HEART: Holistic Empathetic Assistance Response Team
From 428 calls in its first year to 32,000 cumulative. Durham's HEART program is the most rigorously studied mobile crisis program in the country, backed by a National Bureau of Economic Research evaluation that found the program generates $902 in net savings per call — paying for itself through fiscal externalities.
The first program of its kind in North Carolina. More than 32,000 calls handled. Over 10,000 police hours saved.[1] An NBER study finding that each response generates $902 more in savings than it costs.[2] Winner of the 2025 ICMA Community Health & Safety Award.[1]
“I Was Really Hoping It Was Going To Be You Who Showed Up.”
That’s what someone told a HEART team member when they arrived at a downtown Durham business to respond to a crisis call. The Community Safety Department’s director, Ryan Smith, shared other moments like it:
They were driving on the freeway and someone passed them and did the heart sign and said, Thank you. Thank you.
The program has become so popular that neighborhood yard signs reading “Expand the HEART Program” have proliferated across Durham — created and distributed by the community coalition Durham Beyond Policing, not by the city government.[3]
We’ve made this one of our top five priorities this year for the budget… you’ve got a council that supports this, and we’re going to make this happen.
Durham’s HEART — the Holistic Empathetic Assistance Response Team — is the first program of its kind in North Carolina. Only Albuquerque, New Mexico’s program is as expansive in scope.
How HEART Was Created
HEART didn’t emerge from a single incident. It emerged from a convergence of forces over several years.
Starting in 2016, the community coalition Durham Beyond Policing — co-founded by Danielle Purifoy, then a UNC-Chapel Hill assistant professor — organized in opposition to a planned $71 million police headquarters. In 2019, when Police Chief C.J. Davis requested 72 new officers (scaled down to 18), Durham Beyond Policing released a 50-page counterproposal calling for a moratorium on new police hires and a Community Safety & Wellness Task Force. The Durham City Council voted 4–3 to reject all 18 officers.
After George Floyd’s murder in 2020, over 4,000 Durham residents emailed the city council demanding police budget cuts. City Manager Wanda Page commissioned an independent review of 911 data. RTI International, in partnership with the University of Chicago Health Lab, analyzed three years of Durham 911 calls and found that 15% could be addressed by mental health professionals instead of police.[4]
Durham officers had killed 8 people since 2013, at least three of whom were experiencing mental health crises.[7]
We still need policing to help protect our community. But it is unfair to expect them to address every single issue our residents experience.
In June 2021, city leaders earmarked $2.8 million to create the Community Safety Department. Ryan Smith, previously head of Durham’s Innovation Team, was hired as director. Smith studied programs in Eugene, Atlanta, San Francisco, Tucson, and the UK and Canada, then built something more expansive than any of them.
The department was formally established July 1, 2021. HEART launched on June 28, 2022. The launch was sequenced over three days: Crisis Call Diversion started on Tuesday, with mental health clinicians joining Durham’s 911 call center. The Community Response Team hit the streets on Wednesday. Care Navigators started on Thursday.
The Numbers: From 428 Calls To 32,000
~2 months
428 calls. “In-person response teams have not run into any safety issues.” (IndyWeek)
10 months
5,600+ responses; 2,000+ calls diverted from law enforcement (~7/day) — covering only one-third of the city, 10am–9pm, on a $4.8 million budget. (The Assembly NC)
~1 year
6,500 calls. “Saved officers at least 1,500 hours.” (Durham ABC affiliate)
$5M expansion
Over 9,000 calls. Citywide expansion, 12 hours/day. (News & Observer)
~2 years
More than 11,000 calls diverted from police; “saving police officers more than 5,500 hours.” (Harvard Public Health Magazine)
Most recent
Over 32,000 calls; over 10,000 police hours saved. (ICMA 2025 Award)
The safety record: The HEART team has never needed police backup for safety.[5] Responders reported feeling safe after 99% of calls.[5] Only 2% of Community Response Team calls (36 out of roughly 1,800 during the pilot) requested EMS backup. No HEART responder has been harmed, though on one occasion two team members dove behind a minivan to avoid a drive-by shooting unrelated to their call.[8]
What It Looks Like
A Man Who Lost His Job Of 20 Years
Tracy Jackson is a social worker on the HEART team. A week into what he calls his “dream job,” Jackson “saw what a difference he could make” in the city:
911 received a call from a gentleman who was in distress… we responded and he expressed that he was overwhelmed, he had just lost his job that he had for 20 years. He was unsure of how he was going to pay his rent, his children were also in crisis, and he was a single father…. But we were able to connect him to resources to get his rent paid, and also provide some therapeutic support through our clinicians and peer support specialist.
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A Father With A Newborn
An unnamed father described an intervention when he, his partner, and their baby experienced unexpected housing insecurity:
They gave us shelter and they gave us Pampers. We needed Pampers… I didn’t want to ask for it, but they actually showed that they care and they kept calling us and checking on us and they made me feel like all of it that I had built up in me from so much pressure… I actually started crying, man, because I was so in pain.
A Frequent Caller
Jeffrey Billman, reporting for The Assembly NC, accompanied HEART social worker Jessica Laube, peer-support specialist Sammetta Cutler, and paramedic Allison Casey to visit a frequent caller — a man with a crack pipe and screwdriver who called 911 repeatedly during paranoid episodes while high. He had once called 35 times in a single day. Durham police had previously shot his dog during a 911 response.
A documentary titled “HEART: Serving Our Neighbors in Crisis,” produced by RTI International’s Transformative Research Unit for Equity in collaboration with the City of Durham, was screened at a packed downtown theater and contains additional resident testimonials.
How It Works: The Four-Segment Model
Durham views its program not simply as a mobile crisis response team, but as a community safety department with multiple functions. Director Ryan Smith sees the individual programs as “pieces of a larger idea.”
Community Response
Unarmed three-person teams — a licensed clinical social worker, a peer support specialist, and an EMT — dispatched through 911 to non-violent calls. Average response time: 9 minutes during the pilot; approximately 13 minutes after citywide expansion. Average time on scene: 32 minutes across all call types; 77 minutes for suicide threats; 54 minutes for mental health calls. HEART can and will sometimes dispatch two-person units, as long as the unit includes a clinician.
Co-Response
Pairs a CIT-trained police officer and a mental health clinician for calls involving weapons or threats of violence. Average time on scene: 42 minutes; 98 minutes for involuntary commitment calls.
Crisis Call Diversion
A licensed mental health clinician embedded in the 911 call center assesses behavioral crises that may not require in-person response. Can de-escalate over the phone and dispatch the Community Response Team if needed. Average call: 34 minutes.
Care Navigation
Follow-up with people HEART teams encounter — in-person or by phone within 48 hours of the crisis. Connects people to longer-term services. Average contact: 20 minutes.
We only had three buckets to put 911 calls: police, fire, and EMS. But there’s a whole bunch of other reasons people call 911. And a lot of those calls have historically been sorted into the police bucket…. A lot of those calls we can safely and appropriately respond to without sending law enforcement — without sending, you know, someone armed with a weapon.
Eligible call types include mental health crises, trespassing, welfare checks, intoxicated individuals, panhandling/solicitation, indecency, and requests for assistance. Calls involving a weapon or threats of violence are routed to the Co-Response unit, not the Community Response Team alone.
Dispatch uses an automated CAD system (One Solution by Central Square) that identifies all eligible calls for HEART 24/7, regardless of whether HEART units are currently operating. The CSG Justice Center reports that “one benefit of this system is that call takers do not have to memorize new response plans.”
HEART provides transport for people in white minivans. During the pilot, Community Response Teams provided transport for 8% of encounters, “almost exclusively for mental health-related calls.”
They Call Them “Neighbors”
The common words that we hear often in this area are “clients” or “consumers.” None of those felt right to us. Someone brought forward the suggestion of “neighbor,” and it just felt like it embodied the spirit of the work and how we want to be thinking about it.
What many, maybe all of us, have experienced in life is, we’re walking downtown, we see someone in crisis and the instinct is to go to the other side of the street, stay away…. What we’re looking for are people who will draw near to people at that moment of crisis — that sense of physical proximity, of not othering or judging or being afraid. That, to me, is what is embodied by the term “neighbor.”
Every HEART team member has a bird nickname. Ryan Smith is “Chief Chickadee.” Peer support specialist Sammetta Cutler is “Mother Hen” — “I look at everybody like they’re my children.” The naming started when Smith felt uncomfortable with hierarchical titles; someone suggested “Sparrow” and “Dove” as placeholders, and the bird theme stuck. A children’s book, All Are Neighbors, sits on the front desk.
The People On The Team
HEART’s staff are city employees — not private contractors. Because they work for the city, “they can’t refuse calls that fall within the program’s criteria.” HEART’s responders are dispatched to more types of calls than teams in many similar programs, and they can enter people’s homes, which some cities prohibit.
Peer Support Specialists
The most distinctive element of HEART’s staffing is the peer support specialist — a community member who has personally experienced or been close to substance use, homelessness, or criminal justice involvement.
I don’t come to this work with a master’s degree like our clinicians do. I come to this work with lived experience of homelessness, of a substance use disorder, with criminal convictions. I have no problem going under the bridge because I used to live under the bridge.
Abena Bediako, a licensed clinical social worker (Howard University School of Social Work), described the team’s philosophy to CNN: “They’re not subjects. They’re not patients or clients. It could be me that you all may have to help one day.”
Qualifications And Pay
Crisis Response Clinicians: Master’s degree required; must hold a license (LCSW, LCMHC, or equivalent); 2+ years crisis response experience. Hiring range: $65,749–$78,899.
Peer Support Specialists: High school diploma or GED minimum; NC Certified Peer Support Specialist required or willingness to obtain within 6 months; minimum 1 year direct lived experience with substance use, behavioral health, or criminal justice systems. Hiring range: $49,737–$59,613.
Community Safety EMTs: Certification by NC Office of Emergency Medical Services as an Advanced EMT; 1 year EMT experience. Hiring range: $46,093–$56,036.
All are full-time City of Durham employees with full benefits including enrollment in the North Carolina State Retirement System, health insurance, 13 sick days/year, and vacation.
Training
DCSD has not published a detailed training curriculum with specific total hours. What is known: DCSD provides multiple de-escalation trainings and works with the Durham Police Department for additional safety-related trainings. Many Crisis Response Clinicians rotate through at least two programs and are cross-trained. Peer Support Specialists must complete North Carolina’s 96-hour NCCPSS certification program, available through Durham Technical Community College. EMTs receive medical direction from Durham County’s EMS Medical Director. For comparison, Cambridge, MA’s CARE Team — which modeled itself after HEART, with staff visiting Durham to learn — conducts 360 hours of training.
Retention
retention over two years. As of mid-2024, the department had “only replaced six people on a staff of 55.” The program attributes retention partly to intentional culture: built-in 6–7 day breaks every 6 weeks and consistent shift schedules. (NPR)
The Police Chief: “Fully Supportive”
Durham Police Chief Patrice Andrews — hired partly because of her support for alternative response — has been a consistent and vocal supporter:
This expansion is a way to offer more support to our residents experiencing a mental health crisis while enabling us to focus on more appropriate law enforcement needs throughout our community.
Durham Police Department continues to be fully supportive of the HEART Program… because it enables us to focus on more appropriate law enforcement needs throughout our community.
Winning Over The Rank And File
“While Durham Police Chief Andrews has publicly and privately supported HEART, she admitted that many patrol officers were initially skeptical, believing they’d have to constantly rescue amateurs. Some also chafed over the political fights that accompanied the program’s creation. ‘There was this cloud that hung over the Community Safety Department,’ Andrews said during a panel discussion in April.”
But the skepticism faded as the track record grew. “‘I’ve heard officers on the radio asking for HEART. So there is that change.'”
Ryan Smith confirmed: “Now that we have a track record, more and more officers are seeing the value in it. Those are calls they would have had to go to that they don’t have to go to.”
37% → 67%
of Durham police officers who thought HEART would be helpful on mental health calls — the change measured between initial deployment in 2022 and 2024.[6]
HEART teams carry police radios for backup. DCSD and DPD debriefed weekly in the early months, now quarterly. Both departments report to the city’s Deputy City Manager for Public Safety. No formal MOU between the departments has been publicly identified — the integration operates through Durham’s shared 911/CAD dispatch system and co-reporting structure.
Police Hours Saved
hours of police officer time saved since launch, responding to over 32,000 calls for service. The Durham PD has approximately 20% of positions unfilled, making even modest hour savings operationally significant for a short-staffed department. (ICMA 2025 Award; The Assembly NC)
The Research: “The Program Pays For Itself”
A working paper published by the National Bureau of Economic Research — by Bocar A. Ba, Patton Chen, Tony Cheng, Martha C. Eies, and Justin E. Holz (Duke University), NBER Working Paper No. 34344, October 2025 — evaluates Durham’s HEART program using a difference-in-differences design that exploits HEART’s phased geographic rollout across Durham’s police beats.
net savings per call.[2] “The average HEART response costs $1,191 but generates estimated fiscal savings of $2,093 per call… The resulting net savings of $902 per call… means that the program pays for itself through fiscal externalities.”[2]
Crime and arrests dropped. “HEART reduces crime reports, arrests, and response times — primarily through civilian phone and in-person responses, rather than police-civilian co-responses.”
Response times improved. “Response times decreased for both program and police responses, but the decline is nearly twice as large for HEART responses.”
of respondents report a positive willingness to pay for the program, with the mean valuation being $102.91 per year — more than eight times the program’s per-resident cost.
It builds trust, not avoidance. Rather than discouraging 911 use, “HEART does not deter future calls… [residents] served by HEART generate slightly more follow-up calls than those served by police, yet this increased engagement does not translate into higher rates of violence.”
of Durham residents said they were more likely to call 911 thanks to HEART. The 2024 survey found more residents were satisfied with HEART than with any other public safety unit in the city. (City of Durham resident surveys)
The Budget
FY 2021–22
~$2.8 million. Community Safety Department created; 15 staff; pre-HEART.
FY 2022–23
~$4.8 million. HEART pilot launches June 28, 2022; ~20 employees; one-third of city, 10am–9pm. (The Assembly NC)
FY 2023–24
~$6.4 million. 35% increase; 19 new employees; citywide expansion, 12 hours/day. (WUNC; Participedia)
FY 2025–26
17 new positions added — the largest addition of any city department. (INDY Week; ABC11)
HEART is funded almost entirely from the City of Durham’s General Fund, supported primarily by property taxes. Arnold Ventures has funded research and evaluation but not HEART’s operational budget. No direct federal or state operational grants to HEART have been publicly confirmed.
North Carolina secured the enhanced 85% Medicaid FMAP for qualifying mobile crisis services through March 2027. However, HEART itself appears to operate outside this framework — it is a municipal government program, not a traditional Medicaid-enrolled behavioral health provider. Whether Durham could restructure HEART to capture Medicaid reimbursement remains an open question.
The Have a HEART coalition has advocated for $10.7 million for 24/7 operations.
Where HEART Stands — And What’s Missing
HEART currently operates citywide within city limits, 12 hours/day (9am–9pm), 7 days/week. The department employs approximately 55 people.
~20,000
calls missed last year. HEART currently responds to only 50–55% of eligible calls. The co-response team responds to just 12% of eligible calls. (INDY Week)
City Manager Bo Ferguson stated: “There are significantly more HEART eligible calls that we currently don’t respond to during daylight hours, than during calls that we miss in overnight hours.”
HEART has not expanded to Durham County or Durham Public Schools as of mid-2025. The key obstacle: the Sheriff controls county 911 services, preventing HEART dispatch to county residents. All five County Commissioners expressed support in 2024, but the People’s Alliance noted in January 2025 that “despite overwhelming support, the HEART program has not yet been expanded to Durham County or Durham Public Schools.”
Sometimes people don’t need handcuffs, they need a doctor, they need a counselor, they need a meal…
The Broader Public Safety Plan
Office of Survivor Care: Established and operational in 2025 within the Community Safety Department. Provides “compassionate, direct support to individuals and families impacted by gun violence.” Staffed by Ontario Joyner (Program Manager) and Angelica “Angel” Robles (Clinician). Services include bridge therapy, grief circles, healing spaces, and NC Victim Compensation Fund applications. All services are voluntary, free, and confidential.
Opioid reversal kit initiative: Active and expanding, primarily through Durham County. The county has received $21.7 million in opioid settlement funds distributed through 2038 and has installed naloxone vending machines at the Health and Human Services Building and the Durham County Detention Center.
Plan to replace vacant police positions with unarmed teams: The original proposal to transfer 60 vacant police positions was dramatically scaled back. Only 5 vacancies were actually eliminated. HEART has instead grown through dedicated budget increases — 17 new positions in FY2025–26 funded through the general fund rather than police transfers.
Remaining data gaps: HEART’s detailed training curriculum (specific total hours) has not been publicly released. The exact crime reduction percentage from the NBER study is behind a paywall. No official FTE calculation for police hours saved has been published. No specific data on violent crime response time improvements attributable to HEART exists. No formal MOU between DCSD and DPD has been publicly identified. No DPD-authored internal report on HEART has been publicly released. The exact CSD dollar budget for FY2024–25 and FY2025–26 has not been published as a standalone line item. Whether Durham could restructure HEART to capture Medicaid reimbursement — as Denver’s STAR program does at 96% billability — remains unaddressed in any public document.
Sources
[1] ICMA 2025 Community Health & Safety Award; Durham Community Safety Department data.
[2] NBER, Bocar A. Ba, Patton Chen, Tony Cheng, Martha C. Eies, and Justin E. Holz, Working Paper No. 34344, October 2025.
[3] The Assembly NC, Jeffrey Billman; Ryan Smith, Director, Durham Community Safety Department.
[4] RTI International and University of Chicago Health Lab, Durham 911 call analysis.
[5] WRAL, Sarah Krueger and Lora Lavigne; Durham Community Safety Department safety data.
[6] Tradeoffs Podcast, citing Bellwether Collaborative SHINE Study.
[7] Durham Beyond Policing counterproposal, 2019; local Durham news coverage of police encounters 2013-2020.
[8] The Assembly NC, Jeffrey Billman, long-form profile of Durham HEART program.