Baltimore to Transform 911 System Using Opioid Settlement Funds, Sending Mental Health Teams Instead of Police

Baltimore is fundamentally reimagining what happens when residents dial 911, using millions in opioid settlement funds to build a 24/7 crisis response system that sends mental health professionals instead of police to calls involving mental illness, addiction, and homelessness. The initiative represents one of the most ambitious attempts by any American city to transform emergency services through pharmaceutical litigation proceeds, diverting tens of thousands of annual calls away from law enforcement and toward healthcare and social services.

The city has allocated $15 million from its Opioid Restitution Fund to expand mobile crisis teams that currently operate during limited hours into a comprehensive around-the-clock alternative to traditional emergency response. Baltimore logged 1.68 million calls to 911 in 2024, but city officials estimate that tens of thousands of those calls did not require police, firefighters, or EMTs. Instead, callers reported situations like a homeless person sleeping in a store, someone confused in a public park, or a person yelling at passersby—incidents that traditionally resulted in arrest or hospitalization but might be better addressed through social services.

How the New System Works

At the center of Baltimore's transformation are mobile crisis teams operated by Behavioral Health System Baltimore, a nonprofit that functions as the city's mental health department. These teams, which currently respond during daytime hours, pair licensed clinicians with peer counselors who have lived experience navigating mental health challenges and the social service system.

When a 911 dispatcher determines that a caller does not need traditional emergency services, the call is routed to a mobile crisis team. The team meets the individual in the community—at their home, on the street, or in a public space—and spends as much time as necessary assessing needs and connecting them to resources. Unlike police responses, which often last minutes and can escalate into confrontations, mobile crisis interventions typically extend for an hour or more, allowing clinicians to build rapport and develop comprehensive care plans.

In March, mental health clinician Michala Williams responded to a call from a 38-year-old woman who had been arrested the previous month when she tried to drive herself to a hospital during a mental health crisis. The woman, who was dealing with health issues, caring for children ranging from age 2 to 22, and coping with her fiancé's recent incarceration, had called 911 after feeling overwhelmed and unable to eat. By the end of their hourlong conversation, Williams had connected her with referrals to a psychiatrist, therapist, legal assistance, and a case manager who could help determine whether her child with autism qualified for government services.

"She's been through a lot of trauma, and no one is going to deny that," Williams said. "But I now have to take all of that and decide, 'OK, here's steps 1, 2, and 3,' because we got to find a little bit of sliver of something to give her some hope that there's help out here."

The Settlement Fund Strategy

Baltimore's approach to opioid settlement funds differs from many jurisdictions that have struggled to deploy litigation proceeds effectively. The city opted out of the $26 billion national settlement with major opioid companies in 2018, choosing instead to pursue independent litigation that has yielded more than $400 million in recoveries. City officials decided that all settlement awards must be spent on drug-related harms or on services that help prevent addiction, including housing support, healthcare, and education.

Sara Whaley, Baltimore's director of overdose response, views the 911 expansion as part of a larger strategy to address the root causes of crisis rather than simply managing its symptoms. "What are the wraparound services and support that can help prevent them from being involved in this emergency system?" she asked. The philosophy treats 911 calls not as isolated incidents requiring immediate resolution, but as indicators of unmet needs that, if addressed, could prevent future emergencies.

The city has already launched related initiatives using settlement funds, including a program placing naloxone boxes at every subway stop to address overdoses. The 911 overhaul represents a more systemic intervention, aiming to reduce the volume of crises before they occur while ensuring that those that do occur receive appropriate responses.

Evidence from Other Cities

Baltimore modeled its expansion on programs in other cities that have demonstrated the effectiveness of non-police crisis response. Durham, North Carolina, operates the Holistic Empathetic Assistance Response Team (HEART), which has diverted more than 12,000 calls from police over four years. The program reports that police backup was needed for only 0.02% of those calls and that response times have improved for all types of 911 calls as a result of the diversion.

A study recently found that when non-law enforcement teams responded to 911 calls in Durham, it resulted in fewer arrests than when police responded—especially for callers who were Black, men, or ages 25-39. The findings suggest that crisis response programs can reduce the criminalization of behavioral health issues while addressing racial disparities in policing.

Rebecca Neusteter, executive director of the Health Lab at the University of Chicago, who studies the impacts of services like these, said they offer peace of mind for callers that "they're going to be met with the right response at the right time." She added that responders themselves report feeling better equipped to pursue actual resolution to calls rather than simply managing immediate safety concerns.

The Overdose Crisis Context

Baltimore's initiative arrives against the backdrop of a devastating overdose epidemic that has claimed approximately 1,000 lives annually in the city from 2020 to 2023, even as the city's homicide rate decreased by 60% between 2021 and 2025. The contrast between falling violence and rising drug deaths illustrates how the opioid crisis has reshaped public health priorities in communities across America.

The city has experienced the highest overdose death rate of any major American city, with fentanyl driving the majority of fatalities. While national overdose deaths have declined approximately 19% since their August 2023 peak, Baltimore's mortality rate remains elevated, requiring sustained intervention. The settlement funds provide resources for addressing this ongoing emergency, though converting dollars into outcomes has proven challenging nationwide.

Mobile crisis teams represent a harm reduction approach that meets people where they are rather than requiring them to navigate complex healthcare systems during moments of acute distress. For individuals with substance use disorders, the teams can provide immediate connections to medication-assisted treatment, housing resources, and peer support—interventions that research shows can reduce overdose risk and improve long-term outcomes.

Implementation Challenges

Expanding mobile crisis teams to 24/7 operations presents significant logistical challenges. The current teams operate during limited hours, and scaling to around-the-clock coverage will require substantial workforce recruitment and training. Baltimore, like many American cities, faces shortages of mental health professionals, particularly those with specialized training in crisis intervention and addiction medicine.

The program must also develop protocols for determining which calls are appropriate for mobile crisis response and which require traditional emergency services. Dispatchers will need enhanced training to assess situations over the phone, and the system must include clear pathways for escalating to police or EMS when safety concerns arise. The Durham model, which required police backup in only 0.02% of diverted calls, suggests that such escalations are rare, but the capability must exist.

Funding sustainability represents another challenge. Settlement funds arrive over 15-18 years, creating uncertainty about whether programs launched with initial payments can continue once litigation proceeds are exhausted. Baltimore's $15 million allocation represents a significant investment, but maintaining 24/7 operations indefinitely may require identifying alternative revenue streams or demonstrating cost savings that justify continued municipal support.

National Implications

Baltimore's 911 transformation contributes to a growing national movement to reimagine emergency response. Cities including Denver, San Francisco, and New York have launched similar programs, though Baltimore's use of opioid settlement funds to finance the expansion represents a novel approach that other jurisdictions may seek to emulate.

The initiative also illustrates how pharmaceutical litigation proceeds can support systemic reforms rather than simply funding discrete treatment programs. While many jurisdictions have used settlement funds for naloxone distribution, treatment slots, and prevention education, Baltimore is investing in infrastructure changes that could reshape how the entire community responds to behavioral health crises for decades to come.

For the addiction treatment field, the program demonstrates the importance of addressing social determinants of health and reducing barriers to care. By sending clinicians to meet people in crisis rather than requiring them to navigate complex appointment systems, mobile crisis teams can engage individuals who might otherwise fall through gaps in the healthcare system. The approach aligns with research showing that low-barrier, patient-centered services achieve better outcomes than traditional models that require extensive compliance before providing assistance.

As Baltimore implements its 911 overhaul, other cities will be watching closely to see whether the investment produces measurable reductions in arrests, hospitalizations, and overdose deaths. Success could establish a template for transforming emergency response nationwide, while challenges could provide lessons about the complexities of converting litigation proceeds into sustainable public health infrastructure.