Reimagining Crisis Response: Experts Discuss the Future of 911

As cities across the country try to ensure that a 911 call summons the right kind of help —  including for those with mental health and substance use issues — a Harris School of Public Policy and Health Lab event explored ways to “reimagine and improve crisis response.” 

“First-Response for Chicagoans Experiencing Addiction and Mental Health Crises,” which took place on July 27, was the second of three Summer of Social Impact signature events at Harris Public Policy. The 75-minute event included a fireside chat, featuring Katherine Baicker, dean and Emmett Dedmon Professor at Harris, and Health Lab Faculty co-Director Harold Pollack.

To kick off the event, Baicker and Pollack spoke about the Health Lab’s mission and its first-response work in Chicago and throughout the nation – including the new TRANSFORM911, an initiative that will convene a diverse set of stakeholders in search of solutions. They touched on ways predictive analytics and research can help improve first-response outcomes.

Baicker noted that, with limited time or resources on a busy night for first responders, the nature and impact of the response “plays out very differently in different communities.”

The 911 system, Pollack said, “is a tremendous resource in that if you’re having an emergency, the idea that there’s this place that you can call 24/7 365 and get help is extremely valuable.”

But “it is also so limited,” Pollack added.

That conversation was followed by a panel discussion which centered on the intersection of public health and public safety, digging into the inequities of crisis response systems and highlighting what is being done, and can be done, to improve them. 

The panelists agreed that the 911 system’s limitations have been sparking demands for reform nationwide, and have led to critical conversations about unmet needs within the system.

Dr. Nneka Jones Tapia, managing director of justice initiatives for Chicago Beyond; Dr. Nicole Gastala, who practices in the Department of Family Medicine at Mile Square Health Centers and is medical director of the Substance Use Prevention and Recovery Division at the Illinois Department of Human Services; Matt Richards, deputy commissioner of behavioral health at the Chicago Department of Public Health; and Joel K. Johnson, president and CEO of TASC, Inc, participated in the panel. The panel was moderated by Jason Lerner, Health Lab portfolio director.

As panelists discussed a broader definition of “crisis response,” including follow-up after a 911 call, attention also turned to prevention, and how public officials could intervene to help people before a 911 call is ever made.

“The reality, at least from my perspective,” said Tapia, “is that we’re talking about this crisis response really because Chicago, the County of Cook, the State of Illinois, and this country as a whole have not committed to the significant and sustained investment in prevention and early intervention that’s required to fully support the health and wellness specifically of Black and brown people, and more generally of poor people.” 

Tapia, who was previously warden of the Cook County Jail, also stressed the importance of taking a community-wide approach to prevention and early intervention, saying, “the expertise is in community.” 

Building on Tapia’s comments, Johnson said early intervention and prevention are crucial.  “We’re talking about a crisis system that’s not really a system. We’re in crisis and we’re responding. It’s not really a system of care.” Johnson, who was recently appointed to the Chicago Board of Health, described barriers to solving such issues as scarce infrastructure and funding and the absence of ways to ensure continued care and support.

Gastala illustrated what she called the “handoff” problem by noting the differences in how two patients who end up in an emergency room — one with a heart attack and one for an opioid overdose — are treated.

“The patient who survives an opioid overdose has a higher mortality risk within that year than the patient who survived the heart attack,” she said, “but guess who gets all of the services? Guess who gets an immediate appointment with cardiology, gets started on medication, maybe they are watched over night and observed and then connected to all of the out-patient resources that they need?

“That doesn’t really happen with patients who survive an opioid use disorder.”

This, she added, is one of the “great fractures within our health system that we really have to focus on addressing” to help substance use patients overcome roadblocks, particularly those who are underserved and may have other problems such as housing and food insecurity. 

“What we’re talking about,” Lerner said, “are a number of really systemic issues including issues of equity in the health-care, justice, and many other systems. Clearly, a more comprehensive approach is needed to address these issues.” 

What are solutions to do that? Speakers, expanding on things already mentioned, shared several that are in place or on the horizon such as:

• Placement of mental-health professionals in 911 response centers to handle calls, something Chicago is to debut as a pilot program later this year. 
• Expansion of Chicago’s Narcotics Arrest Diversion Program, which the Health Lab partnered on and which allows eligible people who otherwise would have been arrested for drug possession to avert arrest by instead opting into treatment.
• Education to reduce stigma about issues such as homelessness.
• A holistic approach to addressing trauma, like the Healing-Centered Framework that Chicago Public Schools launched in March with Chicago Beyond and the Children First Fund. The framework is an acknowledgement that what is needed for students, staff, and families must go beyond required resources to include culture and climate in reducing trauma and must apply an equity lens, Tapia said.
• Establishment of initiatives such as Chicago Beyond’s Holistic Healing Fund, a $10 million transformative investment, Tapia said, “in community healers like Pastor Donovan Price of Solutions & Resources (S&R) and Asiaha Butler of Resident Association of Greater Englewood (RAGE). Like the panelists mentioned, 911 is limited.  So how do we actually expand what we think about when it comes to addressing crises and invest in community healers?” 
• Exploration of flexible funding options including from the philanthropic community and non-traditional cash sources to, as Johnson said, “fund a revolution.” 

“There’s a lot to be hopeful about,” Lerner said. 

“I’m really excited,” he added, “to see how we can continue to reimagine and improve crisis response in Chicago and beyond.”

The final Summer of Social Impact signature event will be titled “Personalized Education and the Great COVID Catch-Up,” featuring work from the Education Lab, and will take place on August 24.