Baltimore's Mental Health Crisis Response: $15M, No Insurers

Baltimore is building a fourth branch of first responders. Police, fire, EMS, and now a team dedicated to mental health and other non-emergency 911 calls, according to NPR (July 15, 2026). Funding comes from $15 million in opioid litigation settlement money.

No insurer wrote that check, and no premium anywhere paid for it.

Quick answer: Baltimore is building a dedicated mental health crisis response branch, funded by $15 million in opioid settlement money, modeled on Durham, NC’s four-year-old HEART program that has diverted more than 12,000 calls from police. This is what it looks like when a city stops waiting on insurers or hospital ERs and pays for behavioral-health infrastructure directly, with money that was never a premium to begin with.

What Baltimore is actually building

Adding a fourth category of first responder is a bigger structural move than a new hotline or a pilot grant. Mental-health calls get routed to a team built for them instead of defaulting to police, because police are who 911 sends. NPR’s July 2026 reporting describes the goal as round-the-clock mobile crisis response, backed by the city’s $15 million allocation.

An ambulance gets dispatched to a car accident, and until now nothing comparable got dispatched to a bad night.

For decades, “someone is in crisis” and “someone is dangerous” were treated as the same 911 call. Same responders. Same tools. Same short menu of outcomes, including a few nobody wanted. Cities that pulled those two calls apart, and built a branch around de-escalation instead of enforcement, are the ones producing the numbers further down this page. Baltimore just joined that list, and it joined with evidence in hand rather than a hunch.

Where did the $15 million actually come from?

Opioid settlement money, not insurance money. Baltimore and other jurisdictions won these funds through litigation against companies found to have fueled the opioid crisis, according to WYPR (March 30, 2026), and NPR’s July coverage confirms the $15 million going into round-the-clock crisis response.

A courtroom funded this branch of first response. Not a health plan.

Think about what that means. Commercial insurance was the system that was supposed to fund behavioral health care: premiums flowing through employer plans and individual policies, year after year, decade after decade. It didn’t produce this. A legal settlement against opioid manufacturers did. When a city can fund same-night crisis response with litigation money while premiums keep rising and coverage keeps narrowing, that says something about where the actual investment has been coming from. It hasn’t been the people collecting the premiums. Some of that gap traces back to the same workforce shortage that’s been reshaping the whole mental health system, where the people qualified to staff a crisis line are also the people insurance networks have been losing for years.

Baltimore is not the only jurisdiction sitting on settlement money it still has to allocate.

Durham already ran this mental health crisis response experiment

Baltimore isn’t guessing. NPR points to Durham, North Carolina, where the HEART program (Holistic Empathetic Assistance Response Team) launched on June 28, 2022. That makes it roughly four years old this summer. Its Community Response Team arm has diverted more than 12,000 calls away from police since launch, according to the CSG Justice Center.

Four years is long enough to stop calling something a pilot.

The safety data should end most of the skepticism. An independent evaluation from RTI International found Durham’s HEART responders called for police backup on just 0.02% of calls and EMS backup on 0.36%. Put that in plain numbers: out of every ten thousand crisis calls HEART handled, roughly two needed a police officer at all. Two. Whatever people picture happening when you send counselors instead of cruisers, Durham’s own evaluators watched four years of it, and the escalation almost never came.

Why is Albuquerque a stronger comparison than Denver?

Because of diversion rate. Albuquerque’s Community Safety Department launched in September 2021 and has responded to more than 120,000 calls, diverting over 85% away from police or fire, according to the City of Albuquerque’s four-year report from September 2025. NPR names both cities as peers. Only one has posted numbers at that scale.

Denver’s STAR program is the more famous name and the thinner evidence. STAR launched in June 2020 and logged more than 25,000 cumulative incidents through June 2025, per Axios Denver (June 2025). Volume isn’t a diversion rate, though, and the two get conflated constantly. What share of STAR-eligible calls actually reached a STAR team is not something the reporting here establishes, and earlier independent evaluations have put it well below Durham’s and Albuquerque’s rates. Denver belongs in this comparison as an open question, not a proof point.

Denver’s program is real and worth watching. It just isn’t the proof on its own.

Stacking three cities’ data instead of one is what makes Baltimore’s bet look reasonable rather than hopeful. Durham supplies the safety record. Albuquerque supplies the scale. Denver supplies the honest caution: a program can exist on paper, get good press, and still miss most of the calls it was built for.

City / program	Launched	Reported volume	Diversion	Source
Durham, NC (HEART)	June 28, 2022	Published cumulative totals vary by source, so none is used here	12,000+ calls diverted from police (Community Response Team arm)	NPR (2026); CSG Justice Center
Albuquerque, NM (ACS)	September 2021	120,000+ calls responded to	85%+ diverted from police or fire	City of Albuquerque (Sept. 2025)
Denver, CO (STAR)	June 2020	25,144 incidents, June 2020 to June 2025	Not established by these sources; earlier evaluations put it below Durham’s and Albuquerque’s	Axios Denver (2025)

Why didn’t insurance or the ER build this?

Because nobody in that pipeline could bill for it. A crisis team knocking on a door at 2 a.m. isn’t a procedure code the way a therapy hour or an ER visit is. Hospital emergency departments are built around triage, beds, and throughput. A person in crisis on a sidewalk, with no injury to treat, doesn’t fit any of that.

That isn’t a moral failure so much as a design spec doing exactly what it was designed to do.

Consider what the other end of that 2 a.m. call looks like for a licensed clinician. You can work someone through the worst hour of their week by phone, walk a safety plan out loud, listen for whether it’s landing. What you cannot do is get there. There’s no dispatch for a clinician, and there’d be no code to bill the hour if there were. What’s left is a voice, a plan, and 911. That third option is the one everybody dreads, because it converts a mental health emergency into a police matter.

Durham built the thing that was missing from that list.

So where does insurance still fit?

It still fits, and the gap isn’t only about crisis. Someone in crisis may still need a hospital bed, a prescriber, or ongoing outpatient care no mobile team can provide alone. But the same pipeline that never funded a crisis van is the one that makes a clinician ask permission before delivering care they’re already licensed to deliver. Insurance has a role. It just never had this one.

Meanwhile, cities are covering it with whatever public money exists.

Sometimes that’s a budget line. In Baltimore, it’s settlement money that exists specifically because pharmaceutical companies were found liable for a public health crisis they helped cause. There’s a kind of rough justice in that. Money extracted from one manufactured health catastrophe is now paying for the response infrastructure to a different one that commercial insurance quietly declined to build.

The first sixty minutes decide whether someone ends up handcuffed, hospitalized, or simply talked through a bad night at home. Traditional care left that hour open. Cities are the ones closing it.

What does this mental health crisis response model mean outside Baltimore?

If your city hasn’t announced anything like this, you’re not behind some curve. Most haven’t. What’s useful is knowing the model has four years of Durham data and a 120,000-call record in Albuquerque behind it, not a pilot press release. When your local government debates how to spend opioid settlement funds, or any windfall public money, a mobile crisis branch modeled on Durham or Albuquerque is a proven ask, not a speculative one.

Ask for the thing that already has four years of receipts.

Two caveats belong in that conversation, and in our experience they’re the ones that get skipped. Staffing is the first: a fourth branch of first response needs clinicians on it, which runs straight into the provider-shortage map. Funding is the second. Settlement money runs out, and federal crisis infrastructure has its own budget fights, including the one playing out around the 988 line. A branch on an org chart isn’t a branch until somebody staffs it and keeps paying for it.

It’s also a reminder that access to mental health care in a crisis was never guaranteed by having “coverage.” A person can be fully insured and still have no good option when a crisis hits at midnight on a Tuesday. What actually reaches people in that moment has, so far, come from cities willing to build it directly rather than wait for the insurance system to get around to it.

FAQ

What is Baltimore building for mental health crisis response? Baltimore is standing up a fourth branch of first responders, alongside police, fire, and EMS, for mental health and non-emergency 911 calls, according to NPR (July 2026). The expansion is funded with $15 million from opioid litigation settlement money and aims at round-the-clock mobile crisis response.

How is Baltimore paying for its new crisis response system? With $15 million from opioid settlement funds, not insurance premiums, according to NPR and WYPR reporting from March and July 2026. That money exists because pharmaceutical companies were found liable for the opioid crisis, and Baltimore is redirecting it into crisis-response infrastructure instead of waiting on health plans.

Does this kind of program actually work? What does Durham’s experience show? Durham, NC’s HEART program, launched June 2022, has diverted more than 12,000 calls away from police over roughly four years, per NPR and the CSG Justice Center. RTI International’s independent evaluation found HEART responders called for police backup on only 0.02% of calls and EMS backup on 0.36%.

Are other cities running similar mental health crisis response programs? Yes. Albuquerque’s Community Safety Department has handled more than 120,000 calls since September 2021, diverting over 85% away from police or fire, per the city’s own four-year report. Denver’s STAR program has logged over 25,000 cumulative incidents since 2020, but that is a volume figure rather than a diversion rate, and Denver’s diversion share is not established by the sources cited here.

Why didn’t insurance or the ER system build this already? Because mobile crisis response was never a billable clinical encounter insurers were built to fund, and hospital ERs are designed around triage and beds, not a person having a public mental health crisis. Cities are filling the gap with public money, in Baltimore’s case opioid settlement funds, because nobody in the insurance-and-ER pipeline built it first.

Sources

1. NPR, “Baltimore to overhaul how it responds to calls for mental health and other services” (July 15, 2026; retrieved July 2026).
2. WYPR, “Baltimore is rethinking 911 response. Opioid settlement funds are helping.” (March 30, 2026; retrieved July 2026).
3. CSG Justice Center, “Durham, NC: Expanding First Response” (updated 2025-2026; retrieved July 2026).
4. RTI International, “Alternatives to Police Response” (2025 evaluation; retrieved July 2026).
5. City of Albuquerque, “Albuquerque Community Safety Department Marks Four Years of Impact and Innovation” (September 2025; retrieved July 2026).
6. Axios Denver, “What’s next for the STAR police response alternative” (June 9, 2025; retrieved July 2026).

Figures current as of July 2026.

Disclaimer

This article is for educational and informational purposes only. It does not constitute medical, clinical, legal, or therapeutic advice, and reading it does not create a therapist-client relationship with Matthew Sexton, LCSW or Mental Wealth Solutions, Inc. Although the author is a licensed clinical social worker, the content in this article is not clinical assessment, diagnosis, or treatment. The clinical experience described above is generalized and includes no identifying client details.

Municipal crisis response programs, their funding sources, diversion rates, and call-handling procedures vary by city, change as programs scale, and may be updated after this article is published. Nothing here is a substitute for confirming a specific city’s current crisis response resources with local government or public health officials. If you or someone you know is in an active mental health crisis, contact local emergency services or the resources below.

If you are in immediate emotional crisis, you can reach the 988 Suicide & Crisis Lifeline by calling or texting 988 (US). If you are experiencing domestic violence or are in physical danger, contact the National Domestic Violence Hotline at 1-800-799-7233 or visit thehotline.org. In a life-threatening emergency, call 911.