New Audit: Comptroller Finds Over a Third of Eligible Mental Health Calls Did Not Get a B-HEARD Team Response for Untracked Reasons

 

Comptroller Lander re-ups “Safer for All” plan to overhaul 911 so every mental health call is met with an EMS, peer, or mental health professional triage

In a new audit, New York City Comptroller Brad Lander exposed that tens of thousands of mental health calls were never routed to the Behavioral Health Emergency Assistance Response Division (B-HEARD) pilot program, as they were supposed to be. Rather than sending police officers to a scene with an emotional distressed person without weapons or imminent risk of harm, B-HEARD is a program designed to better connect individuals in crisis to mental health services: a Health and Hospitals (H+H) mental health professional alongside two Fire Department of New York (FDNY) paramedics. In Fiscal Years 2022-2024, 911 assessed 37,113 calls as eligible for a B-HEARD response. Of these calls, 13,042 calls deemed eligible for B-HEARD (35%) failed to receive program services, with no reason provided. In addition, B-HEARD was not dispatched to 14,200 eligible calls that came in overnight between 1 a.m. to 9 a.m.  

“Tens of thousands of New Yorkers experiencing mental health crises needed help that the Adams Administration promised to provide, but failed to deliver,” said Comptroller Brad Lander. “Despite claiming this was a public safety priority, the Adams Administration consistently failed to connect B-HEARD teams to people in crisis or track the program’s outcomes. Without better management, capacity, and rigorous evaluation, New York City’s public safety will remain off track, endangering the lives of people in crisis, officers, families, and neighborhoods.” 

Launched in 2021, B-HEARD is a “heath-centered” response designed to respond to 911 mental health calls with two FDNY EMTs and a H+H mental health professional to reduce use of police resources, increase connection to community-based care, and reduce unnecessary transport to hospitals, for individuals with no imminent risk of harm to self or known weapons involved, with the goal to route these calls to a B-HEARD team. B-HEARD teams currently operate seven days a week from 9 a.m. to 1 a.m. in certain parts of Manhattan, the Bronx, South Brooklyn and Western Queens, covering a total of 31-of-78 police precincts, including subway stations. 

Of the 96,291 mental health calls from within the pilot areas and hours of operation between FY22-24, 59,178 calls (over 60%) were considered “ineligible” for a B-HEARD response because calls were considered potentially dangerous, were ineligible because a mental health professional was already at the scene, or were unable to be triaged because FDNY EMS did not take the call or all necessary information could not be collected about the person in distress. Some calls deemed ineligible for B-HEARD might have been eligible calls. Of the remaining 37,113 calls assessed as eligible for a B-HEARD response, 24,071 (65%) resulted in 911 dispatching a B-HEARD team, but over 13,000 calls did not result in a dispatched B-HEARD team. In addition, 14,200 eligible calls came in outside the program’s hours of operation. While participants rated their experience highly when asked, the audit found a troubling lack of data collection and performance measurement records—creating critical barriers to assessing the effectiveness of the pilot program in both the short- and long-term. 

Other findings: 

1. During FY22, only 55% of the calls that B-HEARD teams responded to resulted in a mental health assessment of the patient, then decreased to 31% in FY23 and 25% in FY24. 

1. During FY24, B-HEARD made contact with patients during just 50% of the calls B-HEARD teams attended. The decreasing assessments show B-HEARD is not meeting one of their program standards. Program administrators attributed the infrequency of contact to the fact that patients leave the scene or refuse contact. But administrators did not track this data and therefore the Comptroller’s Office cannot confirm. 

1. Despite the program goal of limiting unnecessary transports to hospitals, the auditors’ review of data published by the Mayor’s Office of Community Mental Health (OCMH) found a decline in the percentage of patients transported to community based care—from 10% between July 1 and December 31, 2022 to 6% between January 1 and June 30, 2023—and an 8% increase in the number of people taken instead to a hospital over the same period. 

In January, Comptroller Lander released Safer For All: A Plan to End Street Homelessness for People with Serious Mental Illness in NYC, an in-depth look at the crisis of people with serious mental illness cycling between the city’s streets, subways, hospitals, and jails—including the B-HEARD program. The Comptroller re-upped calls to rethink the City’s mental health crisis response framework, incorporating best practices from the CAHOOTS program in Eugene, Oregon. Operating 24/7 for over 30 years until last month, CAHOOTS provided a citywide response to mental health crises, handling 100% of 911 calls related to mental health with police joining the response team in cases where individuals present an immediate danger (which comprise less than 1% of cases in Oregon). CAHOOTS focused heavily on serving vulnerable populations with approximately 60% of its calls involving unhoused individuals and 30% addressing serious mental illnesses. Unlike B-HEARD, CAHOOTS was the default response, deploying civilian crisis workers, such as mental health practitioners and EMTs in every case, and limiting a police co-response to situations that involve a weapon or imminent threat. This approach significantly increased the likelihood that individuals will be connected with mental health services and reduced the likelihood of law enforcement escalation during mental health crises, saving the local government an average of $8.5 million each year. 

The Comptroller also backed advocates’ calls for a baseline allocation of $4.5 million to improve compensation and resourcing for Peer Specialists to increase the capacity and reach of the City’s mental health crisis response teams including the B-HEARD staff. Today’s audit findings underscore the calls from advocates to properly staff and resource the B-HEARD program to address the critical gap in the mental health professional staffing. 

Read the full audit here: https://comptroller.nyc.gov/reports/audit-of-the-behavioral-health-emergency-assistance-response-divisions-effectiveness-in-responding-to-individuals-with-mental-health-crises-and-meeting-its-goals/