Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at .
A 24-hour crisis call diversion program is embedded within Houston’s 911 call center, providing a fourth emergency response — mental health and substance use intervention. The program allows the center to divert nonviolent, non-criminal 911 calls and police department non-emergency line calls with a behavioral health component and dispatch mental health clinicians.
The collaborative framework, which began as a three-year pilot in 2016, predates and complements 988, the national crisis and suicide hotline.
The uniqueness of the civilian-only program, run by the Harris Center for Mental Health and Intellectual and Developmental Disabilities, is its phone counselors, says Chiara Jaranilla. She manages the diversion program, overseeing daily operations and coordinating in real time with 911 call center partners, including the city’s police and fire departments. (Houston’s fire department provides fire and EMS services.)
“We were pulled out of the existing 24-hour crisis line, so our counselors receive the same training as a 988 counselor would have here in the Houston area.”
In anticipation of and since the launch of 988 in July 2022, many communities have wanted to replicate the diversion program. Houston’s Police Department’s Mental Health Division is a Justice and Mental Health Collaboration Program’s learning site. They frequently connect with community organizations to visit and learn from the crisis call diversion program, says Jaranilla. She provides technical assistance and support to agencies across the nation on law enforcement diversion.
Communities are not only focused on 911 diversion for mental health and substance use challenges but also on improving the interconnection between the traditional emergency response system and the behavioral health one. In many communities, the 911 and 988 systems still don’t talk to one another. That’s not the case in Houston.
Initially, the city’s mobile crisis outreach team and the crisis call diversion’s rapid response were part of the same team, with the mobile crisis outreach team collaborating with 911 partners to divert behavioral health calls. Today, they are two programs: mobile crisis outreach teams assess people through 988, while rapid response teams respond to 911 calls.
Rapid response used to have “mobile crisis outreach” in the program name but that confused community members, says Jaranilla.
“People didn’t know who would go out to what calls.”
Regardless of the program, the response is the same: two licensed clinicians, one with a master’s degree and the other with a bachelor’s, provide a mobile response, going directly to the person in need. Aside from the access point — 988 versus 911 — the only difference is that the mobile crisis outreach team, a larger, more extensive program than rapid response, can provide additional case management services for 30 to 60 days.
Rapid response doesn’t have case management capability but its interconnectivity with the mobile crisis outreach team allows for a “continuum of services,” where rapid response does the assessment and subsequently refers the person to the mobile crisis outreach team, helping bridge the gap between the crisis event and long-term linkage, explains Jaranilla.
A frequent gap in 988 response is with third-party callers, something many 988 contact centers are trying to address, whether connecting with quality-of-life service providers or responding directly.
In Houston, both 988 and 911 respond to third-party callers. However, because 911 is still more commonly known for emergencies, the 911 crisis call diversion program receives many third-party callers. In 2024, roughly 70% of calls processed by the crisis call diversion program were with either a friend or family member, a third party or a community organization, says Jaranilla.
“Some are passersby who just happen to be in the right place, right time to help the person out.”
Third-party callers often have little to no knowledge of the person’s history, so phone counselors tailor the assessment to observations, like whether the person appears intoxicated or has said anything to the caller.
Call takers ask specific questions to determine if a call should be diverted, such as “Do they appear to have mental health issues?” or “Is this call in reference to their mental state?”
“A ‘yes’ to either question typically results in a Crisis Intervention Team code, which helps CCD identify potentially eligible calls,” said Jaranilla. The most common call type the diversion program assists with is a ‘3041,’ a general disturbance with an identified mental health component.
The counselor will try to assess the risk of harm for the person in distress, including the risk of suicide or violence. However, there can be limitations as third-party callers may simply be unable to provide clear context. “But we will still try to gather as much of that information as we can,” said Jaranilla.
If calls reveal current suicidal ideation or thoughts of violence, call counselors try using risk mitigation like verbal de-escalation and safety planning. That includes identifying who in the person’s network they can go to for distraction or help.
There are multiple access points in the 911 triage process for someone to reach the crisis call diversion program, which is integrated into the public safety answering point’s computer-aided dispatch system, often called CAD.
Calls can be diverted by 911 call takers, police department dispatchers, fire department call takers and through the CAD system.
When a person dials 911, a call taker assesses the nature of the emergency and determines the response the call requires and priority type. Call takers can directly “live transfer” callers experiencing mental health or substance use concerns so long as there’s not an imminent, life-threatening risk or criminal activity.
Even if the call isn’t transferred, Jaranilla and her colleagues can identify eligible calls — 911 calls awaiting response are put into the CAD waiting queue — and reach out to the caller. Similarly, dispatchers or command supervisors can identify calls with a behavioral health component and ask the crisis call diversion to do a callback.
The center’s 911 partners can also later transfer calls they identify as eligible for diversion. For instance, a caller may ask for EMS, but then once they get over to EMS, report mental health issues, not medical ones, explains Jaranilla.
Sometimes, calls eligible for diversion pass all the catchment diversion points. Even so, patrol officers in the field can request rapid response through their dispatcher, providing another diversion point and allowing officers to move on to the next caller.
Crisis call diversion and rapid response relieve the other first responders, police, fire and EMS, from responding to behavioral health-related calls, freeing them to respond to other emergencies or, in cases that require multiple services, allowing for what Jaranilla calls “tandem response,” two services dispatched at the same time.
Regardless of the access point, phone counselors go through the same process — they build rapport, assess risk, provide de-escalation, if needed, and summarize outcomes back to dispatch.
There are two sets of criteria: one for crisis call diversion, an over-the-phone assessment, and another for dispatching rapid response. Both require calls to be non-imminent risk and have a mental health component, priority three or lower. Generally, levels 1, 2 and 3 involve low- to moderate-risk scenarios.
There are a couple of exceptions.
If the person is suicidal, says Jaranilla, the call can be diverted “as long as the person can maintain safety and is willing to have an at-the-location conversation.” She adds the person doesn’t need to agree to go to the hospital or take medication to access diversion.
Also, in Texas, where an estimated third of adults live in a household with a firearm, if the weapon “isn’t being wielded or can be put away,” she says it’s not considered part of the crisis situation.
Assessing risk of violence has always been part of the diversion calculus but over the years, Jaranilla and her colleagues have also learned to consider both the subject of the call and those close to them.
“Maybe we have somebody calling for help but they’re in a domestic violence situation,” said Jaranilla. “We might need to meet them elsewhere, like a McDonald’s.
“They’re not excluded from eligibility; we just need to go to a safer place.”
In 2024, crisis call diversion diverted 5,033 calls from 911, a 21.6% increase from 2023, and rapid response resolved 84% of calls without law enforcement involvement. The year prior, the Harris Center launched RainbowCare, a platform interconnecting the crisis call diversion and rapid response teams, allowing the diversion program to document calls and dispatch rapid teams through the platform’s mobile app with GPS tracking.
RainbowCare emulates CAD, where the crisis call diversion program can dispatch rapid response in real time, says Jaranilla. “The rapid response team member will get the dispatch on their phone and we will see when the team is en route, on the scene and transporting.” According to the 2023 annual report, the technology improved “response times to crisis calls in the community.”
However, the RainbowCare and CAD dispatch systems don’t talk to one another, so phone counselors act as a conduit between the two. “They manually transcribe CAD slip information in call notes in Rainbow and put a summary into CAD to let dispatchers know outcomes.”
The integrative, collaborative effort between the four 911 branches is why diversion has been successful, yet there’s still much more to accomplish regarding data tracking, says Jaranilla.
“There’s a long history of working well together but even if we’re co-located, we still need to improve our data feedback loop.”
Jaranilla highlights the CAD system, while excellent for dispatching, is not designed for data tracking, resulting in data gaps. “I would love to get statistics every month on how many calls were identified as CCD eligible,” she said, adding that without sufficient data, the team can only imperfectly guess the number of eligible calls by those diverted.
She hopes to see the 911 center expand data tracking, through systemic changes in the 911 workflow process, so she and her colleagues can identify calls eligible for diversion but not flagged. This baseline would help Jaranilla identify if the program needs to expand staffing or whether the partners need to dive deeper and evaluate behavioral health calls still receiving a police response despite access to crisis call diversion.
“That way, we can find the cracks in our workflow and work together to improve how we serve the community.”
The long-standing partnership has revolutionized how Houston does 911, says Jaranilla, making the response better tailored to people’s individual needs.
“Together, we focus on the unique needs of the people we’re talking to, rather than trying to make their call fit into a square peg.”
