"Baltimore is transforming its approach to public safety by leveraging opioid settlement funds to create a 24/7 crisis response system that prioritizes mental health and social support over traditional law enforcement, aiming to reduce arrests and provide more effective, compassionate help to residents in distress."
Baltimore is at the forefront of a significant paradigm shift in how communities respond to public safety emergencies, particularly those rooted in mental health crises, addiction, and social vulnerability. By strategically allocating a portion of its substantial opioid-related legal settlement funds, the city is expanding its mobile crisis teams and developing a comprehensive, round-the-clock service designed to address a wider spectrum of non-criminal emergencies. This initiative moves beyond the limitations of existing mental health-specific units, aiming to reroute calls that historically would have resulted in police intervention, thereby reducing unnecessary arrests, mitigating potential trauma, and connecting individuals with the appropriate social services and healthcare resources. The program is built on the principle that many 911 calls do not require the presence of law enforcement, but rather a more nuanced, supportive, and specialized response.
The transformative potential of this initiative is vividly illustrated by the experience of a 38-year-old woman in Baltimore. Her desperate call to 911 in March, made from a McDonald’s parking lot, highlighted the profound need for a different kind of emergency response. Sobbing uncontrollably and expressing suicidal ideation, she was overwhelmed by a cascade of personal crises: caring for children aged 2 to 22, managing health issues, and dealing with the recent incarceration of her fiancé. Her situation had reached a point where she could not eat, a stark indicator of her deep distress.
Previously, her attempt to seek help had led to an unintended encounter with the justice system. Driving to the hospital the month prior, she was pulled over due to an expired car registration. Her plea to the officer, expressing an urgent need to reach the hospital, was met with arrest due to her erratic behavior. Instead of receiving medical attention, she found herself incarcerated in a cold jail cell, a deeply dehumanizing experience that compounded her suffering.
When she contacted 911 again, the dispatcher recognized that her situation was not a matter for traditional law enforcement. Instead, a specialized mobile crisis team, comprising mental health clinician Michala Williams and a peer counselor, was dispatched to meet her. This immediate, targeted response offered a lifeline. During an hour-long conversation, Williams not only validated the woman’s extensive trauma but also began to construct a path forward. Referrals were made for psychiatric and therapeutic support, legal assistance was arranged to address her fiancé’s situation, and a case manager was assigned to explore eligibility for government services for her child with autism.
"She’s been through a lot of trauma, and no one is going to deny that," Williams stated, emphasizing the complexity of the woman’s needs. "But I now have to take all of that and decide, ‘OK, here’s steps 1, 2, and 3,’ because we got to find a little bit of sliver of something to give her some hope that there’s help out here.” This sentiment underscores the core mission of the expanded crisis response: to offer tangible hope and actionable solutions in moments of profound vulnerability.
For years, Baltimore’s mobile crisis teams, overseen by Behavioral Health System Baltimore (BHS Baltimore), the city’s designated mental health authority, have been instrumental in diverting calls from police to mental health professionals. However, their scope has traditionally been confined to acute mental health emergencies. The new initiative, fueled by approximately $400 million in opioid-related legal settlements, aims to significantly broaden this capacity. The city plans to establish a robust, 24/7 service capable of responding to a diverse array of crises where police presence is neither necessary nor beneficial.
Baltimore’s 911 system handles a substantial volume of calls, with 1.68 million logged in 2024 alone. According to Tahir Duckett, an expert in community safety at Georgetown Law, a significant portion of these calls – tens of thousands – do not necessitate traditional emergency services like police, firefighters, or EMTs. These often involve individuals experiencing homelessness, confusion in public spaces, or behavioral disturbances that stem from underlying social or health issues rather than criminal intent.
Duckett articulates that such situations "don’t require a badge, a gun, and handcuffs to resolve." The current system often leads to individuals in these non-criminal predicaments being arrested, thereby entering the criminal justice system instead of receiving the support they genuinely need. Research, including a recent study from the National Bureau of Economic Research (NBER), has shown that non-law enforcement response teams in Durham, North Carolina, resulted in fewer arrests compared to police responses, particularly for Black individuals, men, and those aged 25-39. Furthermore, police encounters can be traumatizing and less effective in achieving a positive outcome than a community service-oriented approach. The Baltimore model directly addresses this by prioritizing needs assessment and connection to resources over punitive measures.
The city’s strategic use of opioid settlement funds is particularly pertinent given the complex public health landscape. Baltimore has experienced a significant decrease in its homicide rate, a 60% drop from 2021 to 2025, indicating progress in addressing violent crime. Concurrently, the city has grappled with a severe drug overdose crisis, with approximately 1,000 residents dying annually from overdoses between 2020 and 2023. This dual challenge underscores the interconnectedness of public safety, mental health, and substance use.
Baltimore’s proactive stance on the opioid crisis began in 2018 when it opted out of a global settlement with opioid manufacturers and distributors, choosing instead to pursue independent legal action. The resulting settlements have been earmarked for addressing drug-related harms and funding preventative services, including housing support, healthcare, and education. A new program exemplifies this commitment by deploying naloxone, the opioid overdose reversal drug, at every subway station.
Sara Whaley, Baltimore’s Director of Overdose Response, highlighted that $15 million in settlement funds has been allocated to expand 911 services as part of a broader strategy to bolster city services. She envisions this expansion as an opportunity to fundamentally alter the city’s response to residents in crisis, regardless of the reason for their 911 call. Whaley views these calls not as problems to be policed, but as opportunities to intervene and offer solutions. "What are the wraparound services and support that can help prevent them from being involved in this, in that emergency system?" she questioned, emphasizing a preventative and supportive approach.
The goal is to connect individuals, such as the person found sleeping in a store, with essential resources like community housing. This comprehensive strategy aims to reduce violence, ensure individuals receive appropriate care, and break the cycle of incarceration for those struggling with poverty, addiction, and mental health challenges.
Rebecca Neusteter, Executive Director of the Health Lab at the University of Chicago, a body that studies the impact of such community-based services, noted the significant benefits. She explained that these programs offer "peace of mind for callers that they’re going to be met with the right response at the right time." Moreover, Neusteter observed that responders themselves feel better equipped with a more extensive "toolbox in their ability to pursue actual resolution to these calls."
In developing its expanded system, Baltimore has drawn inspiration from other cities that have successfully implemented similar diversion models. Durham, North Carolina, offers a compelling case study with its Holistic Empathetic Assistance Response Team (HEART). Over four years, HEART has reportedly diverted more than 12,000 calls, with police backup required in only 0.02% of cases. This program has also contributed to improved response times for all types of 911 calls.
Durham’s HEART program has cataloged its interventions, demonstrating the breadth of non-police responses. These have ranged from securing housing for a woman escaping domestic violence to arranging medical appointments for a homeless veteran. In one notable instance, a hotel manager called 911 seeking assistance for a blind man who could not be accommodated in the hotel’s accessible rooms. HEART responders not only booked him a room for the night but also facilitated a ride the following day to meet with a housing assistance organization. These examples illustrate the tangible impact of specialized crisis response teams in providing immediate, effective, and compassionate solutions to complex human needs.
This article is a product of a partnership involving WYPR, NPR, and KFF Health News.
