Embedding a Crisis Specialist at 911 Steered Suicide Calls Away From Police

When someone dials 911 in the middle of a suicidal crisis, the default response in most American cities is a squad car. Two officers arrive, assess the situation, and often transport the person to an emergency department, a journey that can end in hours of waiting, involuntary hospitalization, or, in the worst cases, a violent escalation. A new study suggests there is a surprisingly simple way to interrupt that pipeline: put a mental health crisis line specialist physically inside the 911 dispatch center itself. Researchers at the University of Chicago’s Crown Family School of Social Work, Policy, and Practice analyzed what happened when the city of Mesa, Arizona, embedded a crisis counselor at its emergency communications center, and found that the move was associated with a substantial and statistically meaningful drop in police responses to suicide calls.

The study, published in Community Mental Health Journal, is the first empirical test of a 911-to-crisis-line call routing intervention of this kind. Using a quasi-experimental technique known as synthetic control analysis, Leonard Swanson, Aaron Gottlieb, and Margaret Thomas compared Mesa’s suicide call rates after the intervention against a weighted blend of twenty comparable cities across the United States. Their findings indicate that embedding a crisis line specialist at the 911 center reduced police responses to suicide calls by roughly 22 to 48 calls per quarter per 100,000 residents relative to the synthetic control. Translated into officer time, that reduction amounts to an estimated 228 to 491 police hours saved per quarter in a city of just over half a million people.

The logic behind the intervention rests on a mismatch in how Americans reach help during a mental health emergency. The 988 Suicide and Crisis Lifeline, launched nationwide in July 2022, offers around-the-clock counseling through a network of roughly 200 local call centers, and fewer than 2 percent of its calls ever require an emergency dispatch. Yet 911 remains the number people actually know and dial. An estimated 240 million 911 calls are placed every day across the country, and some analyses suggest that as many as one in five involve a mental health component. Even under a conservative estimate, mental health-related 911 calls would vastly outnumber the roughly six million calls 988 receives annually. Survey research underscores the awareness gap: only about one in five Americans knew of 988, while more than half said they would call 911 in a crisis.

Mesa’s path to reform began years before the embedded specialist arrived. In 2019, the Mesa Police Department and Solari, the nonprofit crisis line that answers 988 calls for Arizona, drafted a policy allowing 911 call-takers to route suicide calls to the crisis line when the caller expressed suicidal thoughts without plans or means and consented to the transfer. Dispatchers received an hour of training on identifying eligible calls. A similar policy for broader mental health calls followed in August 2020. But the decisive change came on June 5, 2021, when Solari placed a licensed counselor inside the emergency communications center itself. The embedded specialist did not take calls. Instead, the counselor sat alongside 911 professionals during their shifts, listened for the types and severity of calls Solari could handle, coached dispatchers in real time, and translated abstract routing policies into concrete, call-by-call decisions.

That physical presence, the researchers argue, may have been the ingredient that previous paper policies lacked. Emergency communication centers are overwhelmingly police-operated, and 911 professionals frequently default to law enforcement responses out of concern for legal liability and a lack of trust in alternative resources. Call-takers feel personally responsible when a caller expresses suicidal ideation, and strict call-taking protocols often leave little room for nuance. By working shoulder to shoulder with dispatchers, learning their procedures, norms, and coding practices, the embedded specialist built the interpersonal and institutional trust needed to make call routing a routine practice rather than a risky exception. Once the program was established, a behavioral health technician with a lower credentialing burden could assume the role, making it financially sustainable for other jurisdictions.

To measure the effect, the team turned to the synthetic control method, an approach originally developed in comparative politics and increasingly used in criminology. Rather than hunting for a single comparison city with matching pre-intervention trends, which is notoriously difficult, the method constructs a weighted combination of donor cities whose pre-intervention suicide call rates collectively mimic Mesa’s. The researchers scoured public data portals from all 369 U.S. cities with populations above 100,000, searching for jurisdictions that published computer-aided dispatch or calls-for-service data containing suicide-related call types. Twenty cities made the final donor pool. The resulting synthetic Mesa drew most heavily from Everett, Seattle, and Tacoma, with smaller contributions from New Orleans and Norman, and tracked Mesa’s actual suicide call rates closely before the intervention, with differences never exceeding 18 calls per 100,000 people per quarter.

After the specialist was embedded in mid-2021, the trajectories diverged. Mesa’s suicide call rate fell below its synthetic counterpart in quarter after quarter, with the gap widening to nearly 48 calls per 100,000 people by late 2022 before narrowing somewhat in 2023. To rule out chance, the researchers ran placebo tests, constructing synthetic controls for each donor city as if it too had received the intervention. Mesa’s observed decline exceeded nearly all of these placebo estimates, reaching conventional significance thresholds in several post-intervention quarters, including one quarter in which Mesa’s difference was larger than every placebo site. The team also conducted robustness checks, dropping individual cities to test for outsized influence and examining non-suicidal call trends for confounding influences, and the core result held.

The implications extend beyond officer hours. Police responses to mental health crises can escalate situations that might otherwise be resolved peacefully, sometimes ending in arrest, use of force, or death. Officers predominantly transport people in crisis to emergency departments, where patients can wait weeks for psychiatric placement in a practice known as ED-boarding, and where connections to follow-up care are often tenuous. Crisis lines, by contrast, can de-escalate a caller over the phone, activate a mobile crisis team, and link the person to ongoing mental health resources, all without a uniformed response. Deflecting calls upstream, before they enter the criminal-legal or acute care systems, is precisely the kind of intervention that crisis system frameworks from the Substance Abuse and Mental Health Services Administration envision, and the quantifiable reduction in police labor may give law enforcement administrators a pragmatic incentive to support such programs.

The study also exposes a stubborn data problem that hampers research in this field. The researchers had hoped to analyze whether Mesa’s broader mental health-related call rate declined as well, but definitions and coding practices for mental health calls vary so widely across jurisdictions that no meaningful cross-city comparison was possible. Some calls coded as mental health-related are not, and many genuinely mental health-related calls are buried under categories like check welfare or public disturbance. Suicidality, with its clearer concepts of ideation, threats, and means, proved far more comparable across cities. The authors note that this coding ambiguity itself shapes outcomes: when 911 professionals lack confidence in identifying mental health concepts that require clinical judgment, they tend to default to dispatching officers, and the absence of a standard definition inhibits empirical evaluation of deflection programs nationwide.

The authors are careful about causal claims. Mesa’s earlier routing policies laid groundwork that the embedded specialist built upon, and other cities may not replicate the results by embedding a counselor without first establishing transfer policies and training. The synthetic control method absorbed the effects of those earlier policies into the pre-intervention baseline, which strengthens the case that the observed decline reflects the embedded specialist’s distinctive contribution. Still, the association is striking: a single embedded clinician, working within a police-operated dispatch center, coincided with hundreds of police hours redirected away from suicide calls each quarter. As cities across the United States and abroad experiment with alternatives to police-led crisis response, the Mesa model suggests that the most powerful lever may not be a new mobile team or a retrained officer corps, but a counselor with a headset sitting in the room where the first call for help arrives.

Subject of Research: Embedding a mental health crisis line specialist in a 911 emergency communications center to reduce police responses to suicide calls

Article Title: Deflecting Suicide Calls From Law Enforcement With an Embedded Crisis Line Specialist at a 911 Center: A Synthetic Control Analysis

Article References: Swanson, L., Gottlieb, A., & Thomas, M. (2026). Deflecting Suicide Calls From Law Enforcement With an Embedded Crisis Line Specialist at a 911 Center: A Synthetic Control Analysis. Community Mental Health Journal. https://doi.org/10.1007/s10597-026-01726-2

Image Credits: AI Generated

DOI: 10.1007/s10597-026-01726-2

Keywords: 911, 988 crisis line, suicide prevention, mental health crisis response, police deflection, synthetic control method, emergency communications center, Mesa Arizona, crisis intervention, mobile crisis teams, law enforcement, community mental health