Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at .
Like many communities across the nation, Fulton County in Georgia is working to build a public safety infrastructure that links people in need to community providers and services without criminal justice involvement.
Moki Macias is the executive director at the Policing Alternatives and Diversion Initiative (PAD), which started as a pre-arrest diversion program in Atlanta for people detained for violations related to substance use, mental health, or extreme poverty. She says developing a non-police public safety response requires determining what drives police involvement in the first place.
Criminal justice research has primarily centered on arrest data. Emergency 911 call data, notes Macias, has been far more elusive. “What’s been absent from the conversation is an analysis of why people actually call 911,” she says.
That’s why PAD commissioned Shila Hawk, Ph.D., and Kevin Baldwin, Ph.D., at Applied Research Services, Inc., to analyze roughly 3.4 million 911 calls in the Atlanta metropolitan area. “We wanted to look inside the black box,” says Macias.
The Atlanta 911 study is one of many cross-sectoral initiatives. Arguably, the initiative that eventually led to this point is Stepping Up, which the county board of commissioners adopted in May 2016. Joan P. Garner, commissioner of Fulton County at the time, spearheaded the effort. She died nearly a year later, after a lengthy battle with breast cancer.
“Commissioner Garner was a member of the National Association of Counties, NACo, which leads the national Stepping Up initiative,” says Kristin Schillig, justice and mental health initiatives project manager at Fulton County Superior Court. It’s what shifted the county’s lens toward a data-driven approach in reducing the overrepresentation of people with mental illness in jails. Schillig and her superior court colleagues have led the effort.
The Stepping Up initiative has four key measures:
- Reduce the number of people with mental illness booked into jail
- Shorten the average length of stay for people with mental illness in jails
- Increase the percentage of connection to care for people with mental illness in jail
- Lower the rates of recidivism
A justice and mental health task force develops the initiative’s data-driven action plans and recommendations. PAD, along with other cross-sectoral partners, is on the task force.
The task force grew from a group of stakeholders who took part in the county’s sequential intercept mapping workshop in 2017. The Sequential Intercept Model (SIM) was developed by Mark R. Munetz, M.D., Patricia A. Griffin, Ph.D., and Henry J. Steadman, Ph.D., alongside SAMHSA’s GAINS Center.
The Fulton County Superior Court contracted Policy Research Associates (PRA) to develop a map of the behavioral health and criminal justice systems. Workshop participants were asked to identify the county’s community connections, priorities, resources, and gaps for people with mental illness and co-occurring disorders. “The SIM process,” says Schillig, “gives jurisdictions a framework for who should be at the table if you really want to be comprehensive in the work.”
Besides PAD, participants were law enforcement, judges, prosecutors, public defenders, social workers, peers, advocates, and representatives from city, county, and state agencies and NAMI Atlanta.
Macias says digging into call for service, arrest, and booking data has been much like Theseus’ ball of thread. As it unwinds, there are the clues for what the task force must address next to operationalize the sequential intercept mapping workshop objectives to deflect people from the criminal legal system.
“To adequately divert people to more appropriate care instead of jail, it’s critical to understand how 911 dispatches calls,” says Macias.
The City of Atlanta 911 Center gets roughly one million calls a year. How that breaks down into what services people request has long been a mystery. Macias says the opaqueness around 911 data has added to the uncertainty over how many calls can divert elsewhere.
“One million calls is an overwhelming number,” she says. “If that’s the volume—how do we even start standing up other resources without understanding what non-emergency callers need?”
Dr. Hawk and Dr. Baldwin’s study of the county’s 911 calls-for-service has helped demystify the data. The numbers are vast—3.4 million calls over a roughly 3.8-year period from January 1, 2017, to August 30, 2020. However, the researchers estimate that approximately 600,000 calls (18.4%) may have been suitable for diversion from 911. The researchers labeled these calls “calls of focus.”
Macias notes that research by S. Rebecca Neusteter, Ph.D., executive director at University of Chicago Health Lab, has illustrated that even with 911 call data, determining exactly how many calls could divert from 911 is difficult because of call code ambiguity, lack of call code standardization, and variability in data quality. There’s also no feedback loop in many 911 call centers (called public safety answering points, PSAPs).
“An officer might go out on a call coded ‘person screaming,’” says Macias, “but follow-up details aren’t entered into the system that might update the call with a more tailored code.”
Many 911 call codes like “person screaming,” “suspicious person,” and “problem-solving” are vague. However, Macias notes there are obvious patterns, especially when compared with other data sets. For example, trespassing is the third most common 911 call code in the study’s 600,000 “calls of focus.” It’s also the primary jail charge for Familiar Faces, a project Schillig leads that identifies people who frequently interact with multiple systems, such as criminal justice, behavioral health, medical, and homeless services.
“911 coding isn’t highly specific,” says Macias, “but we can conclude that most people we are trying to keep out of jail, and PAD is diverting, are arrested on these types of charges.”
PAD provides Atlanta Police Department and MARTA public transportation officers the ability to divert people they’ve detained for violations related to mental health, substance use, and extreme poverty.
An essential finding of the study is that many callers intentionally did not reach out to 911. In fact, 41% of “calls of focus” callers dialed the Atlanta Police Department’s non-emergency number (404-658-6666).
“They were deliberate in doing so,” says Macias. “Yet, these calls are just routed through the 911 call center, anyway.”
What further illustrates that many “calls of focus” were non-emergency is the allocated response times, with 92% assigned a 20-minute or 50-minute response. “Even given these limited details, we need to look at whether it may be better to address these types of calls outside of the 911 emergency service system,” says Macias.
The Atlanta 911 study echoed what Macias and Schillig already knew: Fulton County didn’t have a sufficiently integrated rapid response system for behavioral health and quality of life calls. Even when someone tried to request a different response through the non-emergency police department number, the call routed straight to 911 dispatch.
“How can we minimize law enforcement interaction for behavioral health or quality of life issues when our primary service system is designed to dispatch police?” asks Macias.
Schillig points out that low-level offenses like criminal trespassing, disorderly conduct, possession and use of drugs, and indecency make up 8-10% and 30-35% of annual bookings at the Fulton County Jail and the Atlanta City Detention Center, respectively.
She says that a racial justice lens is critical to all the county’s initiatives. “There’s an overrepresentation of Black and brown individuals in our criminal legal system, and we need to work towards reducing these disparities and harm,” says Schillig. In fact, 93% of people in the Familiar Faces cohort, people who interact with multiple systems, are Black.
“It’s vital to evaluate and pull apart 911 data to see what options are available and build out a full continuum that not only addresses behavioral health crises,” she says, “but all quality of life barriers and racial inequities.”
That’s why PAD has partnered with 311, the City of Atlanta’s non-emergency line. Historically, people used the three-digit number to report non-emergency matters like missed trash pickup or potholes. However, residents can now call 311 to refer quality of life concerns people might be experiencing, including basic needs, behavioral health, disturbance, public health, public indecency, and welfare. The initiative launched on January 25.
Agents answer 311 calls Monday-Friday, from 7 a.m. to 7 p.m. They screen and triage by asking callers questions that identify the best service to match the person’s needs. Agents can reroute calls to 911 or United Way 211. The latter matches people with resources like food pantries, job search and placement agencies, and financial emergency assistance. The agents can refer behavioral health calls to the Georgia Crisis and Access Line (GCAL), Peer2Peer Warm Line, or CARES Warm Line.
If the call warrants an in-person response, the agent will submit an outreach request to PAD, and a two-person PAD Harm Reduction team will respond.
Local law enforcement and the City of Atlanta have publicized the 311 PAD initiative, encouraging people to call 311 for non-emergency issues.
As communities build out their behavioral health crisis system in anticipation of 988—the three-digit number for behavioral health emergencies that must be available nationwide no later than July 16, 2022, Macias says they should consider initiatives like PAD 311 Community Referral Services.
“We must acknowledge that not only is the local criminal justice system a place to detain and hide people experiencing mental health emergencies,” says Macias, “but also those who have a whole range of other needs related to poverty, housing, and healthcare.”
People, notes Schillig, who are missing a safety net.
If states don’t sufficiently build a community-based infrastructure of resources that addresses quality of life needs, Macias and Schillig say 988 will be overwhelmed by the sheer volume of people looking for a vast array of services and supports, not just those related to behavioral health emergencies.
The PAD 311 Community Referral Services initiative is a symbiotic preventative approach that will build robust protections around a community in conjunction with 988. “Addressing a person’s quality of life needs and matching them to services may help prevent crises,” says Macias.
“The drumbeat across America has long been ‘see something, say something,’ encouraging an over-reliance on 911,” she says. “It’s time to shift our thinking so we can respond with care and offer the services and supports our communities need.”
Learn more about PAD 311 Community Referral Services, Stepping Up, and the Atlanta 911 study.
Data for graphics in this article are from the Atlanta 911 study.
