Baltimore is building out a service that changes who arrives when someone calls 911 during a mental health or social crisis, expanding behavioral health responders to operate around the clock rather than within the narrow window mobile crisis teams have covered until now.
The city is drawing on money from roughly $400 million it has received from opioid-related legal settlements, according to reporting from NPR, WYPR and KFF Health News. The scale is more modest than the headline pool suggests: Baltimore's director of overdose response, Sara Whaley, said there is $15 million in settlement funds allocated so far across a broader set of city services, of which the 911 expansion is one part.
For residents, the practical change is what happens after they dial. A person in distress, or a family member calling on their behalf, may be connected to a clinician or counselor instead of receiving a patrol car.
Operational Design Behind the Diversion
The system has two layers, and the distinction matters for anyone trying to understand what will actually happen on a given call.
The first is call diversion at the dispatch level. Behavioral Health System Baltimore, a nonprofit that functions as the city's mental health department, worked with the city on a 911 diversion program that redirects certain calls to the 988 helpline. In its first 17 months, 643 callers to 911 were reconnected to 988, where counselors provide emergency emotional support.
The second is in-person response. Mobile crisis teams staffed by mental health clinicians travel to the caller. Those teams have existed for years but with a limited scope focused specifically on people in mental health crises, which is the constraint the expansion is meant to address.
Dispatchers make the determination based on how a call is described. Calls involving weapons, violence, or an immediate threat to life continue to receive a traditional emergency response. Calls describing distress, disorientation, housing instability, or a person who needs help rather than enforcement are candidates for diversion.
The new service is designed to reach further, covering crises that are not strictly psychiatric and connecting callers to social services and health care before a situation escalates.
Scale of the Problem the City Is Addressing
Baltimore logged 1.68 million calls to 911 in 2024, and tens of thousands of them did not require police, firefighters or emergency medical services, according to Tahir Duckett, a community safety expert at Georgetown Law. The examples cited in the reporting are ordinary rather than dramatic: a homeless person asleep in a store, someone who seemed confused in a park, someone shouting at passersby.
The city's public health picture explains the urgency. Between 2021 and 2025, Baltimore's homicide rate fell by 60 percent, a record decline. Over roughly the same period, about 1,000 people died of drug overdose each year from 2020 through 2023.
Those two trends running in opposite directions describe a city where violence responded to one set of interventions while a health crisis did not, and where a substantial share of emergency calls involve problems that arrests do not solve.
The funding structure is unusual and worth understanding. Baltimore opted out of the global opioid settlement in 2018 and sued manufacturers and distributors independently. As those suits resolved, city officials decided settlement money must be spent on drug-related harms or on services that help prevent addiction, including housing support, health care and education. A companion program places naloxone boxes at every subway stop.
Evidence That Exists and Evidence That Does Not
This limitation belongs early rather than at the end. Baltimore's expanded service is new, and there is no outcome data for it yet. Claims about what it will accomplish are projections.
What exists is evidence from comparable programs elsewhere. A study found that when a non-law-enforcement team responded to 911 calls in Durham, North Carolina, the result was fewer arrests than when police responded, with the difference most pronounced for callers who were Black, men, or between 25 and 39.
Fewer arrests is a meaningful outcome but a narrow one. It does not by itself establish that people got better mental health care, that repeat crises declined, or that anyone avoided hospitalization. Those are the harder measures, and they take years to accumulate.
Duckett makes a related argument that also has not been quantified here: police responses can cause trauma or produce a less satisfactory outcome than a community service response would. That is a reasonable expectation rather than a measured result in Baltimore.
Baltimore's own diversion numbers are similarly limited. The figure of 643 callers reconnected to 988 over 17 months describes activity, not results. Whether those callers received care that helped is a separate question that the count does not answer.
Readers evaluating this model, in Baltimore or in the many cities piloting versions of it, should watch for outcome reporting rather than volume reporting.
What Residents Should Know Before They Need It
Anyone in Baltimore or elsewhere facing a mental health crisis can call or text 988 directly, which reaches the 988 Suicide and Crisis Lifeline without going through 911 at all. That is the fastest route to a counselor and is available around the clock.
Call 911 when there is an immediate danger to life, a weapon involved, a serious injury, or a medical emergency such as a suspected overdose. Naloxone should be given if an overdose is suspected, and 911 called regardless.
When calling either number about someone in crisis, describing the situation clearly helps dispatchers route it correctly. Saying that a person is distressed and needs mental health help, and that no weapon is involved, gives the dispatcher information the system depends on.
Families can also plan in advance. Knowing the local crisis line, keeping a list of a relative's medications and diagnoses accessible, and identifying which nearby hospital has psychiatric capacity all make a difficult night less chaotic. People with recurring crises can ask a clinician about a written crisis plan naming preferred contacts and interventions.
What happens next in Baltimore is the buildout of round-the-clock coverage and, eventually, reporting on whether it changes outcomes. MedicalDaily will report those results when they are published.
The bottom line: Baltimore is expanding who responds to 911 calls that do not require police, funded by a portion of its opioid settlement money; the model has promising evidence from other cities on arrests but no outcome data of its own yet, and residents can reach a counselor directly through 988 at any time.
If you or someone you know is struggling, the 988 Suicide and Crisis Lifeline is available 24 hours a day by call or text.
Frequently Asked Questions
What is Baltimore changing? The city is expanding behavioral health and social service responders for 911 calls that do not require police, firefighters or paramedics, funded partly by opioid settlement money and designed to operate around the clock.
How much money is involved? Baltimore has received roughly $400 million from opioid-related settlements. About $15 million has been allocated so far across a broader set of city services, including this expansion.
Which calls get diverted? Calls describing distress, disorientation, or a need for help rather than enforcement. Calls involving weapons, violence or an immediate threat to life continue to receive a traditional emergency response.
Who decides? Dispatchers, based on how the caller describes the situation.
Has the program been shown to work? Not yet. The expanded service is new and has no outcome data. A study in Durham, North Carolina found non-police response teams produced fewer arrests, but that is a narrower measure than health outcomes.
Should someone in crisis call 911 or 988? Call or text 988 to reach a crisis counselor directly. Call 911 when there is immediate danger to life, a weapon, serious injury, or a medical emergency such as a suspected overdose.
How can families prepare in advance? Save the local crisis line, keep a list of medications and diagnoses accessible, know which nearby hospital has psychiatric capacity, and ask a clinician about a written crisis plan for someone with recurring episodes.
