Re-imagining New York City's mental health emergency response

A new health-centered approach to mental health emergencies

B-HEARD - the Behavioral Health Emergency Assistance Response Division - is part of New York City's commitment to treat mental health crises as public health problems - not public safety issues. For the first time in New York City's history, teams of health professionals - including EMTs/paramedics and mental health professionals - are responding to 911 mental health calls in Harlem, Washington Heights, Inwood, and parts of the South Bronx through a pilot program that launched in spring 2021.


Learn more about B-HEARD using the links below.

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Data on operations from January to March 2022

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About the pilot

B-HEARD at a glance

B-HEARD Frequently Asked Questions

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Latest news on B-HEARD

The latest news on B-HEARD

In November 2021, the B-HEARD pilot expanded to respond to 911 mental health calls from East Harlem to the Hudson River. In March 2022, the B-HEARD pilot expanded to Washington Heights, Inwood and parts of the South Bronx. In June 2022, B-HEARD expanded to two additional police precincts in the South Bronx.

 

 

The City has made significant investments to strengthen mental health crisis prevention and response including and beyond the B-HEARD pilot. To learn more about the City’s investments in supporting New Yorkers living with serious mental illness, read Susan Herman's testimony before the City Council Committee on Mental Health, Disabilities, and Addictions in September 2021.

 

Have a question about B-HEARD? Collapse and expand the FAQ below to learn more about the pilot.

 

What is B-HEARD?

The Behavioral Health Emergency Assistance Response Division, or B-HEARD, is a health-centered response to 911 mental health calls launched in June of 2021. Beginning with a pilot in Harlem, B-HEARD Teams — FDNY Emergency Medical Technicians (EMTs)/paramedics teamed with a mental health professional from NYC Health + Hospitals — are dispatched as first responders to people experiencing a mental health emergency. B-HEARD Teams operate seven days a week, 16 hours a day.

The B-HEARD Teams use their physical and mental health expertise, and experience in crisis response to de-escalate emergency situations and provide immediate care. These teams have the expertise to respond to a range of behavioral health problems, such as suicidal ideation, substance misuse, and mental health conditions, including serious mental illness, as well as physical health problems, which can be exacerbated by or mask mental health problems. If the person requires emergency medical services, the EMTs or paramedics on the B-HEARD Team are able to provide emergency medical care and call for an ambulance transport. B-HEARD teams do not transport patients.

In emergency situations involving a weapon or imminent risk of harm to self or others, a traditional emergency response is dispatched, which includes NYPD officers and an ambulance.

How does the B-HEARD pilot work? What should 911 callers expect?

New Yorkers experiencing or witnessing an emergency should continue to call 911 for themselves, a loved one, a neighbor, or others.

When a B-HEARD Team is dispatched, the team arrives in an FDNY-branded vehicle and will have the same Basic Life Support equipment as an ambulance. Teams can be identified by their FDNY EMS uniforms and H+H identification. Callers cannot specifically request a B-HEARD Team. Based on a description of the circumstances, 911 operators will route the caller to speak with a trained EMT to triage and assign calls to B-HEARD based on the call location, dispatch criteria and availability of B-HEARD Teams.

What are the goals of the B-HEARD pilot?

B-HEARD is grounded in New York City's commitment to treat mental health emergencies as a health issue, not a public safety problem.

Before B-HEARD, NYPD officers and FDNY EMTs responded to nearly all mental health 911 calls; however, that often is not the most appropriate form of help for those experiencing a mental health emergency and lacks a mental health professional in the response. B-HEARD helps people with emergency mental health needs quickly get appropriate help and health-centered assessments from trained medical and mental health professionals.

The B-HEARD pilot has reduced unnecessary transports to hospitals, increased connection to ongoing mental health care and reduced the number of times police respond to 911 mental health calls. The results of this pilot will inform how the City responds to mental health emergencies in other neighborhoods.

What kinds of expertise do the B-HEARD Teams have?

B-HEARD Teams include two EMTs/paramedics and a mental health professional. As trained health professionals, the B-HEARD Teams can respond to a range of behavioral health problems, such as suicidal ideation, substance misuse, and mental health conditions, including serious mental illness, as well as physical health problems, which can be exacerbated by or mask mental health problems. Team members bring significant experience with mental health crises and are trained jointly to use their physical and mental health expertise and experience in crisis response to assess and de-escalate emergency situations.

What kind of assistance can the B-HEARD Teams provide?

Once on the scene, the Team works with the person in need of assistance, and if appropriate, other involved parties. The Team uses their experience with crisis response to help de-escalate situations, if needed. They conduct physical and mental health assessments and can provide on-site assistance, including but not limited to connecting the person to their existing medical and/or mental health provider, crisis counseling, or, with their consent, connecting them to follow-up services. If the person requires emergency medical services, the B-HEARD Team provides emergency medical care and calls EMS for an ambulance transport.

Do B-HEARD Teams provide follow-up care?

Everyone served by B-HEARD is offered follow-up care. This can include help from Department of Health and Mental Hygiene Health Engagement and Assessment Teams (HEAT), a Department of Homeless Services outreach team, or a hospital-based program. It can also include connecting or reconnecting clients to community-based healthcare or social service providers.

HEAT, in particular, offers pre- and post- short-term case management crisis support service to people presenting with behavioral health challenges and/or a health concern that is affecting daily functioning. Each HEAT team consists of a behavioral health professional and a Health Navigator, or peer with lived experience with mental health, substance misuse, homelessness, and/or the criminal legal system. Services are generally in place for up to 90 days, depending on the person’s level of engagement.

Can I specifically request a B-HEARD Team?

No. Callers cannot specifically request a B-HEARD Team. Based on a description of the circumstances and need, 911 operators and EMS are trained to triage and assign calls to B-HEARD Teams based on the call location, dispatch criteria and availability of B-HEARD Teams.

Are B-HEARD Teams deployed in violent situations? When a person is suicidal?

B-HEARD Teams will not be dispatched to 911 mental health calls where violence and/or imminent harm is identified by the 911 operator. Such calls will continue to be handled by NYPD and EMS. Once on the scene, NYPD or EMS can request support from B-HEARD Teams.

Are B-HEARD Teams available for youth under 18 years old?

Yes. B-HEARD is a option for all ages, and responds to 911 calls from schools.

How are police involved in this pilot?

B-HEARD Teams respond to all mental health emergency calls without law enforcement with a few exceptions where there is increased risk for harm, including situations on subway tracks or involving weapons, imminent harm (as identified by 911 caller), crime in progress, or other circumstances requiring law enforcement assistance.

Once a B-HEARD Team has arrived at a location, they can request backup from NYPD if it is not safe for the B-HEARD Team to intervene.

In all neighborhoods other than the pilot neighborhoods, NYPD officers and FDNY/EMS EMTs will continue to provide coordinated responses to mental health emergencies. When there are no B-HEARD Teams available in the pilot neighborhoods, an ambulance and police officers will continue to respond.

When and where do B-HEARD Teams operate? How are the pilot areas selected?

B-HEARD Teams operate seven days a week, 16 hours a day in Harlem, Washington Heights, Inwood, and parts of the South Bronx. In Fiscal Year 2023, the B-HEARD pilot will expand to several high-needs neighborhoods in Central Brooklyn and Eastern Queens. These areas were identified based on the volume of 911 mental health calls coming from these communities (these radio zones have among the highest volume of 911 calls in the city) as well as the availability of community-based mental health resources, such as Comprehensive Psychiatric Emergency Programs (CPEPs), outpatient clinics and other behavioral health providers.

Which city agencies are in charge of the B-HEARD pilot?

B-HEARD represents a coordinated effort by FDNY/EMS, Health + Hospitals, the Department of Health and Mental Hygiene, the NYPD, and the Mayor's Office of Community Mental Health to move towards a more health-centered approach to mental health emergencies. FDNY EMS and H+H manage the B-HEARD Teams and provide training and ongoing support. The Mayor’s Office of Community Mental Health provides programmatic oversight for this pilot.

What’s the difference between B-HEARD Teams and other crisis responder programs such as Co-Response Teams and Mobile Crisis Teams?

The key difference between B-HEARD Teams and other crisis responder programs are (1) when the teams intervene, (2) how quickly they arrive, and (3) the kinds of professionals who are on each team.

B-HEARD Teams respond to 911 mental health emergency calls within a comparable time as traditional EMS ambulance and include two EMTs/paramedics and a mental health professional, from FDNY/EMS and NYC Health + Hospitals.

Co-Response Teams (CRT) offer pre- and post-crisis intervention and do not respond to 911 calls. A collaboration between the NYPD and the Department of Health and Mental Hygiene, each team includes two police officers and a clinician, serving community members presenting with mental health or substance use challenges who are at an elevated risk of harm to themselves or others. CRTs offer short-term engagement to facilitate connections to care and linkages to support services. CRT officers volunteer for the assignment, and all CRT members have been trained in Crisis Intervention Training (CIT) and are skilled in working with community members presenting with mental health and substance use challenges.

Mobile Crisis Teams respond to referrals from NYC Well for urgent mental health crises and do not respond to 911 calls. From 8:00am to 8:00pm seven days a week, Mobile Crisis Teams arrive within hours to help people who are unable or unwilling to engage in care. Both responses involve face-to-face interventions with the identified individual in crisis, as well as their family or other support systems, to engage, assess, de-escalate and connect individuals to the most appropriate services. Most Mobile Crisis Teams include both professional and paraprofessional staff, for example, a master’s-level clinician with a peer support staff person. These teams consist of mental health clinicians and peers who can provide mental health services, primarily serving both children and adults in their homes. Mobile Crisis teams typically make between one and three contacts with the person in crisis over one to two weeks, provide crisis intervention, de-escalation, assessment and linkage to ongoing mental health and substance use treatment and support.

What is a mental health emergency? When should I call 911?

An emergency is a situation that requires an immediate in-person response from first responders. If someone is at immediate risk of hurting themself or someone else or is in imminent danger because of a health condition or other situation, call 911 immediately.

Beyond 911, New York City also offers other options for people experiencing behavioral health crises. A behavioral health crisis is defined as a non-life-threatening situation in which a person experiences an intense behavioral, emotional, or psychiatric response that may be triggered by a precipitating event. The person may be at risk of harm to themself or others, disoriented or out of touch with reality, functionally compromised, or otherwise agitated and unable to be calmed; and if this crisis is left untreated it could result in an emergency.

Call NYC Well at 1-888-NYC-WELL (1-888-692-9355), text “WELL” to 65173, or chat online at nyc.gov/nycwell to connect to help in a crisis that does not need an immediate in-person response. Counselors are available to provide free, confidential support 24/7 over call, text, or chat. If you’re not sure if 911 or NYC Well is more appropriate, contact NYC Well and a trained counselor will help to assess the most appropriate next steps, including connection to 911 or the City’s full array of urgent mental health services.

Can I text 911 with a mental health emergency?

Text-to-911 is a reliable and safe way to reach emergency services in New York City. You should always call 911 if you can and text 911 only if you can’t call. Text-to-911 is beneficial to the Deaf, people with hearing loss or speech disabilities, and those who can't safely call 911, including those experiencing domestic or intimate partner violence. For more information, go to https://www1.nyc.gov/site/text911/index.page.

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