Dallas Works to Avoid Sending People in Crisis to Emergency Rooms or Jails

This article was edited on December 10, 2020 to clarify the number of bookings into jails each year rather than the number of people booked.

In communities across the United States, police, jail officials, and emergency room physicians too often provide the only services available around-the-clock to respond to people with untreated mental illness or substance use disorders. However, a team in Dallas has been piloting a new multidisciplinary approach so that people can get the help they need—and stay out of the criminal justice system.

Most cities and towns continue to rely on law enforcement as the first response to people in crisis. This practice contributes to more than 2 million bookings into jails each year of people with serious mental illness. Criminal justice stakeholders and mental health advocates say sweeping policy changes are needed to focus on safe crisis response interventions that can reduce the role of police in managing calls related to behavioral health emergencies while creating access to services and assuring public safety.

The default to police, jails, and emergency rooms has proved costly and typically prevents people from accessing evidence-based treatments to address their mental health needs safely. Even before this year’s calls to rethink approaches to law enforcement and associated funding, a pilot program in Dallas—the Rapid Integrated Group Healthcare Team, or RIGHT Care—has focused on addressing health needs first. The program model, in place since 2018, redefines the city’s response to those in crisis, redirecting many from the justice system to community-based services. And that shift appears to be working.

Data from communities across the country show that 1 in 5 jailed adults has a serious mental illness. In Texas, about 30% of people in local jails had at least one such illness in 2015, according to an analysis by the Hogg Foundation for Mental Health at the University of Texas, Austin. That year, the Meadows Mental Health Policy Institute (MMHPI) partnered with the Dallas Police Department and city officials to use a data-driven approach to understand the number and location of 911 calls that identify mental health issues as the primary concern. MMHPI also conducted focus groups with police officers across Dallas to hear their concerns and recommendations as primary responders to mental health calls.

MMHPI and its partners discovered a 17% increase in 911 calls from 2012 to 2015 that involved mental health concerns, and an 18% increase in the number of people booked into the county jail who were identified as having severe mental health needs. In response, the Police Department, Dallas Fire-Rescue, and Parkland Hospital teamed up to pilot the program, which is intended to reduce the use of jails and emergency departments and connect people experiencing mental health emergencies to appropriate services.

In the Police Department’s South Central Patrol Division, RIGHT Care brings together a multidisciplinary team of paramedics, police officers, and social workers who collaborate to provide screening and support to divert those with mental health needs from jails or emergency rooms. With this health-centered approach, the team puts medical responders in the lead, ensuring that people can be swiftly connected with the services that most appropriately meet their behavioral health needs.

Trained clinicians at the 911 call center flag those calls that raise mental health concerns and provide resources over the phone when possible. If further support is deemed necessary, the RIGHT Care team responds. For higher-risk calls, a police unit ensures that the area is secure, and the team then approaches the scene. With the RIGHT Care officer on-site to provide security and assess for crimes committed against the person in crisis—something that is far too often overlooked—a paramedic will conduct a medical assessment while a social worker does a behavioral health evaluation. The approach helps to ensure that people have streamlined access to the evidence-based treatments and supportive services they require, as well as protection from ongoing victimization while freeing up limited emergency and law enforcement resources.

Early results indicate promising outcomes. Since its inception, the team has responded to more than 6,000 calls resulting in fewer than 300 arrests, and many of those arrests were for outstanding felony warrants. Data indicate that more than 2,500 people were diverted from hospitals and jails and referred to a range of social or medical services, based on the severity of their conditions.

This alternative approach to 911 calls involving mental health disorders, and compelling data highlighting RIGHT Care's initial successes in a single police precinct, has created interest for program expansion in Dallas. It also has received national attention as cities grapple with similar concerns in their jurisdictions.

Recognizing the promise of this new approach, Pew and MMHPI began working together in April 2020 to help identify specific practices that Dallas would need to put in place and potential funding sources, including support from local philanthropic organizations, to expand the program citywide. As a result, the city and county governments have endorsed expansion of the program's reach and are more than doubling their investment to $3 million in fiscal year 2021.

In reimagining the response to people in distress, the RIGHT Care team is demonstrating better outcomes for those in need of behavioral health services by connecting them to appropriate supports and diverting them from the often harmful collateral consequences, including repeat offenses, that can come from further involvement in the criminal justice system. Moreover, the pilot offers support to overburdened law enforcement and health care systems and ultimately may save taxpayer dollars by reallocating funds to more appropriate, evidence-based programming.

 “RIGHT Care has been a success in its own right, but it has also been a vehicle for better integrating care across Dallas,” said Dr. Andy Keller, MMHPI’s president and chief executive. “With the city and county as partners, and Fire and Rescue, police, and the major Dallas hospital operating in tandem, RIGHT Care illustrates that innovative solutions can be found to one of the most pressing social issues we face.”

In a time when decision-makers across the country are seeking to make critical policy and practice reforms, the RIGHT Care model demonstrates promising tactics to move the system of crisis response from a law enforcement to a health-centered approach.

Tiffany Russell directs The Pew Charitable Trusts’ mental health and justice partnerships project, and Alyssa Doom is an associate manager with Pew’s Results First initiative.