Presenting: The Fifth Branch

Summary

Podcast Summary: "Presenting: The Fifth Branch"

Lost Patients Episode: Presenting: The Fifth Branch
Release Date: September 27, 2024
Produced by: KUOW News and Information in collaboration with Seattle Times and The Marshall Project

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Introduction

In the inaugural episode of Lost Patients titled "Presenting: The Fifth Branch," host Will James delves into the intricate and often problematic intersection of mental healthcare and law enforcement in America. Drawing a vivid analogy, James describes the current system as a "sprawling house" with disjointed architectural designs, leading to a maze-like experience for patients navigating mental health crises. This episode focuses on Durham, North Carolina, as a pioneering city attempting to overhaul its emergency response to better serve individuals with severe mental illnesses.

The Problem: Policing and Mental Health Crisis

Will James sets the stage by highlighting the alarming statistics: police in Seattle responded to nearly 10,000 scenes involving individuals in crisis last year, with severe mental illness cases often funneling individuals between the streets, jails, clinics, and courts without receiving adequate care. This system, as James points out, "almost by design, loses patients with psychosis to an endless loop" (00:00).

Durham's Radical Experiment: Introducing HART

The episode introduces Durham's Community Safety Department and its innovative Holistic Empathetic Assistance Response Team (HART). Ryan Smith, the director of HART, spearheads this initiative aimed at disentangling mental health care from policing. Instead of dispatching armed officers to respond to mental health-related 911 calls, Durham sends unarmed social workers and mental health professionals.

Key Quote:

"We can do both. We can have a wonderful professional police department. We can also have amazing public safety partners in Hart." — Ryan Smith (17:03)

Overcoming Initial Skepticism: Gaining Police Buy-In

One of the significant hurdles in implementing HART was overcoming the deep-seated skepticism within the Durham Police Department. Police Chief Patrice Andrews and Ryan Smith faced resistance from rank-and-file officers who were accustomed to traditional policing methods. In early meetings, officers expressed fears about safety and job security, with some declaring, "I thought it was a very bad idea" (20:18).

To address these concerns, Ryan Smith utilized data-driven approaches to demonstrate the efficacy and safety of alternative responses. Chief Andrews played a pivotal role in fostering dialogue, encouraging officers to see HART as a partner rather than a replacement.

Key Quote:

"We're not replacing you. You still have work that you need to do as a law enforcement officer." — Ryan Smith (22:55)

A Turning Point: The Barricaded Man Incident

A pivotal moment in the episode recounts an August night in 2022 when a man with a history of mental illness barricaded himself, making threats to shoot officers if they entered his home. Instead of immediately deploying SWAT, Chief Andrews calls upon Ryan Smith and the HART team.

Notable Moments:

• Intervention Strategy: Abina Beriako, a social worker with HART, engages the man through calm conversation, validating his feelings and de-escalating the situation without force (26:19).
• Outcome: After persistent, empathetic dialogue, the man agrees to seek hospital care voluntarily, successfully avoiding a potentially violent confrontation.

Key Quote:

"He let officers come and search his room. To make sure that, you know, he was okay." — Abina Beriako (27:33)

This incident significantly shifted the perception of HART within the police department, showcasing the practical benefits of an alternative response team.

National Perspectives and Broader Implications

The episode expands its scope to include national insights, featuring interviews with experts like Kristi Thompson from The Marshall Project. It discusses how other cities are adopting similar models and the legal challenges emerging, such as lawsuits alleging that sending armed police to mental health crises violates the Americans with Disabilities Act.

Key Quote:

"Some communities are afraid that if they're sending social workers and others, that someone's going to get hurt and killed." — Abina Beriako (09:03)

Progress and Future Directions

Back in Durham, the success of HART has led to a substantial increase in police officers who now recognize the program's value—from an initial 37% supportive to 66% (30:09). The episode underscores the importance of continuous engagement, data transparency, and building trust between police and alternative responders to sustain and expand such programs.

Key Quote:

"If what we're really doing is about, you know, sending the most appropriate response, then I want that to be available for as many people in as many moments as possible." — Abina Beriako (10:26)

Conclusion

"Presenting: The Fifth Branch" offers a comprehensive exploration of Durham's transformative approach to handling mental health crises, highlighting both the challenges and successes of integrating social workers into the public safety framework. By emphasizing empathy, data-driven strategies, and collaborative efforts between police and mental health professionals, Durham serves as a potential model for other cities grappling with similar issues. The episode leaves listeners contemplating the broader implications of such reforms and the necessary steps to create a more humane and effective emergency response system.

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Notable Quotes with Timestamps

• Will James: "Imagine a sprawling house in which every room, doorway, and hall passage was designed by a different architect." (00:00)
• Ryan Smith: "We can have a wonderful professional police department. We can also have amazing public safety partners in Hart." (17:03)
• Abina Beriako: "He let officers come and search his room. To make sure that, you know, he was okay." (27:33)
• Patrice Andrews: "We just needed to make sure that our officers knew that this is not, we're not replacing you." (22:55)
• David Prater: "Police unions can be a limiting factor in the expansion of these programs." (31:22)

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Note: For more detailed insights and to listen to the full episode, visit tradeoffs.org/thefifthbranch or find Lost Patients on your preferred podcast platform.

Transcript

[Will James]

Hey, this is Will James. One thing we talk about in Lost Patients is how our systems for managing mental health care and our systems for managing crime have blended together. Police here in Seattle responded to nearly 10,000 scenes of people in crisis last year. One of the only remaining paths into Washington state's largest psychiatric hospital is through jail. But some cities around the US are trying to change that equation. They're trying to disentangle mental health care from policing, setting up new branches of emergency services that specifically handle mental illness, addiction and homelessness. These changes have, not surprisingly, created some friction. We're talking in many cases about taking responsibilities away from police and giving them instead to unarmed mental health care workers. I wanted to share a recent podcast series that tells this story. The team behind the podcast trade offs has teamed up with the Marshall Project to put out a special three part series called the Fifth Branch. It tells the story of what happened when one city upended the way it used to handle emergencies and built a new branch of mental health specialists. Here's the first episode of the Fifth Branch. It's called Convincing the Cops. And it covers the origin story of of a new community safety department in Durham, North Carolina and the conflicts and challenges that emerged in those early days. You can find all three episodes of the Fifth Branch wherever you get your podcasts.

[Patrice Andrews]

The phone rings a little after 6, a sunny August evening in 2022. Police Chief Patrice Andrews picks up.

[Ryan Smith]

One of my deputy chiefs said, so we have a barricaded person.

[Patrice Andrews]

The deputy tells Patrice the man had a history of mental illness. The family is worried he might hurt himself. They're asking officers to force him to go to the hospital. Officers are now camped outside the house and the man is making threats.

[Ryan Smith]

He said, I'm not coming out and if you come in, I'm going to shoot you all.

[Patrice Andrews]

The deputy tells Patrice a hostage negotiator is now on scene and he's about to call the SWAT team.

[Ryan Smith]

And I said, well, wait, wait a minute, wait a minute. Let's hold on. Let's, let's, let's talk about this for a second.

[Patrice Andrews]

Patrice takes a breath. A cop for more than 20 years, she wanted everyone to take a breath.

[Ryan Smith]

Whether, you know, he would have shot an officer or officers would have shot him, I didn't, I don't have a crystal ball, but I tell you, there were the makings in that for maybe it not to end well.

[Patrice Andrews]

Patrice knew what she wanted to do.

[Ryan Smith]

I said, let me call Ryan.

[Patrice Andrews]

Ryan Smith headed up a brand new department in the city. A radical experiment in public safety, Patrice knew the last people Ryan would send would be a SWAT team. Ryan would send a social worker. I'm Dan Gorenstein, and this is the fifth branch, a special series from trade offs and the Marshall project on what it looks like when one community dramatically changes how it responds to people in crisis. Police in America have shot and killed 1,939 people in the middle of a mental health crisis since 2015. That's 20% of all police killings in the last decade. One of every five. Those numbers are helping fuel a movement. Cities like Denver, Albuquerque, Houston, Louisville, and New York have launched what are called alternative crisis response programs. Instead of armed police, a new generation of RESP EMTs and social workers now handle 911 calls involving mental illness, addiction, or suicidal thoughts. These programs have kept popping up as we reported on America's mental health crisis. And we wanted to know whether they're working. So about a year ago, we gave trade offs producer Ryan Levy an assignment. Find a city doing this work.

[Dan Gorenstein]

We wanted to find a place that experts thought could be a model for other cities. They needed to be serious about data and be willing to let me spend a bunch of time with them. I talked to several interesting programs. New Orleans, Denver, Rochester, New York. In the end, we went with Durham, North Carolina, and its holistic empathetic assistance response team, what locals call Hart. National experts were big fans.

[David Prater]

They did it the right way. Thinking, designing, assessing, researching, evaluating. And then they went to work.

[Dan Gorenstein]

And Hart was willing to give us a lot of access. I interviewed their leaders.

[Abina Beriako]

I knew that it would be hard. I knew that it would be messy.

[Dan Gorenstein]

Dozens of their responders.

[Abina Beriako]

Is there a level of risk in this job? There is. Do I consider it an acceptable risk? I do.

[Dan Gorenstein]

I rode along on 911 calls.

[Ryan Smith]

Are you guys here for the guy.

[Dan Leader]

At the top of the street? Yes. He was dead, smacked in the middle.

[Ryan Smith]

Of the driveway when I got here, like, knocked out.

[Dan Gorenstein]

Interviewed their critics.

[Unnamed Critic]

I mean, I said I thought it was gonna be a disaster. I thought it was the worst idea ever.

[Dan Gorenstein]

And met with people who called Hart in crisis.

[Ryan Smith]

The police, they have to be the law, you know, and this is love and mercy. That's the difference.

[Patrice Andrews]

Orion and I agreed it made sense to tell this story out of Durham. In the two years since the program launched, curious officials from 50 cities around the country have reached out to Hart with lots of questions. Over the course of three episodes, we're going to focus on a few of the biggest. How did Hart get off the ground? Does it keep People safe. How big should Hart be today? Ryan will begin at the beginning. How Durham pulled off what many cities struggle to do. Getting the police bought into a new way to treat people in crisis. From the studio at the Leonard Davis Institute at the University of Pennsylvania. This is tradeoffs.

[Dan Gorenstein]

You're going to hear from a lot of people I talked with during my five trips to Durham this year. But there are three folks in particular I want you to meet.

[Ryan Smith]

Patrice Andrews. I am the chief of police for the Durham Police Department.

[Abina Beriako]

My name is David Prater. I'm a peer support specialist with the Durham Community Safety Department's HART team. I'm Ryan Smith. I'm director of Durham's Community Safety Department.

[Dan Gorenstein]

Patrice, David and Ryan stand out to me because they're the ones who best helped me understand why the city is transforming, the way it responds to people in crisis, how they're doing it, and whether it's working out. So you'll hear from them a lot throughout the series. George Floyd.

[Dan Leader]

George Floyd.

[Dan Gorenstein]

We stand force Floyd. They all told me that. The story of Hart begins in late June 2020. Sometimes I feel like a motherless child. Hundreds march through downtown Durham.

[Ryan Smith]

I understand y' all anger. See us black people. Let me tell you something. We are tired.

[Abina Beriako]

We've seen these protesters hit the streets.

[Dan Gorenstein]

Here in Durham for almost 10 days now. There are some quote unquote, good cops.

[Patrice Andrews]

But if you're letting the bad ones.

[Dan Gorenstein]

Keep doing what they're doing, you're just as bad. I'm an incompatible. The protests here look a lot like they do across the country following the murder of George Floyd by a Minneapolis police officer. Signs, chants, calls to reform the police. Protesters paint the word defund in bright yellow letters on Main street with an arrow pointing to police headquarters a few blocks away. The word fund in the same crisp yellow with an arrow pointing toward the Department of Social Services. These protests spark City hall to launch an independent review of Durham's 911 data. They find that violent crime represents less than 2% of all calls. Trespassing, verbal disturbances and mental health crisis calls make up much of the rest. So to respond to those calls, city leaders earmark $3 million in June 2021 to create the Community Safety Department. They tap Ryan Smith to run it.

[Abina Beriako]

This work, in part, is about helping people imagine something that they may not have imagined.

[Dan Gorenstein]

This new agency gives Ryan a chance to solve an old public safety problem.

[Abina Beriako]

Your house is on fire. We send fire. You're having cardiac arrest. We send ems. There are shots fired. There is violent crime. Or criminal activity. We need to send law enforcement. But people call 911 for a whole bunch of other reasons. And most of those reasons because we haven't had another branch to sort them into, have gone to law enforcement for decades.

[Dan Gorenstein]

Durham had four branches of public safety, 911 answering the call. Police, fire and EMS. City leaders want Ryan to build a fifth branch where 911 dispatches social workers and other mental health workers instead of armed officers. They give him 12 months, one year to design this new branch of the public safety tree and convince his town that it'll be safe.

[Abina Beriako]

I think most communities are afraid that if they're sending social workers and others, that someone's going to get hurt and killed.

[Dan Gorenstein]

Unarmed response in the US has actually been around for a while. The first programs to send mental health workers to 911 calls date back to the 1980s. 27 of the country's 50 largest cities have now launched or piloted alternative response programs to build his. Ryan talks with several of them. Denver, San Francisco, Albuquerque. And he learns how safe this work can be.

[Abina Beriako]

This work in part is about helping tell the story of what this is looking like in other communities. These are the calls they're already sending these types of responders to all the bad things that you're worried about. These, we're not seeing evidence of that.

[Dan Gorenstein]

Ryan designs a program with four parts. Put a mental health worker inside 911 who will resolve some calls over the phone. Deploy teams of unarmed social workers, EMTs and people with lived experience to respond to nonviolent calls involving mental illness and homelessness. For crisis calls that involved the threat of violence, 911 would dispatch a clinician and a specially trained Durham cop. The last piece, Hart teams would work with people to connect them to longer term help after a crisis call. Ryan knows this is audacious. No other city he'd found had a model this comprehensive.

[Abina Beriako]

If what we're really doing is about, you know, sending the most appropriate response, then I want that to be available for as many people in as many moments as possible.

[Dan Gorenstein]

To do that, though, Ryan has to figure out how to deal with this.

[Unnamed Critic]

I'm like, this is gonna be a disaster. I said, it is not gonna go over well.

[Dan Gorenstein]

A whole lot of officers in the Durham Police Department, like Sergeant Dan Leader there, see this new department as an attack. Ryan understands their point of view. The idea of this new branch came from the defund protests. Based on what he learned from other cities, Ryan believes getting police buy in gives the whole enterprise its best shot.

[Abina Beriako]

One thing that I've noted is the inability to get law enforcement buy in can lead to programs like ours being much smaller than they need to be or is warranted.

[Dan Gorenstein]

A quick word about why Ryan seemed up to this challenge. He's calm. The 45 year old is quick to empathize and slow to anger. And behind his khakis and button downs, Ryan has this quiet intensity to him. A spirit that just keeps pushing. Finally, and this is random, but it'll make sense in a minute, he's got a bird name.

[Abina Beriako]

My bird name is Chickadee. That's an important part of our identity in the department.

[Dan Gorenstein]

Actually, everyone at heart has a bird name. Ryan's assistant director came up with the idea, a kind of department bonding thing. Ryan got Chickadee. Can you give me the short version of why Chickadee for you.

[Abina Beriako]

Here. Let's go. I'll read it to you.

[Dan Gorenstein]

Ryan reads to me from a colorful printout.

[Abina Beriako]

Chickadees move in a small group called a banditry and forage together. It decreases their chances of a hawk taking them by surprise.

[Dan Gorenstein]

It's taped to his office window in City Hall.

[Abina Beriako]

By example, the chickadee shows us how working in a cooperative team means more eyes and ears and fewer opportunities for predators.

[Dan Gorenstein]

Ryan is good at seeing problems and finding solutions. If he can get Durham's police leaders on board, he thinks they can help him persuade all the skeptical rank and file cops.

[Abina Beriako]

For the police chief to say yes, this is good work to me. That was the dream. Can I make that happen?

[Dan Gorenstein]

Turns out Ryan was lucky.

[Ryan Smith]

Are you ready, Chief? Yes, ma'.

[Dan Leader]

Am.

[Dan Gorenstein]

It's December 2021.

[Ryan Smith]

I I state your name. Patrice Andrews.

[Dan Gorenstein]

Patrice Andrews stands on stage at North Carolina Central University, the same historically black school in Durham she'd attended 30 years.

[Ryan Smith]

Earlier and bear true allegiance and bear true allegiance to the state of North Carolina.

[Dan Gorenstein]

Dressed in her black ceremonial Durham Police Department uniform, she takes her oath becoming the city's 33rd police chief. There are a few things I want you to know about Patrice. She comes from an old Durham family. Her dad integrated city schools. She worked as a beat cop here for 20 years. But here's the most important thing. She's taking this job at 48, in part because she wants to reduce the harm police can cause. Patrice grew up hearing stories from her parents about the racism and harassment they faced.

[Ryan Smith]

Law enforcement was an extension of an oppressive government. I mean, just in a nutshell.

[Dan Gorenstein]

Patrisse worried as a black woman what some people in the black community might think about her being a cop. Patrisse's dad gave her some advice.

[Ryan Smith]

You have to do the work. And if what you're trying to do is make law enforcement better, you're trying to make an impact, then you have to stay focused on that, not worry about how people view you as a black woman in this field, Patrice determined.

[Dan Gorenstein]

All those years ago to be the kind of cop that would make everyone feel safe. She struggled sometimes, though, to find her identity in the uniform.

[Ryan Smith]

There were times where I knew that some of the force that I saw and participated in was excessive. Right, but how do you call that out? How do you. It's very hard to call that out when you don't necessarily feel like you would be supportive and supported in doing that. That I will endeavor. That I will endeavor to support. To support.

[Dan Gorenstein]

As she prepares to become Durham's top cop, Patrisse understands law enforcement's opposition to Hart runs deep. But she also understands firsthand how hard it can be for cops to respond to a person with mental illness.

[Ryan Smith]

I remember responding to a call, and there was a woman that was seeing things in her home.

[Dan Gorenstein]

Patrice had been on the forest for a few years by this point. She and her partner had driven to the home of a woman who had repeatedly called 911, saying there were intruders. It quickly became clear there were no intruders.

[Ryan Smith]

She'd point to a lamp, and she'd say, they're behind the lamp. And so we'd go over there and say, you're trespassed. You can't be here.

[Dan Gorenstein]

Patrice and her partner hoped chasing these figures away and these figures only this woman could see would bring her some peace. But she called 911 again and again.

[Ryan Smith]

And we kept saying, you can't call us anymore for this. You know, we've told the people to get out of your home, and they're out. You can't call us anymore. Don't call us anymore.

[Dan Gorenstein]

She kept calling.

[Ryan Smith]

We didn't know what to do. We didn't have the knowledge, the professional knowledge on how to work with someone that clearly was going through a moment of crisis. The only thing we knew to do was take her to jail, because for us, that was solving our problem. It felt so wrong. You know, you hear the word ick. It was the biggest ick, one of the biggest icks I've ever had in this career.

[Dan Gorenstein]

Patrice never learned what happened to that woman, just that the calls stopped.

[Ryan Smith]

I often wonder, did we harm her? Did we harm her mentally more in doing that? Did it serve a purpose aside from our wanting her to stop calling? 911.

[Dan Gorenstein]

Patrice spent 20 years seeing the limits and the abuses of policing.

[Ryan Smith]

I knew right from wrong, but I didn't necessarily know how to change a system that had seemingly always done it the wrong way and had gotten away with it.

[Dan Gorenstein]

She had learned change could come through policy by becoming a supervisor, a leader, a chief.

[Ryan Smith]

So help me God. So help me God. Congratulations, chief. Thank you.

[Dan Gorenstein]

And now she's ready to be that change.

[Ryan Smith]

I am going to be unapologetic about saying, you're wrong, that's wrong, and you know, we're going to fix this.

[Dan Gorenstein]

The ceremony ends. Crowd thins. As she heads home, Patrice thinks to herself that Hart, this new unarmed public safety response, offers her and really her whole department a chance to do better, for cops to do their best work and for Hart to do something different.

[Ryan Smith]

We can do both. We can have a wonderful professional police department. We can also have amazing public safety partners in Hart.

[Dan Gorenstein]

Now she just has to convince a few hundred deeply skeptical officers.

[Patrice Andrews]

After the break, Patrice and Ryan Smith map out a plan to get rank and file cops bought in.

[Dan Leader]

Is there more to this story? Help us tell it. We want to hear about your experiences with crisis response team. What advice would you give to someone considering calling a response team for themselves or for a loved one experiencing a mental health crisis? Go to tradeoffs.org the fifth branch to share your story and join us for a virtual discussion on August 15th, where we'll answer your questions and share your insights. More [e-mail] the Fifth Branch.

[Patrice Andrews]

Welcome back. Trade offs producer Ryan Levy has spent much of the past year on the road or on the phone, talking with people in cities that are trying to find new ways to respond to mental health crises. In Durham and more than two dozen of the largest cities in America, that means sending unarmed social workers rather than police. As we heard before the break, cops have often been skeptical of alternative crisis response programs. Police Chief Patrice Andrews and Ryan Smith, the head of Hart, to chip away at those fears, a tall task. Again, here's Ryan.

[Dan Gorenstein]

Cops were pissed.

[Unnamed Critic]

Nothing is ever 100%, but it was darn close that this was a bad idea.

[Dan Gorenstein]

Police Sgt. Dan Leader spent one Saturday in the fall of 2021 with some other cops at headquarters listening to Hart director Ryan Smith make his pitch.

[Unnamed Critic]

He was in a very tough spot. The director had to try to convince a bunch of cops that, you know, this is something you need to buy into and, you know, it wasn't going over very well.

[Dan Gorenstein]

Police Chief Patrice Andrews had started to notice rank and files reaction to the New department eye rolls, officers muttering about agendas. The woke generation. One senior officer asked Patrice, what's this BS about being defunded through Hart? That's why Patrice had invited Ryan to these meetings, to come talk with every single patrol officer, hundreds of cops. She wanted to give them a chance to get into it.

[Ryan Smith]

You had to break down perceptions, you know, you had to break down feelings, and you had to create environments where people could speak openly and honestly.

[Dan Gorenstein]

The officers had plenty to share with Ryan.

[Unnamed Critic]

I said, I just want to make sure I understand if there's a disturbance call and I'm around the corner. We have to wait for the clinician who's across the city. I did not think it was going to work. I thought it was a very bad idea.

[Dan Gorenstein]

The cops had lots of concerns. Most of them came down to fear. Fear for residents, fear for their jobs, fear for the safety of the new responders.

[Unnamed Critic]

If they're going to deal with some of the same people that we've had to deal with, like if we're getting assaulted, what's going to happen to them?

[Dan Gorenstein]

Ryan Smith expected this big blue wall in the meetings. He could feel the existential dread in the air. The city was hemorrhaging. Officers 58, left the department between June 2020 and the end of 2021, 8% of their total staff driven away largely by the pandemic and the protests. Sergeant Dan Leader said plenty of rank and file felt unfairly lumped in with the Minneapolis officer who murdered George Floyd.

[Unnamed Critic]

What did we do? We're good cops. We didn't do anything wrong. Why are we having to go through this?

[Dan Gorenstein]

First there'd been that huge defund arrow spray painted on the street, and now all this about new responders.

[Unnamed Critic]

Things are changing, and this is a train that is not stopping. No matter how much you don't want to do this, guess what? You're doing it. There was a lot of trepidation about, well, what is this going to mean for us? You know, how is this going to affect what we've been doing for years?

[Dan Gorenstein]

The cops were right. Hart was happening. Ryan wasn't showing up for these weekly pummelings to cut some kind of grand bargain. He wanted officers to be prepared for this change and maybe earn a bit of goodwill with police.

[Abina Beriako]

We needed to build confidence that we could do this and not get someone killed point blank.

[Dan Gorenstein]

But building that confidence, Ryan knew, was going to take time. That was true for community activists, too. To convince them that Hart was truly an alternative crisis response program, he co hosted virtual town halls with the advocates and held smaller in person focus groups in English and Spanish.

[Abina Beriako]

It was clear to me that it had to be a very intentional effort. It had to be consistent. You weren't going to do it with a few words or small gestures.

[Dan Gorenstein]

These steps, the town halls, the focus groups, the meetings with cops. This was Ryan trying to live up.

[Abina Beriako]

To his nickname, the Chickadee. Shows us how working in a cooperative team means more eyes and ears and fewer opportunities for predators.

[Dan Gorenstein]

Throughout the end of 2021 and the first half of 2022, Ryan Smith and Chief Andrews addressed rumors, tried to reassure officers.

[Ryan Smith]

We just needed to make sure that our officers knew that this is not, we're not replacing you. You still have work that you need to do as a law enforcement officer.

[Dan Gorenstein]

They used data to walk through officers fears that Hart would put people in danger.

[Abina Beriako]

Everyone's going to have that. Well, I remember this time when this one trespass call ended in a gunshot and an officer was hurt. That's a valid thing. We name that and then we look at the data and put that into context that that happens on like less than 1% of 1% of the time.

[Dan Gorenstein]

Ryan and Patrice agreed to ditch the plan to have the social workers and cops arrive on scene separately. And still they were a long way from getting most rank and file officers bought in. On June 28, 2022, Hart launched hello Durham. 911 clinicians started answering 911 calls. Unarmed social workers, EMTs and peer support specialists jumped in vans and hit the streets. They respond to homeless people panhandling. How you doing, buddy?

[David Prater]

All right.

[Dan Gorenstein]

What's your name? People thinking about suicide.

[David Prater]

He acknowledged that he attempted to kill himself.

[Dan Gorenstein]

Parents past their breaking point.

[Ryan Smith]

It's all screaming and hollering and throwing.

[Dan Gorenstein]

Stuff and kicking stuff. Sergeant Dan Leader listens to it all unfold on his police radio, certain he's going to hear social workers screaming for the cops to come save them. That's not what he hears.

[Unnamed Critic]

So I'll hear these calls come out, I'll hear the CO responders or the Hart team responding to it and you don't see it come back.

[Dan Leader]

Trespasser at Planet Fitness 1010 MLK.

[Unnamed Critic]

I mean, the call's been handled. Whatever it is they're doing, they're doing it right. And the call doesn't come back again.

[Dan Gorenstein]

Much to Dan's surprise, these new teams seem to be doing just fine. But there was still a bunch of skepticism and suspicion. Some officers would swoop in and respond to calls meant for Hart. Others would ignore orders to Wait for Hart before engaging with a scene. This lingering pushback from officers frustrated chief Patrice Andrews. She wanted them to see that Hart could make their jobs better, safer. Which brings us to that August night in 2022. Hart's been live for less than two months. When Patrice gets the call about that barricaded man making threats, he said, I'm.

[Ryan Smith]

Not coming out, and if you come in, I'm going to shoot you all.

[Dan Gorenstein]

The commander outside the home is proposing a SWAT team. At that moment. Patrice knows busting down the door could lead to violence, exactly what she wants to avoid. So she gets Ryan on the phone.

[Ryan Smith]

I said, look, this is what I have. I know that you all are done working for the day, and is there any way that someone can go out?

[Abina Beriako]

She called me, and I told her that I would reach out to Abena. Aben is one of our clinical managers.

[Unnamed Caller]

So I get the call from Ryan. I was with my children. I had just picked them up from school, and we were headed home. I knew something was going on because it was after hours.

[Dan Gorenstein]

Hart in the early days, shut down for the night at five.

[Unnamed Caller]

I got home, got my children settled, let my husband know kind of what was going on. And then I called chief Andrews to get a little bit more information and details on the situation.

[Dan Gorenstein]

Patrice tells social worker abina berriako, cool the temperature down, convince the man to go to the hospital. Abbott has done this job for 20 years. She lives for moments like this.

[Unnamed Caller]

Some of the officers were already like, yeah, he's not really going to talk to you, but you can try. And I smile because I'm like, okay, I'll try.

[Dan Gorenstein]

The five foot one social worker digs in. She calls the barricaded man's father. Dad tells her that his son has been hospitalized before. Abina calls the man.

[Unnamed Caller]

He was just angry. And so, okay, you can be angry, you can curse, and you can yell. It's fine.

[Dan Gorenstein]

Her calls keep getting interrupted. Dad calling son, son calling dad. Up and down the street, Abena paces.

[Unnamed Caller]

Some of the officers would come and be like, you know, how is he? And I'm like, no, we're still. We're talking. Because sometimes people just need to talk talk. They need to be validated.

[Dan Gorenstein]

Abina on the phone keeps repeating herself.

[Unnamed Caller]

You're okay. Let it out. It's fine, and we're going to be with you.

[Dan Gorenstein]

After Abinah guesses about an hour of calls. The man relaxes. She gives officers the thumbs up. Officers eye Abina like, oh, my goodness.

[Unnamed Caller]

He let officers come and search his room. To make sure that, you know, he was okay.

[Dan Gorenstein]

The man cooperates. He asks Abina, can I stay tonight, go to the hospital tomorrow? Abina calls Chief Andrews.

[Ryan Smith]

Abina said, well, he's not a danger to himself. He is intoxicated. Let's give him a moment. Let's check back in with him. And so we, we went about it a different way.

[Dan Gorenstein]

The next day, Abina drives the man to the hospital. A police escort follows. The man checks himself in. Crisis averted. This was a huge moment for the young department. The idea that Hart was useful to cops was spreading. Patrice saw it.

[Ryan Smith]

Officers said, oh, so we can call them for. This is great. This is great. So that means that we don't have to do this. We wouldn't have to do that, and they can help us.

[Dan Gorenstein]

Sergeant Dan Leader saw it, too.

[Unnamed Critic]

When I'm wrong, I'm the first one to raise my hand and say, you know what? I was wrong. These people are going to help you. They're going to make your job and your lives on this job easier.

[Dan Gorenstein]

For Ryan Smith, this incident captured what he'd been saying to officers for the last year.

[Abina Beriako]

Most people do not think that story can end with that person just walking out without any handcuffs on, with no use of force and be transported to hospital because he has threatened to hurt officers and hurt himself. The idea that a different type of response might be successful there is hard to imagine.

[Dan Gorenstein]

For Abada, the story of the barricaded man is important because it's so unremarkable.

[Unnamed Caller]

I'm a social worker, so this is what I do.

[Dan Gorenstein]

Hart has now responded to more than 15,911 calls. Cops in Durham. People in Durham no longer have to imagine what their new branch of public safety can do. They're seen it every day.

[Patrice Andrews]

Trade offs. Producer Ryan Levy. Back in a minute. We've always seen the Fifth Branch as bigger than the story of just one city. That's why we've partnered with another nonprofit newsroom, the Marshall Project, which reports on our criminal justice system. While Ryan Levy has devoted a lot of time to Durham's heart program, Marshall Project staff writer Kristi Thompson has interviewed researchers, advocates and other leaders in the field to get a more national perspective on the alternative crisis response movement. At the end of each episode of the Fifth Branch, Christy will join me to put that show's theme into a broader context. Today, again, we're talking about buy in. Christy, thanks so much for being here.

[David Prater]

Thanks for having me.

[Patrice Andrews]

So Ryan Levy shared a stat with me that when Hart first launched just 37% of Durham police officers thought Hart would be helpful on mental health calls. Now that's 66%. We know the cops around the country are skeptical about programs like Hart. How are other cities, Christy, trying to get them on board?

[David Prater]

Yeah, I talked with people at the Law Enforcement Action Partnership, also known as leap, which is an organization that works with cops and prosecutors and correction officials who are interested in criminal justice reform. And they said, like in Durham, officers really do seem to be getting on board once they're able to see what these programs can do in the field and how it can free them up to work on more serious calls. One thing that they said was really important is that the messenger really matters here. You know, if somebody from within law enforcement like you had in Durham is able to pitch this program, that goes a long way.

[Patrice Andrews]

I'm curious, Christy, have you found any places where a lack of buy in from law enforcement has stifled or even shut down a program?

[David Prater]

That's actually a more complicated question than it seems. I think that skepticism from law enforcement has slowed down, maybe in multiple places, the expansion of these programs. But it's hard to say exactly how big of a challenge that has been because people are inclined to talk about the success and not focus on the struggle when they're still trying to gain more support for these programs. Something that I did see in my reporting and in local reporting across the country is that police unions can be a limiting factor in the expansion of these programs. So I live in Seattle, and here our crisis response teams are primarily sent out alongside police officers. Part of that is because it was specified in the Seattle police contract that these responders would not be replacing police officers on certain call.

[Patrice Andrews]

What about community activists? Hart director Ryan Smith was worried about losing their support if Hart seemed too close to law enforcement. Is that a concern that you've heard in your conversations?

[David Prater]

Absolutely. You know, that's why some programs, they've chosen to be housed inside the fire department or, you know, in Albuquerque, they've chosen to create an entirely separate public safety agency. But, you know, even then, these teams are being mostly dispatched by 911. But a lot of people are still really wary of calling 911. And that's why in some places, like Atlanta, for example, they've decided to use 311 for people to call to send out their responders so that even if a crisis responder can't come, the caller has the discretion to say, I don't want to be transferred to 911. And they're never going to get a police response that they didn't consent to.

[Patrice Andrews]

You talk about 911 and we call this series the Fifth Branch in part because Ryan Smith was so adamant that 911 was just as important a partner as the police, maybe even more. Because every single call Hart Responds to involves 911.

[David Prater]

Absolutely. What experts were telling me was that the part that we have not talked enough about is getting buy in from these dispatchers and they are the gatekeepers. Right. They're the ones who decide whether to send these teams out. I talked to one former dispatcher who said the motto was when in doubt, send them out. Them being cops, that's really what they've gotten used to. In Chicago, they're sending out a regular update to dispatchers with the outcomes of the calls that they send people to to say, hey, you sent our care team and this person got connected to services. I've heard of other cities who invited dispatchers on ride alongs so they can actually see the teams in action. So they're all ways that they're trying to get the fourth branch 911 dispatchers on board. Because I think they can really be the missing piece of the puzzle in these programs. Expanding as much as they want to and having as big of a presence as they could have within a city.

[Patrice Andrews]

Final question. I know there's some lawsuits out there that are raising the issue of whether buy in as we've been talking about it, will even really matter going forward. Can you tell us a little bit about these lawsuits?

[David Prater]

Yeah, there's two ongoing lawsuits right now that claim that to keep sending armed police to a mental health crisis is actually a violation of the Americans with Disabilities Act. And the Justice Department has said similar things as well. They've been investigating policing in places like Louisville, Kentucky in Minneapolis and most recently in Phoenix. And they've found that those police departments were discriminatory against people with mental health disabilities. By the way, cops were responding to people in crisis. So we're in a really interesting place right now where so far cities have been adopting these programs voluntarily. But it seems like there might be increasing legal pressure for them to have some kind of response like this available.

[Patrice Andrews]

Kristi Thompson, thanks so much for taking the time to talk with us on trade offs.

[David Prater]

Thanks for having me.

[Patrice Andrews]

Next week, does heart make Durham a safer place?

[Ryan Smith]

A lot of the calls that are in crisis, the people can turn on them in a heartbeat and there's nobody there to protect them. They're going to get hurt.

[Patrice Andrews]

What happens when a social worker shows up on the scene instead of a cop.

[Ryan Smith]

Can you please get in the Hart scene? Please?

[Will James]

I dialed 911 and I asked for the heart scene.

[Patrice Andrews]

911 calls are unpredictable and Hart's first responders are on the front lines.

[Abina Beriako]

Is there a level of risk in this job? There is. Do I consider it an acceptable risk? I do.

[Patrice Andrews]

Is Hart making Durham a safer place to live? Part two of the Fifth Branch drops next Thursday. Check it out wherever you get your podcasts. I'm Dan Gorenstein. You're listening to the Fifth Branch, a special series from Trade Offs and the Marshall Project.

[Kristi Thompson]

The Fifth Branch was reported by Ryan Levy with help from Mark Maximoff and edited by Kate Caham. Our partners at the Marshall Project include Christy Thompson and Manuel Torres. The Fifth Branch is supported in part by Just Trust and the Sozoze Foundation. For a full list of credits, Visit our website tradeoffs.org the fifth branch thanks also to the all all our listeners who help to support our work, including Naomi Fenner, Lee Moss and James Wong. Our Media partner is SideFX Public Media, based at WFYI. Tradeoffs is supported in part by the Robert Wood Johnson Foundation, Arnold Ventures, West Health, the California Healthcare foundation and the National Institute for Healthcare Management Foundation.