What Calls Does This Handle?

Not every call that enters 911 is appropriate for clinical routing. Not every call that seems appropriate is. Programs with the clearest documented outcomes have defined specific eligibility criteria — specific enough for dispatchers and clinicians to apply consistently, flexible enough for the ambiguity that characterizes most behavioral health calls.

The Core Call Types

The calls mental health dispatch integration is designed to handle share a structural profile identified in the LEAP/CAP/NYU joint report: a behavioral health component is present, there is no immediate risk requiring law enforcement authority or emergency medical intervention, and what the caller needs is clinical assessment, de-escalation, and connection to resources — not an armed officer.

Mental health crisis calls. Suicidal ideation without active weapons, panic attacks, acute psychiatric distress, psychosis and paranoia without active violence, delusional episodes, emotional dysregulation. Austin’s EMCOT originally built its eligibility list around these presentations specifically: suicidal ideation, parent-child conflicts, and individuals with symptoms of psychosis, paranoia, and delusion — call types where clinical expertise is directly relevant and police expertise is not.

Welfare checks. Third-party callers reporting concern about someone — a family member who has not responded, a neighbor in apparent distress, an unhoused individual in a public space. These are among the most common behavioral health call types in 911. They arrive from third-party callers, not the person in crisis, which means they enter through 911 rather than 988. Austin expanded its eligibility to include welfare checks after the original narrow list proved insufficient to capture the call volume the program was built to serve.

Quality-of-life calls with a behavioral health component. Calls about someone behaving erratically in public, making statements that concern bystanders, appearing to be in distress without posing an active threat. The University of Chicago Health Lab estimated that more than 75% of 911 calls dispatched to police nationally do not involve serious crime or active safety threats — a category that includes most quality-of-life calls.

Repeat callers with known behavioral health histories. A significant share of 911’s behavioral health call volume comes from a small number of individuals who call repeatedly. Guilford County, North Carolina’s Adult Resource Team connected a group of callers who collectively made 344 non-emergency 911 calls in a 30-day period to appropriate ongoing services; their collective calls dropped to four in the subsequent 30-day period, according to WFMY News2 and Spectrum Local News. At the dispatch level, programs with clinical staff can access records to determine whether a frequent caller is already connected to services — information that changes the response.

Substance-use and intoxication-adjacent calls where the primary need is behavioral, not medical. Callers in distress related to substance use or withdrawal, where no immediate medical emergency is present. The distinction between a medical emergency requiring EMS and a behavioral situation requiring clinical support is a dispatch-level clinical judgment — which is what a trained clinician in the call center is positioned to make.

What These Programs Do Not Handle

Every documented program has defined exclusions. These are consistent:

Active safety threats. Any call involving a reported weapon, active threat of violence, or unknown safety status routes to police. Durham’s HEART crisis call diversion unit excludes “anything with a weapon or threat of violence.” Austin’s protocol requires a safety screen before any transfer to dispatch clinicians — the call-taker checks for weapons and immediate threats first.

Medical emergencies. Overdoses requiring immediate medical intervention, cardiac events, physical injuries — these go to EMS. A dispatch clinician who determines during a call that a medical emergency is present routes to EMS, not to a clinical team.

Calls with unknown safety status. When available information is insufficient to assess whether a weapon is present or whether the situation is dangerous, programs route to police or co-response rather than civilian dispatch. This is the gray zone every program acknowledges; the design variation is in where programs draw the line and how they handle ambiguous calls.

How Programs Define Eligibility in Practice

Explicit call-type lists. Austin maintains a defined list of call types eligible for EMCOT clinical routing, updated over time as the program has matured. The list began narrow and has expanded as EMCOT built credibility and dispatchers developed confidence in what the program can handle. Durham’s 911 center uses pre-coded question protocols covering approximately 1,500 different call natures; behavioral health calls are automatically flagged for routing to clinical staff.

Safety screen first. Austin’s model requires the initial call-taker to screen for safety before any transfer to the EMCOT clinician. The question sequence checks for weapons and immediate threats. Calls that clear the safety screen move to clinical routing; calls that don’t route to police or EMS.

Embedded clinician assessment. In programs with clinicians physically present in the 911 center — Austin, Houston, Dakota County — the clinician can monitor the call stream in real time and assess eligibility more dynamically than a pre-coded list allows. The clinician can flag calls that the dispatcher might not have identified as behavioral health, which is one reason embedded models consistently outperform training-only models on capture rates.

The Volume Question

RTI International’s analysis of nearly one million Durham 911 call records found approximately 15% were behavioral health or quality-of-life calls, while only 1–2% were CAD-coded as mental health at dispatch — because the presenting complaint (trespassing, neighbor dispute, public disturbance) doesn’t trigger a behavioral health flag even when behavioral health is the underlying driver.

The gap between the eligible volume and the captured volume is what call-type design is trying to close. Programs consistently find that when they expand their eligibility criteria and build dispatcher confidence, the volume they capture grows. Austin expanded its call types over time. Albuquerque’s ACS volumes grew 12.5% year-over-year through FY2025. The eligible volume in most 911 systems is larger than any current program captures.

Bottom Line

Mental health dispatch integration handles behavioral health situations that have been routed to police by default because no clinical option existed at dispatch. The core call types documented across Austin, Houston, Dakota County, and other programs include mental health crises, welfare checks, quality-of-life calls with behavioral components, repeat callers with known histories, and substance-adjacent situations without active medical emergencies. Active weapons, active violence, and medical emergencies route to traditional emergency dispatch across every documented program.