Increased funding to redirect crisis calls to mental health responders rather than the police

October 22, 2020

AUSTIN, Texas — Mackenzie Ulam volunteers at a crisis text line and has stayed up with people as they contemplated ending their life. Ulam knows the weight of her words in those moments.

“You have people texting in, ‘Are you going to call 911 on me because that’s not something I want,’” said Ulam, president of the National Alliance on Mental Illness chapter at the University of Texas at Austin.

Of the 15 largest U.S. cities in 2018, Austin had the highest per capita rate of people killed by police responding to mental health calls, according to a report released by the city of Austin’s auditor. In August 2019, Mauris DeSilva was found holding a knife up to his throat and began walking toward the officers when they opened fire. A mental health officer had been heading to the scene from a different crisis call.

Austin city council members said they recognize the work that needs to be done in redirecting crisis calls to mental health responders, rather than the police.

The city council authorized increased funding by a total of $4,050,000 towards the city’s collaboration with Integral Care, a community-based mental health center that provides behavioral health and intellectual disabilities services in Travis County.

Additional funding for Integral Care’s Expanded Mobile Crisis Outreach Team (EMCOT) will expand the staff to ensure 24/7 access and give 500 tablets to first responders to call in with a nurse practitioner and psychiatrist.

The outreach team will begin receiving direct transfer of 911 calls assigned to Austin-Travis County Emergency Medical Services on Oct. 29.

“This is a program that can save lives, that can serve the community and make sure that people get the response that they need,” council member Gregorio Casar said.

Marisa Aguilar, practice manager of Integral Care’s crisis team, said the pandemic has caused an increase in suicide attempts and ideations, domestic violence and substance use issues.

“By incorporating EMCOT into the 911 Call Center, our community is shifting how we view and respond to mental health crises — treating it as a healthcare issue rather than a criminal issue,” Aguilar said.

Joseph Chacon, assistant chief for the Austin Police Department, said mental health response is one of the police department’s top priorities right now.

“It touches so many different people in our community and it knows no boundaries when it comes to education levels, socioeconomic levels or what town you live in,” Chacon said.

Ulam said there needs to be change around who to call for different circumstances. She said people often call the police department because they don’t know who else to ask for help.

“It can be very traumatizing when the cops are called on you without your consent,” Ulam said. “Then you have people who do die by suicide in the future because they’re afraid of something further traumatizing happening to them.”

Integral Care’s crisis team members receive 500 hours of specialized training on crisis response and are also able to provide mental health training to first responders and APD 911 call takers. All Austin police officers go through a 40-hour Crisis Intervention Team training and CIT designated officers go through an additional 40 hours of training on mental health.

Training consists of scenario-based teaching with actors and a partnership with NAMI and Integral Care that bring in real people to share their personal stories with mental illness.

Transitions are currently in place for all officers to receive the full 80-hour training, but the police department suspended training due to COVID-19.

“Having real-life conversations builds that empathy,” Chacon said. “You can’t do that over Zoom.”

When the outreach team’s clinicians arrive on scene, they give an assessment that includes suicide risk, housing status, food security and substance use and can provide up to 90 days of follow-up services to ensure people have ongoing support and access to behavioral health services.

“When EMCOT responds, they are able to engage around what is causing the behavior rather than the result of the behavior,” Aguilar said. “This is how individuals are successfully diverted from the criminal justice system.”

In fiscal year 2019, Aguilar said EMCOT was dispatched 3,182 times with a 99% diversion rate from arrest and a 90% diversion rate from involuntary commitment.

“Most people will experience a mental health crisis at some point in their life,” Aguilar said. “A crisis can happen after life changing, sad or scary events, and doesn’t always mean someone has a mental illness.”

Ulam said she hopes to see improvements in accessibility, affordability and protection against discrimination regarding mental health and mental illness.

“The easiest change that can be made is the dialogue that we use,” Ulam said. “If you haven’t suffered with mental health before, you need to be able to say, ‘I don’t understand and that’s okay.’”