Dispatchers then connect the officer on the scene by phone with a clinician. In difficult situations, BHR can send to the scene a crisis response unit, made up of a crisis intervention-trained police officer and a mental health clinician.

“Had we had a program like this a few years ago, our team would have been able to deescalate and end that situation differently,” Lacy Clark says of Graves’ death.

The new BHR program in St. Louis comes at a time when Americans are reckoning with police responses to 911 calls, following the killing of George Floyd by a police officer in Minneapolis last year. BHR’s work and other community policing initiatives may offer new models for municipalities and police forces to use as a way to build trust with citizens.

The problems involving mental health episodes and policing are complex and widespread. A 2019 analysis by the Prison Policy Initiative, a criminal justice think tank, found that people arrested multiple times in a single year were three times more likely to have a serious mental illness than people with no arrests in the same year. Many police officers are not adequately trained to handle them, leading to arrests — or, in Graves’ case, far worse — when mental health interventions may be more warranted.

The St. Louis program aims to deescalate situations involving mental illness, to keep people safe and out of the emergency room or jail, and to get residents the important help and services they need to heal. Cities, overtaxed emergency services and prisons not well-equipped to deal with those with a mental illness could also save time and money. St. Louis receives 700,000 calls to 911 each year, with up to 5,000 expected to be diverted to the new service.

Research has shown that crisis intervention training also protects the police officers themselves. Memphis, which pioneered a community-based model of mental health interventions, saw an 80% reduction in officer injuries during these types of crisis calls.

Changes that matter

The BHR program launched in February and is already showing some early signs of success. Through early June, BHR intervened in around 600 calls in St. Louis, guiding people in crisis away from the criminal justice system or emergency rooms and into the hands of several dozen community organizations, including behavioral health providers, vocational services and housing providers.

During one incident, a St. Louis woman’s family called 911 after it was concerned about her behavior at home. BHR dispatched a crisis response team to the family home, and the officer and clinician spent 45 minutes speaking with the woman to where she could safely rejoin her family.

A follow-up care coordinator then connected the woman to a longer-term health provider and support for finding housing and a job. The woman was so impressed with the caring approach that day that she contacted the mayor’s office to give thanks.

“She was really touched,” Lacy Clark says. “The officer’s ability to connect with her was different than she ever experienced before. It meant so much to her to have a different response and tone. Having a clinician there changed the dynamics of the relationship.”

Another police officer with the program who worked with another young woman learned she loved to paint, so he gave her money for art supplies. She painted him three canvases, writing on one, “Thank you for doing what you did. You are kind beyond belief. Your help + caring calmed me down and gave me soothing relief.”

Officers, too, have responded well to the program. It’s community policing presented to them in a new way, Lacy Clark says. Best of all, she says, officers are truly getting to know the people in their community.

“They’re Bob or Craig,” Lacy Clark says. “Now they’re people, not problems.”

Driven by data

Data-driven insights will be essential to show elected officials that programs like this work. To that end, Mastercard plans to work directly with 911 call program leaders by analyzing BHR and police data with its Test & Learn software.

The analytics tool is typically used by business analysts to quickly find out what’s working and what isn’t, uncovering trends in data about, say, airline loyalty offers and banks’ consumer outreach work. For example, Mastercard helped a major European retailer figure out which stores to keep open during the early months of the pandemic. Data quickly showed that traffic was shifting to smaller stores in more residential areas, allowing the company to focus on where its customers were going.

“These insights and the improvements they propel can be powerful tools on the front lines of social change,” says Dimi Dosis, president of Mastercard Advisors. “We hope the use of Test & Learn for this transformational initiative can help more people in need get the help they deserve.”

Mastercard plans to help Lacy Clark and her team uncover insights to improve the program.

“To really understand our impact, these insights are critical,” Lacy Clark says, “and I believe that they will support that this program can save lives in multiple ways.”

Lacy Clark hopes to scale up the program gradually, adding to the number of clinician and officer teams. But for now, she’s thrilled with the help that’s already been given to so many people.

“This program has really helped people see the humanity in others and remember that this is about saving lives,” she says. “There’s less space now for people to fall in between the cracks.”