SCOTT DETROW, HOST:
According to a Washington Post database, police officers in the U.S. have shot and killed 91 people who were in the midst of a mental health crisis this year alone. One in 5 people killed by the police in the last decade - 1,968 people - were experiencing a mental health crisis, and many others have been assaulted by police, arrested or hospitalized against their will. And this has all fueled a movement. More than a hundred cities, including many of the country's largest - Denver, Chicago, Houston, New York - have launched what are called alternative crisis response programs. Instead of armed police, social workers and EMTs now handle 911 calls involving mental illness, addiction or suicidal thoughts.
The health policy news organization Tradeoffs teamed up with The Marshall Project to produce The Fifth Branch, a new podcast about this new generation of first responders. The series focuses on one of the most highly regarded programs in the country, Durham, N.C., Holistic Empathetic Assistance response teams, which people in town called HEART.
In this excerpt of The Fifth Branch, Tradeoff producer Ryan Levi asks a critical question facing these programs. Do they keep their unarmed responders safe?
DETROW: A lot of people are worried about David Prater - well, not David specifically, people in his line of work - unarmed mental health workers who respond to unpredictable 911 calls. They worry responders like David will get hurt. HEART takes the concerns seriously. So after every call, David and his co-workers have to answer a question.
DAVID PRATER: Did you feel safe during this encounter?
RYAN LEVI, BYLINE: Between their unarmed teams, clinicians in the 911 call center and co-response with police, HEART has answered 15,000 calls. Ninety-nine percent of the time, responders said they felt safe. Ninety-nine is the number we'll use to think about the safety of the people who respond to these calls.
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LEVI: After riding around with David and other HEART units for 30 hours, I realized why that number is so high.
UNIDENTIFIED PERSON #1: Do you do you live outside, or do you have a home?
LEVI: I assumed my ride-alongs in HEART's white minivans would feel like some mental health ambulance. You know, we'd race from one crisis to the next. But mostly, it was pretty quiet - checking up on an elderly couple...
UNIDENTIFIED PERSON #2: Your dentist was just really worried.
LEVI: ...Gas station owners with panhandling complaints...
UNIDENTIFIED PERSON #3: They just asked if you wouldn't do that in front of their store. Are you OK with that?
UNIDENTIFIED PERSON #4: I'm OK with that.
LEVI: We gave people rides, helped people in their homes. None of it felt dangerous. HEART director Ryan Smith says that's by design.
RYAN SMITH: We first looked at, what were the calls that other cities already had some evidence to support that it was safe to do this work?
LEVI: Ryan analyzed tens of thousands of calls nationwide. He learned unarmed teams had been safely responding to these calls since the 1980s - trespassing, wellness checks, intoxication. Durham's own 911 data showed those calls rarely ended in violence for police. But just like with firefighters, EMS and cops, Ryan says there is no escaping the danger that comes with this job.
SMITH: I think it would be a mistake and disingenuous to kind of gloss over the risk and uncertainty that is inherent in any 911 call.
LEVI: Ryan has tried to mitigate that risk. If a weapon is present, a HEART social worker responds with a police officer, same thing when someone threatens violence. Durham police train HEART staff to stay alert on scene, and the program outfits teams with police radios to get back up fast. But taking on some risk? That's the job.
SMITH: I think that's part of what being a public servant is. I think government at its best is shifting burden and risk away from those that we serve to those who are signed up to be public servants.
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LEVI: Police in America have shot and killed 1,939 people in the middle of a mental health crisis in the last decade, 1 of every 5 police killings. Ryan believes, like the other branches of public safety, it's worth putting HEART's first responders in harm's way to lower the risk that someone in crisis is hurt by the police. Of course, some disagree with this idea, but some, like David Prater, agree.
PRATER: It is a sacred duty.
LEVI: David's official title is peer support specialist.
PRATER: I don't come to this work with a master's degree like our clinicians do. I come to this work with lived experience of homelessness, of a substance use disorder, with criminal convictions.
LEVI: David told me about the years he spent addicted to crystal meth, living on the streets in Durham and Atlanta, talking to the worker, when the husband storms in.
PRATER: He got out of the car and went in to let management at the gas station know how unhappy he was.
LEVI: Very unhappy.
PRATER: The management of the gas station's response was to show the gentleman the very large gun that they had behind the register. And so in this scene, we've got an armed teller and an angry husband, and they are yelling at each other.
LEVI: David's reaction is swift.
PRATER: So I put my body in between theirs.
LEVI: I want to pause the story right there for a bit of context. Why David inserted himself with that big gun on the counter helps explain why HEART responders report feeling safe 99% of the time.
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LEVI: First, David knows he's got backup. Police are always a radio call away. Second, a bunch of people at HEART told me they have a real faith in this work.
PRATER: When we arrive at a call, we have no arrest power. We have no weapons. We are trying to help somebody get their needs met.
LEVI: And third, HEART has hired a bunch of people willing to make sacrifices.
PRATER: Is there a level of risk in this job? There is. Do I consider it an acceptable risk? I do.
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LEVI: As soon as that gun was out, protocol demanded David call Durham PD. Instead, his instincts took over.
PRATER: We didn't want this gas station owner to hurt someone. We didn't want this angry husband to go to jail. And so I absorbed the risk in that situation by putting myself physically between them.
LEVI: It worked. The husband walked away. The gas station worker offered David coffee as thanks. Again, most HEART calls are not this intense. The point of David's story for me is that they can be. But the evidence shows responders can handle it. HEART's unarmed teams have responded to more than 8,000 calls. They've only called for police backup over any personal safety concern five times, .06%.
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LEVI: This work can also take an emotional toll. I certainly felt drained after seeing people in crisis day after day - a paranoid older woman who kept dialing 911, a mother with two kids about to be evicted with nowhere to go, so many people just trying to survive. David tells me he knows all about it from an old job.
PRATER: If somebody called me at 1:00 in the morning with a crisis, I was expected to support them through that.
LEVI: Before HEART, David helped people with severe mental illness and addiction at a local nonprofit.
PRATER: I would drive thousands of miles every month, running people around different appointments, to court houses, to doctors, to therapists.
LEVI: All those hours, and still, David watched his clients fail to land housing, hold down a job or stay on their meds. David could feel like a failure, and he'd take it out on himself.
PRATER: It was overwhelming for me. And I just - I reached a breaking point working with clients.
LEVI: It could get so bad, sometimes he'd bite himself, hit himself in the head with a metal coffee mug.
SMITH: This work can bleed into every part of your life if you let it.
LEVI: Director Ryan Smith says HEART offers responders free counseling. Supervisors regularly check in, tell folks to take a break after a tough call and turn off at the end of their 12-hour shifts. David says those boundaries and support are huge.
PRATER: That rest and recovery time is what enables me to show up at my best and show up fully when I do come to work.
LEVI: I heard this from a lot of people at HEART, and it seems to be working. The department has only replaced six people on a staff of 55 over their first two years. For David, at the end of most shifts, before he drives home, he stops.
PRATER: I take a moment before I start the car. And I close my eyes. And I take a deep breath. And I exhale the day.
LEVI: All the hurt he's seen, all the people he couldn't help. In this small way, David keeps himself safe.
PRATER: And then I start the car.
DETROW: That was Ryan Levi, the lead producer of the special podcast series The Fifth Branch from Tradeoffs and The Marshall Project. You can listen to all three episodes of The Fifth Branch now by searching for Tradeoffs wherever you listen to podcasts or by going to tradeoffs.org/thefifthbranch. Transcript provided by NPR, Copyright NPR.
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