Mental health crisis response pilot expands, despite ongoing struggles

“What we appeal to is people who are really, really interested in trying to make…

Mental health crisis response pilot expands, despite ongoing struggles

“What we appeal to is people who are really, really interested in trying to make a change to the system,” she said.

Lofty goals aside, B-HEARD is struggling to find enough staff, leading to lower than anticipated spending that prompted city officials to decrease its budget two years in a row. The problem, which the city blamed on national shortages of mental health professionals and EMS workers, has delayed the program’s expansion efforts and limited its bandwidth to serve New Yorkers in the areas where it already operates.

Yet Mayor Eric Adams’ administration has forged ahead with his predecessor’s plan to extend the pilot citywide, despite calls from B-HEARD’s most vocal supporters to to tap the brakes and reassess the program. Last month B-HEARD rolled out its biggest expansion so far, marking its first foray into Queens and giving it a presence in every borough but Staten Island. Its three-person teams will now respond to emergencies in 25 police precincts across the city, up from the three Harlem precincts served when it launched in June 2021 under former Mayor Bill de Blasio.

The expansion comes as Adams has made reforming the city’s crisis response system a priority in his broader mental health policy agenda, after the pandemic exacerbated mental health issues and strained a system that already struggled to meet demand for services. Now his administration has to reconcile two conflicting realities.

While city data indicate that B-HEARD has so far fallen short of its promised impact, the police-driven status quo continues leaving people in crisis seriously injured or dead. About a quarter of all fatal police shootings in the U.S. involve someone in the midst of a mental health crisis, according to one tally.

“I’m so, so grateful and excited that it exists,” City Councilmember Tiffany Cabán, who has been one of the program’s biggest boosters, said of B-HEARD. “But we have to make sure that it is the best sort of product that we could put out in our communities to get the best outcomes.”

Ongoing constraints: After the de Blasio administration unveiled B-HEARD, officials said the teams would become the “primary” responder to mental health-related 911 calls, but available data show the teams are far from hitting that benchmark.

The most recent public data, which reflect the 2021-2022 fiscal year, show B-HEARD responding to only 16 percent of mental health calls in the areas where the program operates.

City officials have defended the performance as on par with similar programs across the country. But CAHOOTS — the pioneering Eugene, Ore., crisis response program that B-HEARD is modeled after — takes almost 24,000 calls a year with 40 team members.

Eugene only has 175,000 residents, a far cry from New York City’s 8.3 million, but its program nonetheless manages to handle about 17 percent of all calls coming through the city’s public safety communications center, according to a news report.

B-HEARD has successfully diverted a number of calls that would have otherwise gone to police and led to possibly unnecessary hospitalizations, but employees acknowledged that hiring challenges and the time-intensive nature of their work are limiting their impact.

NYC Health + Hospitals has 27 mental health clinicians on B-HEARD teams — positions that pay between $66,000 and $98,484, a spokesperson said. Staffing on the EMS side, which is handled by the FDNY through internal recruiting, includes one captain, 13 lieutenants and 50 emergency medical technicians and paramedics.

The Health + Hospitals spokesperson declined to share the number of unfilled positions, saying only that the hiring process is rolling, but the system’s website listed three open social worker roles as of Wednesday.

A spokesperson for the Mayor’s Office of Community Mental Health, which oversees B-HEARD, said its funding has decreased to reflect lower-than-expected spending. A $50 million budget for the 2021-2022 fiscal year fell to $30 million. The $55 million the Adams administration budgeted for the current fiscal year was whittled down to $43 million. The city has not released a complete budget proposal for the upcoming year.

B-HEARD operates between 9 a.m. and 1 a.m. every day, but current staffing levels mean there is typically only one team at a time assigned to respond to 911 calls in a given area. If the team is already in the field when another call comes in, or if a call falls in the 8-hour window when B-HEARD is offline, NYPD and FDNY respond.

It’s not an unlikely scenario, given how much time a team may spend with people in crisis. First the EMS workers check vital signs and identify immediate medical needs. Then a social worker asks about mental health history and what happened in the leadup to the 911 call. The team also talks to family members or anyone else around. But first they have to restore calm. That takes time and a range of tools, from breathing exercises to coloring books.

“Sometimes jobs have taken two hours,” Zoraida Fuentes, a B-HEARD social worker, said in an interview. “It’s because you want to de-escalate the person enough where they can really articulate — in the best way that they can — what they need.”

During the last fiscal year, about 27 percent of all calls forwarded to the teams were instead handled by traditional police and EMS responders. That was typically because B-HEARD teams were out on another call at the time.

Nonetheless, Adams pledged in early March to make B-HEARD available citywide. His administration has not shared a timeline, but budget documents make clear that Adams will expand it slower than de Blasio — who made the same promise — had envisioned.

De Blasio budgeted $92 million for a citywide B-HEARD expansion in the 2021-2022 fiscal year. After Adams took office at the start of last year he slashed B-HEARD’s budget to $50 million and then again to $30 million, which the administration determined would better match costs based on the expansion schedule, said a spokesperson for the Mayor’s Office of Community Mental Health.

The unused funding was reallocated or used to close budget gaps, the spokesperson said.

The continuing role of police: In the eyes of mental health and police reform advocates, a better crisis response system cannot come soon enough.

They point to a recent police shooting in the Bronx as an inevitable consequence of the NYPD continuing to respond to 911 calls that involve “emotionally disturbed persons,” as the department refers to them.

Since 2007, at least 26 New Yorkers have been killed in encounters with police while they were experiencing a mental health crisis, according to a tally by the social services nonprofit Community Access. The group and other advocates cite those incidents and the recent Bronx shooting as evidence that police should not be involved in responding to mental health-related emergencies.

“At least in my mind, it’s not that police can’t be responders — it’s that they should not be first to respond,” said Jordyn Rosenthal, advocacy coordinator for Community Access.

The NYPD’s uniform “can be really triggering for someone in crisis,” who may have had previous negative interactions with police, further escalating a situation that is already at a fever pitch, Rosenthal added.

That appeared to be the case last month for Santo de la Cruz, whose father recounted calling 311 instead of 911 because he “didn’t want something bad to happen” to his son, he told Gothamist. He told the news outlet that he had wanted health care workers to commit his son, who was in the midst of a schizophrenic episode at his apartment, before something went awry. Instead, the police shot him within 28 seconds, after reportedly giving instructions in a language he does not speak.

NYPD Chief of Patrol John Chell said de la Cruz had threatened to kill any police officers who showed up there.

“The subject comes out, clearly becomes agitated when he sees the officers, drops a bag, produces a large kitchen knife and starts advancing towards the officers,” Chell said at a briefing. “The officers give numerous instructions to drop the knife, at which time he did not comply. They discharged the firearms, striking the subject.”

The incident happened in Kingsbridge in the Bronx, where B-HEARD does not operate. Even if it did, 911 call dispatchers do not send B-HEARD calls that involve someone who is being violent, has a weapon or presents a risk of imminent harm to themselves or others.

These calls, which sometimes include cases when dispatchers do not have enough information to assess risk of imminent harm, are handled by NYPD and EMS. Once on the scene, police or EMS can request B-HEARD support, but it is unclear how often that happens.

Similarly, Eugene sends police or EMS instead of or in addition to CAHOOTS to calls that involve violence. But unlike CAHOOTS, which is embedded in Eugene’s 911 system but also has its own phone number, there is no way for New Yorkers to request a B-HEARD response.

Jason Hansman, deputy director of mental health initiatives for crisis response at the Mayor’s Office of Community Mental Health, said New Yorkers could instead call the NYC Well hotline, talk to a counselor and be connected to a mobile crisis team.

But that only applies to non-life-threatening situations. Mobile crisis teams, which include clinical staff and peer specialists, respond within a matter of hours, while B-HEARD teams take an average of 15 minutes and 30 seconds to respond.

There is also no way for 911 dispatchers to patch callers through to NYC Well, a much lesser-known, nine-digit phone number that offers free counseling around-the-clock and connects callers to mental health and substance use services.

“It’s something that we’re thinking about as we think about the crisis system writ large, about how we can make sure that when people call whatever number they’re calling they get the appropriate response,” Hansman said in an interview.

If and when B-HEARD becomes available citywide, it would still be dwarfed by the NYPD — the largest municipal police department in the U.S., with roughly 35,000 uniformed officers.

The city has not detailed what a citywide B-HEARD program would look like. But assuming the program scaled up staffing at the same proportion it has now to serve 25 precincts, that would mean just 280 people for all of the city’s 77 precincts.

“We probably would not expect B-HEARD to ever have the same number of staff as PD and EMS,” Laquisha Grant, senior director of crisis response for the Mayor’s Office of Community Mental Health, said. “Mental health calls are 10 percent of all 911 call volume.”

Behind the scenes: When it comes to calls B-HEARD does answer, teams have succeeded in averting unnecessary hospitalizations and police responses to mental health emergencies.

Fifty-four percent of people assisted by B-HEARD teams were brought to a hospital during the 2021-2022 fiscal year, compared to 87 percent of people who received the traditional emergency response of police and EMS, according to city data.

Thirty-six percent of people were connected to care in their communities, such as mental health and substance use services, counseling and peer support.

Those outcomes are partly a product of B-HEARD’s model, but they also reflect the people who felt drawn to work on the pilot, some of whom have experienced their own mental health challenges.

New team members undergo four weeks of training, which includes a panel discussion among people with firsthand experience of a mental health crisis response. They also practice responding to hypothetical scenarios alongside actors who are trained to dial down or escalate their reactions based on how the trainees interact with them.

Consuegra and four other B-HEARD workers interviewed by POLITICO said the job is emotionally draining but rewarding.

“You see this really wide scope of possibility happen for real healing, where it doesn’t feel like things are repeating themselves,” social worker Salley May said.

However, city officials acknowledged the program has struggled to recruit staff, especially for nighttime shifts. FDNY offers a 6 percent pay bump for any employee who completes mental health and situational awareness training, but there is no increase specifically for EMS workers who join B-HEARD, according to Deputy Chief Cheryl Middleton.

EMT salaries start at just over $39,000 a year.

What’s next: The city’s ability to successfully scale up B-HEARD also depends on other programs having enough capacity to take on more people brought to them over hospitals.

The destinations where B-HEARD teams can take callers include the Department of Health and Mental Hygiene’s Support and Connection Centers in East Harlem and the Bronx, which provide short-term services to stabilize people who need immediate attention for mental health or substance use concerns but do not require hospital-level care. Each one can serve up to 25 people at a time, for stays as long as 10 days.

The East Harlem center saw just under 300 visits during the 2021-2022 fiscal year, according to the most recent available data. The city has yet to release any data on the Bronx center, which opened last summer after a long delay.

De Blasio’s administration had projected in 2020 that the centers would serve about 2,400 people annually, at a cost of $10 million a year.

A Department of Health spokesperson said the two existing centers have the capacity to serve the expected increase in clients from B-HEARD’s latest expansion, but the city has no projections for how many more calls the teams will answer with the 10 added precincts.

Cabán and other advocates noted that they support the expansion but first want to see more data on the program’s outcomes to assess any necessary tweaks. Rosenthal, of Community Access, suggested an oversight hearing to probe why more calls are not being routed to B-HEARD and why sizable shares of people are still being transported to hospitals.

“We have really great ideas about how we want to implement innovative solutions, but then on the ground … different things come in the way that really impede on the vision,” Rosenthal said. “B-HEARD as it currently stands is not sufficient as a non-police alternative.”