"Baltimore is revolutionizing its approach to emergencies by leveraging opioid settlement funds to create a 24/7 crisis response system that prioritizes mental health professionals and community support over traditional law enforcement, aiming to offer hope and resources instead of arrests for residents in distress."
This initiative marks a significant shift in how Baltimore addresses a wide spectrum of public safety calls. By redirecting funds from opioid-related legal settlements, the city is investing in a comprehensive, round-the-clock service designed to respond to non-violent crises with specialized care. This approach moves away from relying solely on police, firefighters, and EMTs for situations that do not inherently require armed intervention, offering a more compassionate and effective pathway to resolution for individuals in need.
Baltimore Pivots to Community-Centered Crisis Care with Opioid Settlement Funds
In a notable departure from traditional emergency response models, Baltimore is deploying significant funding derived from opioid-related legal settlements to build a robust, 24/7 crisis intervention system. This strategic investment aims to address a growing need for specialized responses to non-violent emergencies, prioritizing mental health professionals and peer counselors over law enforcement. The initiative seeks to provide timely and appropriate support for a range of situations, from mental health crises to social welfare issues, ultimately diverting individuals from the criminal justice system and connecting them with essential resources.
The transformative potential of this new system was underscored by an incident in March, where mental health clinician Michala Williams met a 38-year-old woman in a McDonald’s parking lot. The woman, in profound distress, had called the police for help. Sobbing uncontrollably, she spoke of overwhelming challenges: caring for children aged two to twenty-two, grappling with personal health issues, and facing the recent incarceration of her fiancé. Her despair was so acute that she had lost her appetite.
This was not the first time the woman, who requested anonymity to speak openly about her mental health, had sought assistance. The previous month, she had attempted to reach a hospital by driving herself but was pulled over due to an expired car registration. Her desperation was palpable as she recounted, "I don’t care if I get pulled over. But I was saying, ‘I don’t know what to do. I just want to go to the hospital.’" Instead of receiving medical attention, the officer arrested her for erratic behavior, leading to an experience in a "cold cell" where basic needs like using the bathroom were unmet.
Fortunately, on the day she encountered Williams, the 911 dispatcher recognized that the situation called for a different kind of intervention. Instead of dispatching police, the dispatcher routed the call to one of Baltimore’s mobile crisis teams. These teams, comprising a clinician and a peer counselor, are designed to meet individuals experiencing mental health distress directly, offering immediate, on-site support. Within an hour, Williams had not only provided a listening ear but had also secured vital referrals for the woman, including connections to a psychiatrist, a therapist, legal aid, and a case manager. The case manager’s role was crucial in assessing her child with autism for eligibility for government services.
"She’s been through a lot of trauma, and no one is going to deny that," Williams stated, emphasizing the complex needs of the woman. "But I now have to take all of that and decide, ‘OK, here’s steps 1, 2, and 3,’ because we’ve got to find a little bit of sliver of something to give her some hope that there’s help out here."
For years, mobile crisis teams overseen by Behavioral Health System Baltimore (BHSB), the city’s designated mental health authority, have been instrumental in diverting calls from police to mental health professionals. However, their scope has historically been limited to acute mental health crises. The new expansion, fueled by approximately $400 million allocated to Baltimore from opioid-related legal settlements, aims to broaden this service significantly. The goal is to establish a 24-hour operation capable of responding to a wider array of crises where police intervention is not the most appropriate or effective solution.
Baltimore’s 911 system is a bustling hub, logging an estimated 1.68 million calls in 2024 alone. According to Tahir Duckett, an expert in community safety at Georgetown Law, a substantial portion of these calls—tens of thousands—do not necessitate traditional emergency services like police, fire departments, or paramedics. These non-traditional calls can range from addressing a homeless individual sleeping in a public space, to assisting a disoriented person in a park, or de-escalating a situation involving someone shouting in the street.
Duckett argues that such situations "don’t require a badge, a gun, and handcuffs to resolve." He highlights a critical consequence of relying on law enforcement for these calls: individuals often end up in jail rather than receiving the help they genuinely need. This observation is supported by recent research. A study conducted in Durham, North Carolina, found that when non-law enforcement teams responded to 911 calls, arrests decreased compared to police responses. This disparity was particularly pronounced for Black individuals, men, and those aged 25-39. Beyond arrest rates, police responses can inadvertently inflict trauma and lead to less favorable outcomes than those achieved by community service-oriented responses. The underlying principle of Baltimore’s expanding mobile crisis teams and its new comprehensive service is to identify the specific needs of individuals in crisis and connect them with the appropriate resources, thereby avoiding unnecessary arrests.
The city’s decision to invest in this expanded crisis response is situated within a broader context of public health challenges and successes. While Baltimore has experienced a significant decrease in its homicide rate—a 60% drop between 2021 and 2025, setting records for violence reduction—it has simultaneously faced a national crisis of drug overdoses. Between 2020 and 2023, approximately 1,000 individuals in the city died annually from overdoses.
Baltimore’s proactive stance on the opioid crisis was evident in 2018 when it opted out of a global settlement with opioid manufacturers and distributors, choosing instead to pursue its own legal action. As these lawsuits concluded, city officials committed to dedicating settlement awards to addressing drug-related harms. This includes funding services aimed at preventing addiction, such as housing support, healthcare, and educational programs.
One tangible program emerging from this commitment is the installation of naloxone kits, the overdose reversal drug, at every subway stop, directly confronting the epidemic of overdoses. The expansion of 911 services is a key component of a larger strategy to bolster city services, with $15 million from the settlement funds already allocated. Sara Whaley, Baltimore’s director of overdose response, expressed optimism that this expansion will encourage a paradigm shift in how the city perceives and responds to residents in crisis, regardless of the nature of their 911 call.
Whaley views each 911 call as an opportunity to solve problems rather than resorting to punitive measures. "What are the wraparound services and support that can help prevent them from being involved in this, in that emergency system?" she asks, framing the core objective. For instance, an individual found sleeping in a public place might require connection to community housing resources. The overarching aim is to reduce violence, ensure individuals receive proper resources, and break the cycle of incarceration that often ensnares those grappling with poverty, addiction, and mental health challenges.
Rebecca Neusteter, executive director of the Health Lab at the University of Chicago, whose research focuses on the impact of such services, notes that they provide "peace of mind for callers that they’re going to be met with the right response at the right time." Furthermore, she observes that "responders themselves feeling like they have a better toolbox in their ability to pursue actual resolution to these calls."
In developing its expanded system, Baltimore has drawn inspiration from cities like Durham, which have successfully implemented similar models for rerouting non-emergency calls. Durham’s program, known as the Holistic Empathetic Assistance Response Team (HEART), has reportedly diverted over 12,000 calls in four years. Critically, police backup was required in only 0.02% of these instances, and the program has contributed to improved response times across all categories of 911 calls.
Durham’s HEART program has meticulously documented its interventions, illustrating the diverse ways non-police responders have provided assistance. These range from securing housing for a woman escaping domestic violence to arranging medical appointments for a homeless veteran. In one notable case, a hotel manager contacted 911 seeking help to find overnight accommodation for a blind man, as the hotel lacked accessible rooms. HEART responders successfully booked him a room and, the following day, facilitated transportation for him to meet with an organization dedicated to securing housing solutions. These examples highlight the tangible and compassionate outcomes achievable when specialized community services are prioritized.
