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Mental health crisis response

We are launching a pilot initiative to provide residents with the best possible response.

Update: We're looking for 10 Boston residents with professional or lived experiences with mental health issues to join our Community-Led Design Group. The Design Group will create a plan to pilot a community-led response to mental health crises the City.


As one step to promote safety, justice, and healing in every neighborhood, the City of Boston is committed to strengthening our response to mental health crises. In April 2021, the Mayor asked the Health and Human Services Cabinet (HHS) and the Boston Police Department (BPD) to design a pilot program. The goal of the program is to:

  1. increase the role of mental health workers, and
  2. decrease the role of police in responding to mental health crises. 

We heard from the community. We evaluated our current protocols. We looked at best practices across the country. On August 5, 2021, the Mayor announced a pilot initiative to help provide the best possible response for Boston's residents.

Our pilots

Pilots

What is co-response?

For 10 years, BPD has partnered with Boston Medical Center’s Boston Emergency Services Team (BEST). Police officers are paired with mental health workers. Together, they respond to mental health calls that present a public safety risk. 

Co-response has been shown to divert individuals with mental illness from the criminal justice system and the emergency room. It also connects them to the care they need.

What will our pilot do?

Currently, Boston Police co-response cars can be asked to respond to any call type.

The pilot initiative will dedicate co-response cars to calls likely to have a mental health concern. The goal is to make these mental health teams available for the calls that would benefit from their presence the most. The dedicated cars pilot will begin in October, in Boston Police Districts A1 and B2, in the Downtown/Charlestown and Roxbury neighborhoods.

What is alternative response?

Alternative response is a non-police response. Leading models in other U.S. cities pair emergency medical technicians (EMTs) with mental health workers.

What will our pilot do?

We are developing a new unit made up of a Boston Emergency Medical Services (B-EMS) EMT and a mental health worker. This unit will respond to mental health calls that do not present a public safety risk and will be available citywide.

This pilot would also enable B-EMS to connect callers with a mental health call center. They would receive support on the phone.

We will immediately begin developing the alternative response pilot. We're working in partnership with unions representing EMS and BPD employees.

What is community-led response?

Community-led response empowers peers and community members to provide mental health supports to neighbors in need.

What will our pilot do?

We will convene community members to:

  • explore community-led response, and
  • propose a community-led pilot for FY23.

In October, we opened a request for proposals for a facilitator. That facilitator will begin the community process in December.

RFP Announcement

Community-Led Design Group

Community feedback

Community feedback

Community voices drove our work to design the pilot programs. We hosted over 10 listening sessions with community members, including two public meetings. We also received over 90 responses to the resident survey in our Request for Information. The drawers below share themes and quotations from residents' feedback.

WATCH THE July 15 PUBLIC MEETING

There should be a no wrong door approach:

  • Many residents default to 9-1-1 → Train call-takers to triage appropriate response.
  • Some residents, particularly residents of color, are hesitant to call 9-1-1 for fear of the police → Alternative numbers are valuable.
  • There needs to be broader awareness of mental health - and less stigma - in the community. This is needed for folks to call for help in the first place.

“I would like to be able to call 9-1-1 for a mental health care emergency where trained mental health professionals would arrive to the scene with the same urgency as the police, fire, and medical team would in other situations.” 

Better tailor who responds to the needs of each call:

Many community members are asking to increase the presence of mental health workers  either as first responders or co-responders with police. The call is particularly strong for mental health workers with lived experience. The desire is for workers who come from the communities they’re serving.

Community members are asking the City to decrease the presence of police when they’re not necessary for public safety. But, they want to include the police in the response when there’s potential for violence.

Some community members are calling for a community-based, peer-led response without any police involvement.

“I would want someone caring and knowledgeable to help me navigate the moment and to support my family and community in helping to care for me."

The response, carried out with de-escalation techniques and cultural competence, should quickly connect individuals and their families to the care they need:

Cultural competence, mental health, and de-escalation trainings are key. That's true for everyone responding, from clinicians to officers to EMS members.

The response should be able to connect individuals to a broad range of mental health services, beyond the ER. The response should also pay attention to the needs of family members.

Improving crisis response should be just one part of a broader mental health system overhaul. The goal is to ensure access to care before, during, and after a crisis.

"Why do we treat the physically ill with compassion/sensitivity but treat the mentally ill with fear and need to gain control?"

Data

To design the pilots, we evaluated 9-1-1 data in Boston. You can find a data report about mental health crisis response online.

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