Austin mental health team speeds crisis response downtown

Last month, Austin police officer Jamie von Seltmann responded to a 911 call reporting that a woman had barricaded herself in a bathroom at a downtown church. When von Seltmann arrived, she found someone who was clearly in the grips of a severe mental health crisis. 

“You could see the fear on her face,” von Seltmann, who has spent 16 years on the Austin Police Department’s crisis intervention team, said in an interview. “She was nervous, a little paranoid. Immediately, I began to say we’re here to help, not hurt you.”

Von Seltmann wasn’t alone that day but her partners were not fellow police officers. Rather, she was joined by a behavioral health clinician with Integral Care, Travis County’s mental health authority, and a paramedic with Austin/Travis County EMS who specializes in mental health response.

The trio responded to the call as part of a six-month pilot program launched last month called the Field Integrated Response Support Team, or FIRST. The initiative, which is limited to the downtown area, pairs a police officer, a behavioral health clinician and a paramedic to respond to the most urgent mental health crises before they spin out of control.

The unit is meant to be more nimble, effective and cost-efficient than the existing mental health response teams at the Police Department and Integral Care, with a goal of arriving on the scene before traditional first responders.

“It’s all about getting the right resource to a person in need of care as quickly as possible,” said Kedra Priest, the practice administrator of crisis services for Integral Care.

Local officials hope connecting people in crisis to care in a more direct and proactive way will cut costs by reducing hospitalizations and arrests. They also hope the initiative will help prevent fatal use-of-force incidents by police officers, some of whom have been prosecuted in recent years over the shooting deaths of people who were in the grips of mental health crises.

FIRST’s launch comes as the number of high-priority mental health calls in Austin — incidents that often involve the risk of self-harm or violence — have lingered well above pre-pandemic levels. Those types of calls surged during COVID-19 and have declined some since then but remain notably higher than they were pre-2020. 

With the increased call volume, average response times to the most serious calls have grown exponentially —99% since 2014, according to an American-Statesman analysis of 911 call data.

Similar units have proven successful in large metros like Dallas and Chicago, and even smaller cities like Abilene, which have seen a drop in emergency room admissions and arrests, among other positive changes.

Whether FIRST will prove successful in Austin – and how exactly the city will go about determining that – remains to be seen. EMS Division Chief Angela Carr, who is overseeing the pilot program, said the various agencies will be tracking metrics like use-of-force incidents and hospital admissions but they have not set specific goals for what kind of changes they’d like to see by the time the program ends in the spring but that the hope is they will all improve.

At the downtown church last month, von Seltmann and Integral Care Clinician Dawn Handley worked to assess the woman’s mental state by asking questions in a calm and gentle tone. Paramedic Justin Chandler waited just outside the bathroom in case the woman needed emergency medical treatment. 

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After determining the woman did not have the mental capacity to accept or refuse care, the team decided to sedate her before transferring her to a facility where she could receive more robust treatment. Before administering the medication, Chandler recalled the woman asking if she would still feel mentally unwell after it wore off.

“That tells you a lot,” Chandler said. “She wanted treatment, but she wasn’t in the mental state to find it. But we were able to use some of the trust we had built up with the patient to get her there.”

Cities across the nation have experienced an increase in the number of mental health incidents requiring an emergency response, according to a 2023 survey of mayors and Austin is no exception. A Statesman analysis of Austin 911 call data shows a 269% increase in mental health calls of all types and severities between 2014 and 2024. 

During that same decade, the average response time increased by 180%, to 53 minutes and 27 seconds. For the most urgent calls — the kind that FIRST is designed to address — response time increased by 99% to about 16 minutes.

Austin officials have taken steps in recent years to improve response to mental health emergencies, notably by adding a fourth “mental health” option to the 911 call system in 2021, a change that could have contributed to a spike in mental health-related calls in 2021. 

Another approach has been investing in mental health emergency response units, like the Expanded Mobile Crisis Outreach Team. EMCOT, launched in 2013, pairs an Integral Care clinician with police officers responding to mental health emergencies where a law has been broken or someone is facing risk of harm.

But that team isn’t deployed until a different first responder requests its assistance. That can create a lag that delays psychiatric care for people who may be in dire need of support.

The FIRST unit — staffed with a police officer, a licensed social worker and a paramedic — is designed to be more proactive.

The unit does not wait for 911 dispatchers to assign them to mental health calls, instead actively scanning the dispatch system for calls it can jump on.

When a suitable incident arises, the FIRST unit can respond quickly with each member wielding their specialized skill set to successfully address the mental health emergency at hand. The officer can secure the scene for safety, the social worker can assess the patient’s psychiatric needs and the paramedic can administer any necessary medical treatments.

Chandler, the paramedic, said mental health crises are dynamic situations that can devolve rapidly. Being able to respond rapidly to such calls with a diverse team can be the difference between a mental health emergency that ends tragically and one that ends with the patient receiving the care they need, he said.

“When someone is in a crisis, every second counts,” Chandler said.

B. J. Wagner, executive vice president of health and public safety at the Meadows Mental Health Policy Institute, said local governments across the country have launched mental health “co-response” teams like FIRST over the past decade as officials increasingly realize that safe and effective responses to mental health emergencies often require more than just policing skills.

Cities like Chicago and Fontana in California have all experimented with similar units, Wagner said, along with Texas cities like Dallas, San Antonio and Galveston. In 2018, Wagner helped Dallas launch their own initiative, known as the Rapid Integrated Group Healthcare Team, or RIGHT Care.

Like Austin’s FIRST unit, RIGHT Care teams include a police officer, a social worker and a paramedic. Two years after launch, data presented to a Dallas City Council committee showed 

Emergency room admissions had dropped by more than 30% in the ZIP codes where the unit was deployed. While arrests increased citywide during that time period, the increase was notably smaller in areas where the RIGHT team had operated. 

In 2020, Dallas officials expanded the program to cover the entire city.  Tabitha Castillo, a spokesperson for the city’s Emergency Management and Crisis Response, shared 2024 data that shows the positive improvements have continued 

Between 2020 and 2024, arrests dropped by more than 20% while the average time emergency responders spend on-scene at mental health calls has fallen to about 1 hour and 24 minutes from the previous average of two hours. In Austin, the average on-scene time in 2024 was about one hour and 57 minutes. 

Wagner said Austin has the opportunity to see similar results with FIRST, but she encouraged local officials to “think outside the box” in terms of what performance metrics they should measure.

“Everybody can reduce response times, jail bookings and hospital admissions,” Wagner said. “But reducing use-of-force instances, repeat 911 calls and improving the quality of life of people being treated and for the people providing care is also important.”

Carr, the EMS division chief, said the agencies will track a dozen different metrics during the six-month pilot, including use-of-force incidents, hospital admissions, emergency detentions, and the amount of time first responders spend on the scene of mental health calls.

What amount of change are they hoping to see? 

Carr said the agencies haven’t set exact numbers but the hope is that each metric will see a decline. Agency leaders will present Austin City Council with data on program performance after the pilot concludes. 

The council will then have to decide whether to continue or expand the program. Carr said continuation is the plan but it would require new funding. (For the pilot, the three city agencies reassigned existing personnel and equipment so no new money was required.) That could prove difficult amid the city’s budget crunch but the program also could carry significant cost savings over time. 

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Exactly how much is unclear but a 2020 study conducted by Integral Care offers some insight into the potential.

A review of 911 mental health calls placed between December 2019 and August 2020 found that those resolved with the help of a behavioral health clinician cost $65 on average. That compared to $109 for a Police Department response and $831 for the deployment of an ambulance. 

“These types of calls for service are time-consuming, complex, and draining on first responder resources,” the study authors wrote. But alternative response teams – like the FIRST unit allow “resources and costs to be deployed instead to urgent public safety matters.”

Historically, cities have leaned on police officers to respond to mental health emergencies, even though they are generally not trained on how to handle mental health crises.

Priest, of Integral Care, said Austin’s mental health response network is working toward a tiered structure where emergency response starts small and scales up. 

That means that if the behavioral health clinicians staffing Austin’s 911 call center can’t resolve the problem by phone – the least expensive intervention option – they can dispatch a clinician to the scene. That is the next-most costly option, but still far less expensive than dispatching a police officer, paramedic or ambulance, Priest said.

“The goal is to continue to identify the most appropriate response to all call types, so we can get the most appropriate support to a person in their moment of need,” she said.

A structure like that also would free up police, fire and EMS to respond to other emergencies more quickly, as well as result in better outcomes for the person in crisis. Priest said a mental health clinician is much better trained than a police officer in the delicate work of talking a person down from a heightened emotional state so that they might accept mental health care.

Read More: Austin considers civilian staff to fill police roles amid officer shortage

Priest said the FIRST team sits somewhere toward the higher end of the response tier. Because of that, she said the team is unlikely to produce the kind of easily discernible cost savings seen in programs that deploy mental health clinicians in lieu of police officers to 911 calls. But the FIRST unit can improve the rate at which severe mental health calls — the costliest and most time-consuming type of crisis to resolve — are resolved.

In the aftermath of the Prop Q election, Priest said the agencies spearheading the FIRST pilot are even more focused on demonstrating its benefits to the community — including its potential to make Austin’s mental health response system more efficient.

“We have felt the pressure for the pilot to succeed after Prop Q,” Priest said. “We think the program makes sense but we know we have to prove it to the public.”

Von Seltmann and Chandler, the police officer and paramedic, said they hope the FIRST team can replicate the outcome of last month’s call to the downtown church where they were able to get the woman in crisis to accept care and willingly leave the bathroom where she had barricaded herself.

A more traditional response team may have ended up using physical force to extricate her or administer sedation, von Seltmann said.

“We got there quickly and we got to work together to help that woman another way,” von Seltmann said. “I hope we can do that for even more people.