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Social Workers Don’t Stack Up

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Social Workers Don’t Stack Up

An early report on New York’s mental-health first responders earns media cheerleading, but the data are skewed for their success. July 27, 2021
Public safety
New York
Health Care

Last month, New York City joined dozens of other cities experimenting with “alternatives” to policing by launching the Behavioral Health Emergency Assistance Response Division, or B-HEARD, in a pilot study in parts of Harlem. The program dispatches social workers and FDNY paramedics to certain mental-health-related 911 calls. Supporters argue that this approach reorients the response to these calls from public safety to public health.

Now the mayor’s office has put out its first report on the program to a glowing, but misleading, reception in the media. Such outlets as Business Insider and NPR highlighted the finding that those approached by B-HEARD responders were more likely to accept help than those approached by police. NBC New York identified a causal relationship, claiming that B-HEARD is “reducing unnecessary hospitalizations, while increasing the percentage of people who accept help when offered.”

On first inspection, the results look impressive. Just 5 percent of those seen by B-HEARD in its first month refused assistance, compared with 18 percent seen by “traditional mental health response” in the same period. And B-HEARD cases were much less likely to be hospitalized.

Unfortunately, a closer look at the data reported by the mayor’s office suggests a deck stacked for B-HEARD’s success. Responders appear to have received calls that were—perhaps unwittingly—selected to produce better outcomes.

As the mayor’s report notes, the month following B-HEARD’s launch saw roughly 500 mental-health-related calls in the covered area. Of those, roughly a quarter were referred to B-HEARD, which then kicked back a further one in five. In total, the civilian responders considered themselves able to handle just 107 calls, or about 21 percent of the total.

The calls referred to B-HEARD were not a random sample. Responders were not routed calls “that involve a weapon, an imminent risk of violence, or where NYPD or EMS call-takers know that an individual has an immediate need for transportation to a medical facility.” B-HEARD responders were also on call for only 16 hours a day; if they took the night off, they would have been spared dealing with mental health crises among individuals who had declined shelter for the evening.

Hence an apples-to-apples comparison between B-HEARD and “traditional” response suffers from selection bias. The difference in outcomes between the two groups owes at least partially, even mostly, to the difference between the pools of calls that each is responsible for handling. If the NYPD is called in on more serious and violent calls, the people with whom the police interact will be, on average, less willing to accept help—regardless of whatever techniques cops use to deescalate the situation.

This pattern is common across civilian-led mental-health-response initiatives. CAHOOTS, the original alternative program from Eugene, Oregon, is often touted as a model for other cities looking to reduce police activity. But as I noted in a recent report, CAHOOTS responders cover less than 20 percent of 911 calls, with three in four of those involving routine welfare checks or transporting homeless people.

Civilian alternatives, in other words, take the easy calls and mostly do a good job. If cities want that, it’s not a bad use of resources—if anything, it frees up cops’ time to focus on fighting crime. But we should not expect B-HEARD’s high rates of success to persist if it starts picking up more challenging calls.

The reality is that police do a pretty good job handling mental-health situations, and unarmed civilian alternatives will always be reliant on the police as a backup—B-HEARD sought support in seven of the 107 calls they managed, for example. Advocates of “defunding” police will point to B-HEARD’s success as evidence that we can dramatically curtail policing, but let’s be clear about what the data show: we can trim around the edges, but civilians cannot replace cops.

Photo by Spencer Platt/Getty Images

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