CBHJ receives $4M to launch behavioral health emergency response initiative; joins Ohio and Texas in multi-state collaborative

If you encountered someone experiencing a behavioral health crisis-whether mental health distress, substance use emergency, or expressing thoughts of suicide-what is the first thing you would do? For most Americans, the answer is to call 911. But what happens when you place that call? How does the person on the other end decide what should happen next? Researchers at Wayne State University are tackling these questions through the Behavioral Health Emergency Response Initiative (BHERi). Although exploratory work in this area has been going on for the past three years, a new private public partnership launching this fall will expand the scope of this work. The Center for Behavioral Health and Justice (CBHJ) at the Wayne State University School of Social Work is participating in a multi-state collaborative, supported by national and local philanthropic partners to transform behavioral health crisis response systems at the local, state, and national levels, with the goal of building safer, and more efficient and effective alternatives.

Not enough options

In 2023, Michiganders contacted 911 nearly 13.3 million times, and research estimates that as many as 1.9 million of those calls involved behavioral health crisis. Across the country, an estimated 48 million calls to 911 involve behavioral health. For many communities, dispatchers primarily have two options for a response to every one of those calls: police or emergency medical services (EMS).

"Every day, dispatchers, law enforcement and EMS personnel are tasked with managing situations that demand specialized care-not just public safety intervention," said Barbara Davidson, former director of the Ingham County 911 Central Dispatch.

Michigan Department of Health and Human Services (MDHHS) and local communities have made important progress in recent years, including the 2022 launch of 988 through the Michigan Crisis and Access Line (MiCAL) and the growth of community-based behavioral health response models such as mobile crisis teams and crisis stabilization units (CSU). Yet despite these advances, there is little known about matching response type along the axis of public safety risks and acuity of the behavioral health issue due to limited data and fragmented response systems.

"The existing system is often fragmented and ineffective, and as a result individuals in crisis are often subjected to unnecessary harm and law enforcement agencies are overwhelmed by situations that could be better managed through specialized care" said Monroe County Sheriff Troy Goodnough. "While local communities like Monroe County are implementing community-based crisis response options, there needs to be a broader shift in how we approach crisis triage for these efforts to help make our communities safer."

Shifting systems through collaboration

A large body of evidence has identified three essential elements of an effective system for responding to behavioral health emergencies : (1) identifying calls to 911 that involve behavioral health; (2) providing a response to these calls that effectively, efficiently, and safely connects them to the services they need; and (3) ensuring options are available 24/7, other than the emergency department or jail, where first responders can bring people who need immediate care. Designing and implementing strategies that address each of the above elements depends on extensive coordination among first responders (police, fire, EMS, and Emergency Communications Centers) and organizations that provide and administer behavioral health services.

Last year, NYU's SCALE + Lab launched the Behavioral Health Emergency Response Initiative (BHERi), which aims to translate this body of evidence into programs and practices so that anyone experiencing a BH emergency is effectively connected to community-based services. BHERi is concentrating initially on making significant, measurable progress across Texas, Ohio, and Michigan, with a long-term vision for making a major impact on this issue nationally. The inaugural cohort of three implementing partners include CBHJ in Michigan as well as Ohio's Clear Pathways and the Meadows Mental Health Policy Institute of Texas.

Elevating local change to statewide system transformation

As a part of this collaborative, the CBHJ is launching its most ambitious, multi-year strategy to date, backed by $4 million in funding from Blue Meridian Partners and additional support from The Pew Charitable Trusts and a coalition of state, local, and foundation funders.

At the local level, the project will partner with 911 call centers to strengthen how behavioral health crises are identified, coded and triaged, while supporting community-based providers in expanding alternative response models through cross-system collaboration. To ensure long-term impact, the CBHJ will also evaluate outcomes and guide sustainability planning.

At the state level, CBHJ is working with MDHHS, Michigan Mental Health Diversion Council, the State 911 Council and the Cardinal Group to identify best practices and develop a data-driven framework for triaging behavioral health crisis calls. This framework will help communities assess both public safety risks and crisis acuity, ensuring that low-risk calls can be diverted to community-based care-such as local crisis lines or mobile crisis teams-without overburdening law enforcement. WSU SSW/CBHJ faculty member Amy Watson is also working closely with MDHHS to initiate and implement a required training of behavioral health staff working in mobile crisis, understanding the importance of a skilled workforce.

"Through enhanced collaboration between state and local partners we have an opportunity to improve services - and outcomes -for those experiencing a behavior health crisis" said Dr. Sheryl Kubiak, CBHJ director and dean of the Wayne State University School of Social Work. "Bringing partners from different systems together in a shared problem- solving quest is what CBHJ does best."

The CBHJ and Wayne State University lead the way

The CBHJ began exploratory work three years ago, mapping system response to behavioral health emergencies in 10 counties. Using the data derived from that initial project, CBHJ began dissemination and subsequent inquiry, eventually being asked to join this planning process with other states and NYU to plan system transformation. Along the way, these planning efforts have been supported by the Flinn Foundation, the Mental Health Diversion Council, the Michigan Health Endowment Fund, Blue Cross/Blue Shield Foundation and the Herrick Foundation.

"Lasting progress in behavioral health requires strong partnerships and bold systems change," said Andrea Cole, president and chief executive officer of the Ethel & James Flinn Foundation. "This initiative is an example of what can happen when philanthropy, research, and practice come together with a shared vision of building responsive, humane, and effective approaches to behavioral health crises."

The CBHJ and Wayne State University bring the experience and infrastructure that make it the natural home for this transformative project. The BHERi project builds upon a solid foundation of several years of work in partnership with the Michigan Mental Health Diversion Council including research evaluating Michigan's use of crisis response models across the state and providing technical assistance to local communities. The partnership provided technical assistance to several local crisis response systems and evaluated outcomes for crisis response models in Michigan.

Collaboration for lasting impact

"This initiative seeks to address systemic gaps in our current approach through collaborative system transformation," said Bill Ward, chief executive officer at Network 180, Kent County's Community Mental Health Agency. "This work will ensure that individuals in crisis receive the appropriate treatment, ultimately improving their outcomes and reducing strain on first responders."

"We know this won't happen overnight," said Davidson. "But with the right support and partners at the table, we can improve how behavioral health emergencies are handled in Michigan-and get better outcomes for the people we serve."

Written by Jessica Best

The Center for Behavioral Health and Justice is a partner in the Behavioral Health Response Initiative (BHERi), a national effort to improve the response to calls to 911 that involve a person experiencing a mental health and/or substance use emergency. BHERi is concentrating initially on making significant, measurable progress across Texas, Ohio, and Michigan, with a long-term vision for making a major impact on this issue nationally. Additional partners include the Meadows Mental Health Policy Institute and Clear Pathways @ Peg's Foundation. NYU's SCALE + Lab administers the initiative and coordinates the work of the partners. Funding is provided by Blue Meridian Partners. Additional support is provided by The Pew Charitable Trusts.