Changing NYC’s Mental Health Emergency Response By Jason Hansman, Acting Co-Director, New York City’s Mayor’s Office of Community Mental Health
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ew York City (NYC) has historically relied on public safety measures to respond to mental health emergencies. For decades police and ambulances have responded with transportation to a hospital being the primary option for individuals in crisis. In November 2020 the City announced a new health-centered approach to mental health emergencies: teaming emergency medical technicians (EMT) with licensed social workers to respond to calls that do not involve a weapon or imminent harm. This pilot known as B-HEARD (Behavioral Health Emergency Assistance Response Division) launched in June 2021 through a coordinated effort by the New York City Fire Department/EMS, Health + Hospitals, Department of Health, Police Department, and the Mayor's Office of Community Mental Health. Prior to B-HEARD, NYC made several investments to fundamentally improve crisis response and prevention. In 2018, the NYC Crisis Prevention and Response Task Force developed new strategies, such as reducing response times for mobile crisis teams from 17 hours to 2 hours; investing in Crisis Intervention Training for police officers; and creating Support and Connection Centers that offer short-term clinical and non-clinical services to people with mental health and substance use needs as an alternative to avoidable emergency room visits or criminal justice interventions. B-HEARD is accessible via 911 and mental health crisis calls do not need to be transferred to a new number. This ensures connection and continuity with existing emergency services, including comparable response times. Also, public messaging regarding what number to call in an emergency remains unchanged to avoid any confusion. When there is an emergency, everyone knows to call 911. The inclusion of clinical mental health professionals is an important part of the B-HEARD model. Having a licensed social worker paired with EMTs allows us to provide–for the first time ever– rapid and comprehensive mental health evaluations on-site in the community. It also facilitates transition to community-based services, including connection to peers and other paraprofessionals, and warm hand-offs to a hospital if necessary. To further ensure coordination of services, especially in the field, the EMTs and mental health clinicians are trained together for four weeks before responding to calls.
Providing individuals in crisis with more options can lead to better connections to ongoing supportive care while not compromising public safety. In the first six months of operation, 92% of individuals who received a B-HEARD response accepted assistance and only 46% of people assisted by B-HEARD were transported to a hospital for additional care – a much lower percentage than the traditional response, in which 87% of people were transported to a hospital. This means about 47% were served on-site or transported to a communitybased care location, with options for behavioral healthcare that were not previously part of emergency response. And everyone was offered follow-up care that could help prevent the next emergency. The pilot program has faced some challenges operating within several complicated systems, namely emergency services and mental health. In a time when mental health providers are stretched thin, it has been difficult to find providers that can accept individuals on the same day. We have taken steps to address this problem through community provider outreach and making referrals to the local Support and Connection Center, but more work remains to be done. Additionally, we are actively using strategies to grow the number of 911 calls routed to B-HEARD teams including hiring additional EMS call-takers, analyzing calls to ensure new and existing protocols are being followed, and piloting new approaches to triage. This is what a pilot is all about: learning as we go to make sure we get it right. Over the last year, B-HEARD has expanded from its original catchment area in East Harlem to the rest of Northern Manhattan and parts of the South Bronx, with further expansion to come in fiscal year 2023. Our hope is that other cities join us in taking a health-first approach to mental health emergencies as it can lead to better outcomes for cities, communities, and most importantly the individuals in crisis. To learn more about the B-HEARD initiative, visit https:// mentalhealth.cityofnewyork.us/b- heard. NYSAC News | www.nysac.org
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