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.
How HEART Was Created
Durham’s HEART program launched in 2021 in response to both community advocacy and a recognition by city officials that police were spending thousands of hours annually responding to behavioral health calls they weren’t equipped to handle. The Durham Police Department was losing over 5,500 officer hours per year to mental health calls.
Director Ryan Smith leads the program. The team calls the people they serve “neighbors” — not clients, not patients, not subjects. That language choice reflects the program’s philosophy: crisis response as community care, not institutional intervention.
The NBER Study
Net savings per call. The average HEART response costs $1,191 but generates estimated fiscal savings of $2,093 per call. NBER conclusion: “the program pays for itself through fiscal externalities.”
The National Bureau of Economic Research study found crime reports declined over 50% relative to baseline and arrests dropped from a 5% baseline. Response times decreased for both the program and police — but the improvement was nearly twice as large for HEART responses.
Critically, the researchers found that these effects “are driven by the program itself rather than changes in enforcement behavior” — civilian teams are diverting low-risk calls so police can concentrate on higher-priority incidents.
of Durham residents expressed positive willingness to pay for the program, with an average valuation of $102.91 per year — more than eight times the program’s per-resident cost.
The NBER researchers also found that “HEART does not deter future calls.” Residents served by HEART actually generate slightly more follow-up calls than those served by police — yet this increased engagement does not translate into higher rates of violence. The researchers interpret this as evidence that civilian teams “handle emergencies without escalation and may encourage continued, constructive use of emergency services.”
What HEART Looks Like On The Ground
HEART teams consist of crisis counselors, community health workers, and peer support specialists. They respond to behavioral health emergencies including suicidal ideation, psychotic episodes, substance use crises, welfare checks, and mental health disturbances where no weapon or violence is present.
The program has responded to over 32,000 cumulative calls. The police chief is “fully supportive.” The safety record is consistent with national patterns: zero or near-zero serious incidents across the full call history.
We have really been welcomed even more than originally thought.
Director Ryan Smith shared stories from the field: “They showed up to a downtown business and the person said ‘I was really hoping it was going to be you who showed up.’ They were driving on the freeway and someone passed them and did the heart sign and said, Thank you.”
Growth And Scale
HEART grew from 428 calls in its first operational year to handling thousands monthly. The program saves Durham police over 5,500 officer hours annually — hours now available for investigating robberies, solving assaults, and patrolling high-crime areas.
The program’s growth trajectory demonstrates the expansion pattern common across successful mobile crisis programs: start narrow, build a safety record, earn trust from dispatch and police leadership, and expand scope and hours as confidence grows.
What Makes Durham’s Model Distinctive
Durham’s HEART program is distinctive for several reasons. First, it is the only program with a full NBER cost-benefit analysis demonstrating fiscal self-sustainability. Second, the “neighbor” language and community-first philosophy shape every aspect of operations. Third, the program’s relationship with Durham Police has been characterized by mutual support rather than tension. Fourth, the willingness-to-pay data provides the strongest evidence of community demand for any program in the field.
The combination of rigorous economic validation, community trust, and police partnership makes Durham a reference model for any city considering a mobile crisis program — particularly mid-size cities (100,000-500,000 population) looking for evidence that the model works at their scale.
Durham’s HEART program demonstrates that mobile crisis response can be rigorously evaluated, fiscally self-sustaining, and deeply trusted by both the community and law enforcement. The NBER finding that the program pays for itself through fiscal externalities is the strongest economic argument in the field. Durham proves that a mid-size city can build a program that earns the confidence of researchers, police, and the public simultaneously.