A collaboration with American Public Media’s Call to Mind highlighting how Durham, North Carolina, has reimagined its mental health crisis response system — and what it has learned.
We spend a lot of time at Tradeoffs covering mental health. In particular, we try to report on what’s working — looking closely at the evidence behind promising solutions and the tradeoffs they bring for clinicians, policymakers and the estimated 60 million Americans living with a mental illness.
One of the best examples of this is “The Fifth Branch,” our special three-part series produced in partnership with The Marshall Project. The series, originally released in 2024, zooms in on Durham, North Carolina’s HEART program — one of a growing number of examples of cities sending mental health specialists to handle certain 911 calls instead of armed police.
I spent six months reporting on the ground in Durham. I rode along as HEART’s teams of social workers, EMTs and peer support specialists responded to 911 calls. And I talked extensively with city leaders, police officers, program critics and residents who had called 911 in a crisis.
That reporting earned a National Edward R. Murrow Award — one of the highest honors in broadcast and digital journalism. But it was far from the end of the story.
I’ve continued to follow what’s happening in Durham and around the country as communities try to reimagine how they respond to people in a mental health crisis. Today, we’re bringing you an updated version of “The Fifth Branch,” produced in collaboration with Call to Mind, a mental health reporting initiative from American Public Media.
I hope you take the time to listen to this special Tradeoffs episode or read the transcript. I also hope you explore the rest of Call to Mind’s reporting on mental health. They’ll be releasing new episodes each week through the month of May. You can find them all on their website, on your local public radio station, or by subscribing to the Call to Mind podcast.
Episode Transcript
Dan Gorenstein (DG): Hi, it’s Dan.
This week, we’re revisiting The Fifth Branch — our award-winning series with The Marshall Project about how Durham, North Carolina, and many other cities, are radically changing their response to mental health crises.
We’ve continued to follow Durham’s work over the last two years. Today we’re bringing you an updated version of the series in collaboration with Call to Mind, a mental health reporting initiative from American Public Media.
Hosted by veteran journalist Angela Davis, this version of The Fifth Branch will air along with four other Call to Mind specials that will run on public radio stations across the country this year.
Here’s Angela.
Angela Davis (AD): The phone rings. It’s a little after 6 on a sunny August evening in Durham, North Carolina. The year is 2022.
Police Chief Patrice Andrews picks up.
Patrice Andrews (PA): One of my deputy chiefs [said] so we have a barricaded person.
AD: The deputy tells Patrice the man had a history of mental illness.
The family is worried he might hurt himself. They’re asking officers to force him to go to the hospital.
Officers are now camped outside the house. And the man is making threats.
PA: He said, I’m not coming out, and if you come in, I’m going to shoot you all.
AD: The deputy tells Patrice a hostage negotiator is now on scene and he’s about to call the SWAT team.
PA: And I said, well, wait, wait a minute, wait a minute. Let’s hold on. Let’s, let’s, let’s talk about this for a second.
AD: Patrice takes a breath. A cop for more than 20 years, she wants everyone to take a breath.
PA: Whether he would have shot an officer or officers would have shot him, I didn’t have a crystal ball. But I tell you, there were the makings in that for it not to end well.
AD: Police Chief Andrews knows what she wants to do.
PA: I said, let me call Ryan.
AD: Back in 2022, Ryan Smith headed up a brand new department in Durham, a radical experiment in public safety.
Patrice knew the last people Ryan would send would be a SWAT team. Ryan would send a social worker.
I’m Angela Davis and you’re listening to Call to Mind: The Fifth Branch, a broadcast special from American Public Media’s initiative to foster new conversations about mental health.
Police in America shot and killed 2,057 people who were in the middle of a mental health crisis between 2015 and 2024. That’s one of every five police killings in the last decade.
Those numbers are helping fuel a movement.
Cities like Denver, Albuquerque, Houston, Louisville, New York and others have launched what are called “alternative crisis response programs.”
Instead of armed police – a new generation of responders – EMTs and social workers – now handle a growing number of 911 calls involving mental illness, addiction or suicidal thoughts. This is a big departure from conventional practice.
As more and more cities stand up these new units, journalist Ryan Levi has been digging into whether they are working.
Ryan is the managing editor for Tradeoffs, a nonprofit news organization covering health policy. Here’s what he found.
Ryan Levi (RL): We wanted to go to a place that experts thought could be a model for other cities. A place serious about data … and willing to let me spend a bunch of time with them.
I talked to several interesting programs — New Orleans, Denver, Rochester, New York.
In the end, we went with Durham, North Carolina and its ‘Holistic Empathetic Assistance Response Team,’ what locals call HEART.
AD: Ryan spent six months reporting in-depth in Durham in 2024. He produced a podcast series for Tradeoffs in partnership with The Marshall Project, a nonprofit investigative news organization focusing on the criminal justice system in America.
Ryan has continued following HEART’s work in Durham over the last couple years. And for the next hour… he’s going to share his reporting with us. Through Durham’s experience … Ryan will explore three big questions facing any community that wants to change how it responds to mental health crises:
How do you get police to buy into a new way to treat people in crisis? Can it keep people safe? And how big should these programs be?
Here’s Ryan Levi.
*****
Newsclip: We stand for George Floyd!
RL: The story of Durham’s radical rethinking of how to respond to mental health crises begins in late June, 2020.
Newsclip: Sometimes I feel like a motherless child.
RL: Hundreds of people march through downtown Durham.
Newsclip: I understand y’all anger. Us black people, let me tell you something, we are tired. // We’ve seen these protesters hit the streets in Durham for almost 10 days now. // Yes, there are some “good cops”, but if you’re letting the bad ones keep doing what they’re doing, you’re just as bad.
RL: The protests here look a lot like they do across the country following the murder of George Floyd by a Minneapolis police officer.
Signs. Chants. Calls to reform the police.
Protestors paint the word DEFUND in bright yellow letters on Main Street with an arrow pointing to police headquarters.
A few blocks away, the word FUND in the same crisp yellow, with an arrow pointing toward the department of social services.
These protests spark city officials to launch an independent review of Durham’s 911 data.
They find that violent crime accounts for just a small fraction of all calls.
Trespassing, verbal disturbances and mental health crisis calls make up much of the rest.
To respond to those calls, city leaders earmark $3 million in June 2021 to create the Community Safety Department.
They tap Ryan Smith to run it.
Ryan Smith (RS): This work in part is about helping people imagine something that they may not have imagined.
RL: This new agency gives Ryan a chance to solve an old public safety problem.
RS: Your house is on fire. We send fire. You’re having cardiac arrest. We send EMS. There are shots fired. There is violent crime or criminal activity. We need to send law enforcement. [But] People call 911 for a whole bunch of other reasons. And most of those reasons, because we haven’t had another branch to sort them into, have gone to law enforcement.
RL: For decades, Durham had four branches of public safety – 911 answering the call, police, fire and EMS.
City leaders want Ryan to build a Fifth Branch where 911 dispatches social workers and other mental health workers instead of armed officers.
This kind of unarmed response in the U.S. has actually been around for a while.
The first programs to send mental health workers to 911 calls date back to the 1980s.
And more than half of the country’s 50 largest cities have now launched or piloted alternative response programs.
RS: This work in part is about helping tell the story of what this is looking like in other communities. These are the calls they’re already sending these types of responders to. All the bad things that you’re worried about, we’re not seeing evidence of that.
RL: Ryan designs a program for Durham with four parts.
Put a mental health worker inside 911 who will resolve some calls over the phone.
Deploy teams of unarmed social workers, EMTs and people with lived experience to respond to non-violent calls involving mental illness and homelessness.
For crisis calls that involve the threat of violence, have 911 dispatch a clinician and a specially trained Durham cop.
The last piece… HEART teams work with people to connect them to longer-term help after a crisis call.
To make that program a reality though, Ryan has to figure out how to deal with people like Sgt. Dan Leeder.
Dan Leeder (DL): I’m like, this is going to be a disaster. I said, it is not going to go over well.
RL: A whole lotta officers in the Durham Police Department see this new department as an attack.
Ryan understands their point of view, the idea of this new branch came from the “defund” law enforcement protests.
Based on what he learned from other cities, Ryan believes getting police buy-in gives the whole enterprise its best shot.
RS: One thing that I’ve noted is that the inability to get law enforcement buy in can lead to programs like ours being much smaller than they need to be or is warranted.
RL: A quick word about why Ryan seemed up to this challenge.
He’s calm, the 46-year-old is quick to empathize and slow to anger.
And behind his khakis and button downs, Ryan has this quiet intensity to him.
Finally and this is random, but it’ll make sense in a minute – he’s got a bird name.
RS: My bird name is chickadee. It’s an important part of our identity in the department.
RL: Actually, everyone at HEART has a bird name.
Ryan’s assistant director came up with the idea – a kind of department bonding thing.
Ryan got “chickadee.”
Can you give me the, the short version of why? Why, chickadee for you.
RS: Here. Let’s go. I’ll read it to you.
RL: Ryan reads to me from a colorful print-out.
RS: Chickadees move in a small group called a banditry and forage together. It decreases their chances of a hawk taking them by surprise.
RL: It’s taped to his office window in City Hall.
RS: By example, the chickadee shows us how working in a cooperative team means more eyes and ears and fewer opportunities for predators.
RL: Ryan is good at seeing ‘problems’ and building teams to find solutions.
If he can get Durham’s police leaders on board, he thinks, they can help him persuade all the skeptical rank and file cops.
RS: For the police chief to say, yes, this is good work. To me, that was the dream. Can I make that happen?
RL: Turns out, Ryan was lucky.
Swearing-in: Are you ready, Chief? Yes, mam.
RL: It’s December 2021.
Swearing-in: I. I. State your name. Patrice Andrews.
RL: Patrice Andrews stands on stage at North Carolina Central University, the same historically Black school in Durham she’d attended 30 years earlier.
Swearing-in: That I will be faithful…That I will be faithful…and bear true allegiance… and bear true allegiance.
RL: Dressed in her black ceremonial Durham Police Department uniform, she takes her oath, becoming the city’s 33rd police chief.
There are a few things I want you to know about Patrice:
She comes from an old Durham family. Her dad integrated city schools as a kid, she worked as a beat cop here for 20 years.
But here’s the most important thing: she’s taking this job at 48, in part because she wants to reduce the harm police can cause.
Patrice grew up hearing stories from her parents about the racism and harassment they faced.
Patrice Andrews (PA): Law enforcement was an extension of an oppressive government. I mean, just in a nutshell.
RL: Patrice determined, all those years ago, to be the kind of cop that would make everyone feel safe.
She struggled, sometimes though, to find her identity in the uniform.
PA: There were times where I knew that some of the force that I saw and participated in was excessive But how do you call that out? It’s very hard to call that out when you don’t necessarily feel like you would be supported in doing that.
RL: As she prepares to become Durham’s top cop, Patrice understands law enforcement’s opposition to HEART runs deep.
But she also understands – first-hand – how hard it can be for cops to respond to a person with mental illness.
PA: I remember responding to a call and there was a woman that was seeing things in her home.
RL: Patrice had been on the force for a few years by this point. She and her partner had driven to the home of a woman who had repeatedly called 911 saying there were intruders.
It quickly became clear there were no intruders.
PA: She’d point to a lamp and she’d say, they’re behind the lamp. And so we’d go over there and say, you’re trespassed, you can’t be here.
RL: Patrice and her partner hoped chasing the figures away – these figures only this woman could see – would bring her some peace.
But she called 911 again. And again.
PA: We kept saying, you can’t call us anymore for this. You know, we’ve told the people to get out of your home and they’re out. You can’t call us anymore, don’t call us anymore.
RL: She kept calling.
PA: We didn’t know what to do. We didn’t have the professional knowledge on how to work with someone that clearly was going through a moment of crisis. The only thing we knew to do was take her to jail, because for us, that was solving our problem.
RL: Patrice never learned what happened to that woman. Just that the calls stopped.
PA: I often wonder Did we harm her mentally more in doing that? Did it serve a purpose? Aside from our wanting her to stop calling 911?
RL: Patrice spent 20 years seeing the limits and the abuses of policing.
She had learned change could come through policy. By becoming a supervisor, a leader, a chief.
Swearing-in: So help me God…so help me God…Congratulations, Chief…thank you. (applause)
RL: And now, she’s ready to be that change.
PA: I am going to be unapologetic about saying, you’re wrong, that’s wrong. And, you know, we’re going to fix this.
RL: The ceremony ends, the crowd thins.
As she heads home, Patrice thinks to herself that HEART, this new unarmed public safety response … offers her – and really, her whole department – a chance to do better.
For cops to do their best work and for HEART to do something different.
PA: We can do both. We can have a wonderful professional police department. We can also have amazing public safety partners in HEART.
RL: You’re listening to Call to Mind: The Fifth Branch, a broadcast special produced by Tradeoffs. I’m Ryan Levi.
Police Chief Patrice Andrews was on board.
But she still had to convince a few hundred deeply skeptical officers like Sgt. Dan Leeder.
DL: Nothing is ever 100%. But it was darn close that this was a bad idea.
RL: In the fall of 2021, Patrice invited HEART director Ryan Smith to make his pitch directly to Dan and the rest of the force at police headquarters.
Patrice had started to notice rank and file’s reaction to the new department.
Eye rolls, officers muttering about ‘agendas,’ the woke generation.
One senior officer asked Patrice “what’s this BS about being defunded through HEART?”
That’s why Patrice had invited Ryan to these meetings, to come talk with every single patrol officer, hundreds of cops.
PA: You had to break down perceptions. You had to break down feelings, and you had to create environments where people could speak openly and honestly.
RL: The cops had lots of concerns. Sgt. Dan Leeder said most of them came down to fear: fear for residents, fear for their job, fear for the safety of the new responders.
DL: If they’re going to deal with some of the same people that we’ve had to deal with, you know. Like if we’re getting assaulted what’s going to happen to them?
RL: Ryan Smith expected this big blue wall of police resistance. In the meetings, he could feel the existential dread in the air.
The city was hemorrhaging officers. 58 left the department during the height of the pandemic and George Floyd protests. That was 8% of their whole staff.
Dan said plenty of rank and file felt unfairly “lumped in” with the Minneapolis officer who murdered George Floyd.
DL: What did we do? We’re good cops. We didn’t do anything wrong. Why are we having to go through this? There was a lot of trepidation about what is this going to mean for us, how is this going to affect what we’ve been doing for years.
RL: And yet, HEART was happening. Ryan wasn’t showing up for these weekly pummelings to cut some grand bargain.
He wanted officers to be prepared for this change and maybe earn a bit of good will.
RS: With police, we needed to build confidence that we could do this and not get someone killed. Point blank.
RL: But building that confidence, Ryan knew was going to take time.
That was true for community activists, too.
To convince them that HEART was truly an alternative crisis response program, he co-hosted virtual town halls with the advocates and held smaller in-person focus groups in English and Spanish.
RS: It was clear to me that it had to be a very intentional effort. It had to be consistent. You weren’t going to do it with a few words or small gestures.
RL: These steps, the town halls, the focus groups, the meetings with cops, this was Ryan trying to live up to his nickname.
RS: The chickadee shows us how working in a cooperative team means more eyes and ears and fewer opportunities for predators.
RL: Throughout the end of 2021 and first half of 2022, Ryan Smith and Chief Andrews addressed rumors, tried to reassure officers.
PA: We just needed to make sure that our officers knew that this is not, we’re not replacing you. You still have work that you need to do as a law enforcement officer.
RL: They used data to walk through officers’ fears that HEART would put people in danger.
RS: Everyone’s going to have that. Well, I remember this time when this one trespass call ended in a gunshot and an officer was hurt. That’s a valid thing. We named that. And then we look at the data and put that into context that that happens on like less than 1% of 1% of the time.
RL: Still Ryan and Patrice were a long way from getting most rank and file officers bought in when HEART launched on June 28, 2022.
Clinicians start answering 911 calls. Unarmed social workers, EMTs and peer-support specialists jump in vans and hit the streets.
They respond to homeless people panhandling, people thinking about suicide, parents past their breaking point.
Sgt. Dan Leeder listens to it all unfold on his police radio, certain he’s going to hear social workers screaming for cops to come save them.
DL: I’ll hear these calls come out. I’ll hear the co-responders or the HEART team responding to it.
RL: But much to Dan’s surprise, the new teams seem to be doing just fine.
DL: Whatever it is they’re doing, they’re doing it right. And the call doesn’t come back again.
RL: But there was still a bunch of skepticism and suspicion.
Some officers would swoop in and respond to calls meant for HEART.
Others would ignore orders to wait for HEART before engaging with a scene.
This lingering pushback from officers frustrated Chief Patrice Andrews.
She wanted them to see that HEART could make their jobs better, safer.
Which brings us to that August night in 2022. HEART’s been live for less than two months when Patrice gets the call about that barricaded man making threats.
PA: He said, I’m not coming out, and if you come in, I’m going to shoot you all.
RL: The Commander outside the home is proposing a SWAT team.
At that moment, Patrice knows, busting down the door could lead to violence, exactly what she wants to avoid.
So she gets Ryan on the phone.
PA: I said, look, this is what I have. I know that you all are done working for the day. And is there any way that someone can go out?
RS: She called me, and I told her that I would reach out to Abena. Abena is one of our clinical managers.
Abena Bediako (AB): So I get the call from Ryan. I was with my children. I had just picked them up from school and we were headed home. I knew something was going on because it was after hours.
RL: HEART in the early days shut down for the night at 5.
AB: I got home, got my children settled, let my husband know kind of what was going on and then I called Chief Andrews to get a little bit more information and details on the situation.
RL: Patrice tells social worker, Abena Bediako “cool the temperature down. Convince the man to go to the hospital.”
Abena’s done this job for 20 years. She lives for moments like this.
AB: Some of the officers were already like, yeah, he’s not really going to talk to you, but you can try. And I smiled because I’m like, okay, I’ll try.
RL: The 5’1 social worker digs in.
She calls the barricaded man’s father who tells her that his son has been hospitalized before.
Abena calls the man.
AB: He was just angry. And so, okay, you can be angry, you can curse and you can yell. It’s fine.
RL: Her calls keep getting interrupted. Dad calling son. Son calling dad. Up and down the street, Abena paces.
AB: Some of the officers would come and be like, you know, how is he? And I’m like, no, we’re still talking because sometimes people just need to talk, need to be validated.
RL: On the phone, Abena, keeps repeating herself.
AB: You’re okay, let it out. It’s fine and we’re going to be with you.
RL: After about an hour of calls, the man relaxes.
Abena gives a thumbs up to the officers, who look back at her in shock.
AB: He let officers come and search his room to make sure that, you know, he was okay.
RL: The man cooperates. He asks Abena, “Can I stay tonight and go to the hospital tomorrow?”
Abena calls Chief Andrews.
PA: Abena said, well, he’s not a danger to himself. He is intoxicated. Let’s give him a moment. Let’s check back in with him. And so we went about it a different way.
RL: The next day Abena drives the man to the hospital with a police escort following behind.
The man checks himself in. Crisis. Averted.
This was a huge moment for the young department, the idea that HEART was “useful” to cops was spreading.
Patrice saw it.
PA: Officers said oh so we can call them for this is great. This is great. So that means that we don’t have to do this. We wouldn’t have to do that. And they can help us.
RL: Sergeant Dan Leeder saw it too.
DL: When I’m wrong, I’m the first one to raise my hand and say, you know what? I was wrong. These people are going to help you. They’re going to make your job and your lives on this job easier.
RL: When Durham police officers first learned about HEART, just 37% told researchers they thought the new teams would be a big help on mental health calls. Now that’s 77%.
For Ryan Smith, this incident captured what he’d been saying to officers for the last year.
RS: Most people do not think that story can end with that person just walking out without any handcuffs on, with no use of force, and be transported to hospital because he has threatened to hurt officers and hurt himself. The idea that a different type of response might be successful there is hard to imagine.
RL: Put another way, HEART was able to prove that their unarmed responders could handle a volatile situation, and have everyone walk away safely.
AD: We’re going to take a break now, and when we come back, Ryan Levi will tell us whether HEART is actually keeping people safe in Durham and about the biggest challenge facing this radical new department.
I’m Angela Davis. You’re listening to Call to Mind: The Fifth Branch, a broadcast special produced by Tradeoffs, from American Public Media.
BREAK
AD: Welcome back. You’re listening to Call to Mind: The Fifth Branch, a broadcast special from American Public Media’s initiative to foster new conversations about mental health. The Fifth Branch was produced for us by Tradeoffs, a nonprofit news organization covering health policy. I’m Angela Davis.
We’re spending this hour in Durham, North Carolina, one of more than 130 cities and counties across the country that now send unarmed mental health workers to some 911 calls instead of police.
Ryan Levi, the managing editor of Tradeoffs, has been following Durham’s “HEART” unit for more than 2 years.
Here’s Ryan.
RL: One of the biggest fears people have about alternative crisis response programs like HEART is that they’re dangerous.
Dangerous for members of the community and especially dangerous for the unarmed mental health workers now dealing with unpredictable 911 calls.
David Prater is one of those unarmed responders and a lot of people worry that folks like David will get hurt even killed.
HEART takes that concern seriously.
So after every call, David and his coworkers have to answer a question:
David Prater (DP): Did you feel safe during this encounter?
RL: Between their unarmed teams, clinicians in the 911 call center and co-response with Durham police, HEART has answered more than 30,000 911 calls since the summer of 2022.
99% of the time, responders said they felt safe.
After riding around with David and other HEART units for 30 hours, I realized why that number is so high.
I assumed my ride-alongs in HEART’s white mini-vans would feel like some mental health ambulance.
We’d race from one crisis to the next. But mostly, it was pretty quiet, checking up on an elderly couple.
Ride along: Your dentist was just really worried.
RL: Gas station owners with panhandling complaints.
Ride along: They just asked if you wouldn’t do that in front of their store. Are you okay with that?
Ride along: I’m okay with that.
RL: We gave people rides, helped people in their homes, none of it felt dangerous.
HEART director Ryan Smith says that’s by design.
RS: We first looked at what were the calls that other cities already had some evidence to support that it was safe to do this work.
RL: Trespassing, wellness checks, intoxication.
Durham’s own 911 data showed those calls rarely ended in violence for police.
But just like with firefighters, EMS and cops, Ryan says, there’s no escaping the danger that comes with this job.
RS: I think it would be a mistake and disingenuous to kind of gloss over the risk and uncertainty that is inherent in any 911 call.
RL: Ryan has tried to mitigate that risk.
If a weapon is present, a HEART social worker responds with a police officer.
Same thing when someone threatens violence.
Durham police train HEART staff to stay alert on scene.
And the program outfits teams with police radios … to get backup fast.
But taking on some risk? That’s the job.
RS: I think that’s part of what being a public servant is. I think government at its best is shifting burden and risk away from those that we serve to those who are signed up to be public servants.
RL: It’s worth repeating: Police in America have shot and killed 2,057 people who were in the middle of a mental health crisis in the last decade.
One of every five police killings.
Ryan believes, like the other branches of public safety, it’s worth putting HEART’s first responders in harm’s way to lower the risk that someone in crisis is hurt by the police.
David Prater agrees.
David Prater (DP): It is a sacred duty.
RL: David’s official title is ‘peer-support specialist.’
DP: 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.
RL: David told me about the years he spent addicted to crystal meth, living on the streets in Durham and Atlanta.
Remember how all HEART employees have a bird name?
David’s is Phoenix, the powerful, mythical bird rising from the ashes.
DP: I have no problem going under the bridge because I used to live under the bridge.
RL: David stands about 5’9, with short, spiky black hair. He knows that anything can happen on any call. People have spit at him.
DP: She said, look, {beep} white motherfucker, I don’t want your {beep} fucking help.
RL: A shootout forced him to scramble behind a car.
DP: We call for help on our radio. We’ve got shots fired.
RL: David and I did a ton of ride-alongs together over my many visits to Durham.
I asked him a few times if he ever gets scared.
Everytime, he told me no. He said he knows he’s got backup. Police are always a radio call away.
And he has a real faith in this work.
DP: When we arrive at a call, we have no arrest power. We have no weapons. We are trying to help somebody get their needs met.
RL: And like so many of the folks I met at HEART, he’s willing to make sacrifices.
DP: Is there a level of risk in this job? There is. Do I consider it an acceptable risk? I do.
RL: HEART’s unarmed teams have responded to more than 20,000 calls.
They’ve only called for police backup over a personal safety concern, eight times, .04%.
So yes, unarmed mental health workers can safely respond to 911 calls.
The data bear that out in Durham, and other robust programs across the country, in Eugene, Oregon; Denver; Albuquerque.
But programs like HEART are also – of course – being created to keep the people calling 911 safe.
People like Yolanda.
Yolanda: The sun is bright.
RL: We could stay in the shade.
Yolanda is wearing a purple tank top and blue jeans as we pull chairs onto the small cement patio behind her narrow brick-fronted home.
We’re only using Yolanda’s first name to protect her family’s privacy.
We face a small playground, people walk their dogs, planes fly overhead.
It’s a peaceful afternoon.
Yolanda tells me that 24 hours ago, things were anything but.
Yolanda: I don’t know. She just, she lost it. Like screaming and hollering and throwing stuff and kicking stuff.
RL: She had just told her daughter she couldn’t have friends over to celebrate her 13th birthday.
Yolanda had planned a surprise party with family, but before she could explain, her daughter rushed to the bathroom, locked the door.
Screamed at her mom, ‘I hate you.’
Yolanda: She wouldn’t come out of the bathroom. She just sat in there in the dark. It was hard to watch for a child so young to be so emotional.
RL: Yolanda, who was 38 when I met her, told me her daughter struggles with depression.
She worried what might happen in that bathroom.
And Yolanda’s own challenges, depression, PTSD, bipolar disorder, addiction, made it hard at that moment for her to keep it together too.
Yolanda: I started to get upset. I’m not going to lie. It started to bother me that she was so loud.
RL: When these situations hit a breaking point in the past, Yolanda yelled right back.
This time she stopped.
Yolanda: When I saw myself getting upset with her, I knew that was the wrong choice.
RL: Yolanda’s whole family struggles with mental illness.
She says before HEART, she went through a stretch with her middle daughter where she guesses she called 911 about once a week.
It was always the last resort.
Yolanda: I hate to say it like this, but, you know, officers are usually pretty brutal people. None of us like the police. Like none of us like the police.
RL: But the fights, she said, scared her.
Punching doors. Yelling. Tears. Cussing.
She knew she needed help, and 911 was often her only option.
Reluctantly Yolanda would call, always on edge.
Yolanda: What officer is going to show up and be having a bad day and decide that today’s the day that I’m going to use my badge to be able to do whatever it is that I want to do, and nobody’s going to be able to do anything about it because I have a badge.
RL: She worried, will the police take my kids, will the police take me to jail.
Yolanda kept calling 911, but after HEART launched, she found them much easier to trust.
Each time a team came out, she said she learned something, like how to check her own temperature when she was hot.
Those lessons helped Yolanda see how upset she was that her daughter’s special day was going so wrong.
Yolanda: So I grabbed a bag of peas out of my freezer and put them on the back of my neck, and I dialed 911.
RL: She realized, thanks to tips like the peas, this was the first time she called 911 in four months.
911 call: 911. What’s the address of your emergency?
RL: This is a recording of the 911 call Yolanda made. Durham digitally altered her voice.
Yolanda: Can you please send the heart team, please? Can you please get them to come out here?
RL: What happened next, I think, captures the difference between the two public safety branches.
All three HEART teams were busy when Yolanda called.
Instead, a police officer showed up.
Yolanda: He has a daughter that’s around the same age as her, and he was able to kind of calm her down a little bit, but she still was a little irate.
RL: The officer, at Yolanda’s request, radioed for the next available HEART team.
By the time David Prater’s unit showed up about 10 minutes later, the officer had gotten the family to agree that Yolanda’s daughter would spend the night at the hospital.
An improvement over the standoff in the bathroom, but hardly ideal.
DP: What 13 year old wants to believe that like, I’m so broken, I have to go to a hospital on my 13th birthday.
RL: The officer left, HEART’s social worker coaxed Yolanda’s daughter out of the bathroom to talk upstairs in her bedroom.
Yolanda stayed downstairs with the rest of the team.
David says Yolanda was still clearly upset.
DP: I can’t have her here, I need space, you know she’s got to go to the hospital. And so then we began talking. Well, what other options are there? And Big Sister came up.
RL: The HEART team asked if the 13-year old could spend the night at Big Sister’s place.
Yolanda got the OK from her older daughter.
A few minutes later, the social worker came back downstairs with the 13-year-old.
Yolanda: Whatever they talked about was exactly what my baby needed to get off her chest. She wanted to cuddle. She was back to her usual self, the playful baby that I know.
RL: Mom and daughter agreed a Big Sister sleepover beat spending the night at the hospital.
Yolanda looks at me, a light breeze stirs on the patio.
She says as helpful as that police officer was, HEART helped more.
Yolanda: She texted me today and was like, hey, I love you. So she’s better.
RL: Two years after the birthday party blow-up, Yolanda says things in her house are a lot better.
She’s sober and HEART referred her to a therapist, who connected her with therapists for her daughters.
She says the skills HEART gave her family have helped them avoid arguments and meltdowns.
She’s still felt the need to call 911 a handful of times in the last couple years.
That’s what happens when you’re dealing with as much mental illness as she and her daughters are dealing with.
But Yolanda tells me when she does call, she trusts who’s on the other side of the door.
Do you feel safer knowing that heart is an option that you can call heart?
Yolanda: Oh, yeah. Definitely. Help is on the way. That’s how I feel. Normally when you hear 911 say that, it means absolutely nothing. But when you ask for the heart team and they say help is on the way, to me that is the biggest sigh of relief that I could possibly take during an altercation.
RL: You’re listening to Call to Mind: The Fifth Branch, a broadcast special produced by Tradeoffs. I’m Ryan Levi.
In a 2023 survey of Durham residents, 57% said they were more likely to call 911 thanks to HEART. In a survey a year later, more residents were satisfied with HEART than with any other public safety unit in the city.
But not everyone feels that way.
Apartment managers and gas station owners I met wanted the police to show up when they called 911. They were angry when HEART showed up instead.
And I talked to a few business owners who question HEART’s value.
Independent research on the safety impacts of unarmed response is still limited.
A study published in October 2025 by researchers at Duke and the University of Michigan found that an unarmed HEART response was less likely to result in a crime report or arrest than if police responded to the same type of call.
It found no difference in the likelihood of police use of force, which is already incredibly rare in Durham.
The paper has yet to be peer reviewed … but the findings line up with two other recent studies on unarmed response from Michigan and Oregon.
HEART’s unarmed teams have diverted more than 20,000 911 calls from police since the program launched four years ago.
Durham Police Chief Patrice Andrews says adding HEART gives her more uniforms to throw at the dangerous calls.
There’s one other way Patrice sees HEART improving police safety and that’s by limiting their exposure.
Sometimes, that’s from violence.
Sometimes, that’s trying to protect them from future remorse.
PA: I don’t want any officer to ever look back. Five, ten, 15, 20 years from now. And regret how they treated someone.
RL: Patrice carries that regret. Early in her career she’d handcuffed a suspect’s hands behind his back.
But he kept “stepping through” the cuffs, bringing his hands in front of his body.
PA: I told him several times, don’t do that. Stop doing that.
RL: He ignored her.Another officer asked if she was going to let this guy get away with that.
PA: And um, I said, well, no. And he said, well, well then you need to do something about it. I took that as meaning that, you know, you need to teach him a lesson.
I remember grabbing him and just kind of picking him up and pushing him back down and picking him up and pushing him back down while he was in handcuffs. That was excessive. And that was wrong.
RL: Decades later, Patrice is known as a reformer, someone committed to making policing better.
But sitting in her home in Durham, Patrice still struggles with what she did.
PA: If my dad knew that I had done that. My parents, they would have been so disappointed. How could I treat someone that way? How could I treat another human being that way?
RL: Patrice knows there’s no excuse, and little sympathy, for cops who use excessive force.
At the same time, she knows it happens. And it’s that much more likely to happen when cops respond to a volatile mental health crisis.
HEART, she says, can protect her officers from their own worst impulses, like her with that man in the handcuffs.
That’s one reason she’s supported HEART from the beginning.
PA: It’s me trying to make amends. I don’t know where that man is now. I don’t remember his name. I don’t know that he ever remembers mine, but it’s a part of me that wants to make it right because I had gotten it so wrong.
RL: My time in Durham makes it clear to me HEART, in many ways, is exceeding expectations.
The program has established and maintained deep support from elected leaders, law enforcement and the community. It’s proven that unarmed mental health workers can safely respond to 911 calls that used to be answered by the police.
But the last leg of HEART’s mission — connecting people to services to deal with the underlying problems that led to that 911 call — director Ryan Smith says that is very much still a work in progress.
RS: I knew that it would be hard. I knew that it would be messy. But that it would be the hardest thing that we do? That’s the thing that surprised me.
RL: Ryan told me that when he designed the program, he knew his team would meet people with problems bigger than anything social workers could solve out of a van.
But he wanted to avoid the department from sliding into long-term care, so Ryan limited what they call “care navigation” to 30 days.
RS: We’re not there to provide all the services. We’re there to try to make the most of sometimes our underfunded, fragmented system of support. That’s why we have care navigation.
RL: Over and over again, though, HEART’s care navigation efforts have run into obstacles.
HEART has connected just 20% of people to follow up care.
Some of that is because one of every three people HEART meets on a 911 call never respond when care navigators reach back out.
Some of that is because housing and mental health services in Durham are really limited.
RS: We don’t control all of the other agencies that we’re working with. We don’t have access to all of the housing that we need. And yet still, when there’s an emergency call, we’re the ones showing up trying to figure out how to do our best with a system that is not resourced enough.
RL: Ryan tells me his team can feel demoralized, especially when it comes to dealing with people who are unhoused.
Ryan hears people in the office say, “It feels like we’re just a band-aid. I don’t want to just be a band-aid.”
The department has made some internal changes to try to better connect people to care, like more quickly matching care navigators to people in crisis.
But more and more Ryan feels like that’s just not enough.
RS: I feel very clear of where our boundaries are. And yet this role of being kind of a last line of care means that we’re in this state of pushing up against those boundaries and trying to figure out how to advocate for a broader solution.
RL: In HEART’s early years, Bo Ferguson was the personification of those boundaries Ryan was pushing on.
Bo Ferguson (BF): He and I talk about this every week.
RL: Bo was Durham’s deputy city manager for public safety and Ryan’s boss.
Like a lifeguard at the beach, Bo kept an eye on Ryan, made sure he didn’t swim out farther than he should.
It was important to Bo that HEART stay focused on crisis response.
BF: I have worked really hard to keep some buffers and boundaries around the expectations of what this team is supposed to do, so that we can focus on fulfilling this really critical mission that we were given, which is to respond to 911 calls when people are in crisis and help them resolve those emergencies.
RL: But Bo heard Ryan when he told him that people were falling through the cracks, that his team wanted to do more than be a Band-Aid.
So Bo gave Ryan the greenlight to test the waters of stuff that fell well outside the scope of 911 response.
Like a small pilot program HEART launched in 2024 to help some of the city’s residents with the most complex needs.
This pilot allowed HEART to go far beyond the normal 30 days of care navigation and meet several times a week with five of these folks in hopes of getting them the treatment, housing and support they need.
RS: We have to stand in this gap because at the end of the day, we’re going to keep getting 911 calls.
RL: The poster child for this pilot was a guy we’re going to call Martin.
RS: I’ve worried a lot about Martin.
RL: “Martin” has lived on the streets of Durham for more than a decade. He struggles with mental illness, usually unmedicated. City officials have held meetings just about Martin.
RS: There was a clear gap. No one was working with Martin.
RL: Martin’s too sick to jump through the necessary hoops to apply for housing, but he’s not sick enough to be admitted to a psychiatric hospital against his will. His case helped convince Ryan and Bo that HEART needed to leap over their first-responder boundary.
The department declined my request to shadow staff who work with Martin over concerns that a stranger with a microphone might antagonize his paranoia.
HEART staff spent months painstakingly building trust with Martin. They brought him food and clothes. They tried to get him connected to housing and treatment.
When HEART helped Martin get an ID, Ryan felt like that was a huge win.
John Warasila was less impressed.
John Warasilla (JW): Once you’ve gone to that point that you’re putting in those kind of investments, people are going to expect results out of it. And the results we were seeing were not satisfactory.
RL: John is an architect and a real estate developer in downtown Durham. Martin often takes over a 5 x 20 foot corral where John’s business tenants take out their trash. Sometimes Martin scatters that trash, sometimes he screams at people.
JW: How is it that one individual can disrupt 20 people’s lives and investments and well-being and that’s okay?
RL: In the months after I met John, he kept me posted on Martin, sent me pictures of him surrounded by garbage, emailed me a story from a neighbor who said they saw Martin scream at a young family.
To be clear: John likes HEART.
He likes the idea that someone other than police can show up and de-escalate certain situations.
And he appreciates that HEART is investing time and resources into helping Martin.
But John sees HEART as ill-equipped to tackle all the major problems they’re trying to address.
JW: They will tell us we’re working on it. They tell us this list of things they’re doing. At the end of the day, it’s not resolved. So at a certain point you’re like, I appreciate all the effort that’s going into this, but this is not functioning as a solution.
RL: Ryan Smith understands John’s frustration. He shares it. Bo Ferguson does too.
At the beginning of 2025, Bo was promoted to Durham’s City Manager.
He heard almost immediately from business owners like John, as well as other residents, city council members and nonprofits, that the city needed a new approach to homelessness.
So in one of his first major moves as city manager, Bo officially let Ryan head for the deep end.
BF: I moved our homeless services from a department that was primarily focused on housing and moved it to the Community Safety department.
RL: Like a police department has a homicide unit and a traffic unit, Durham’s Community Safety Department now has HEART with its unarmed 911 responders, and what the city calls a Stabilization Services unit.
This new unit connects people that HEART meets on 911 calls to longer term care and support. They do street outreach to the city’s homeless population … and oversee all of Durham’s work to address homelessness.
Bo and Ryan agree that it made sense for the Community Safety Department to start with just 911 calls.
Adding HEART was a radical shift to Durham’s emergency response … and Ryan and his team needed to focus on getting that right.
But as Bo told me, HEART grew up fast.
BF: Going from kind of a scrappy new idea that we were figuring out as we went, to a clearly established, well respected branch of public safety.
RL: Bo saw the pilot work HEART was doing with Martin.
How limited they were in their ability to actually address the problems Martin faced and the problems he created for people like John.
Bo also saw how when given the opportunity to really dig in, HEART was able to do what most people thought was impossible.
BF: I remember when Ryan texted me the picture of Martin unlocking the door for his house for the first time.
RS: After 14 months we were able to find placement for Martin in a permanent supportive housing unit where he is still.
RL: Martin still has a long way to go on his journey.
HEART staff still meet with him regularly, to keep him on his meds, and connected to other services to make sure he stays housed.
And Ryan Smith still has a long way to go on reimagining Durham’s homelessness services.
But Bo is confident he can do it because Ryan’s done it before.
BF: Some of this is acknowledging I have a tremendous leader and giving that leader some of the hardest problems in Durham, because that leader was successful at the last batch of really hard problems at Durham. And if you come back in two years, we’ll see what else I’ve thrown at him.
RL: Ryan keeps taking on these daunting challenges because he knows how high the stakes are.
RS: Some of the people that we encounter most often in this work are in such precarious, vulnerable positions with seemingly no one else in their corner that if we don’t continue to show up, then it does feel, and we do worry, that it’s a matter of life and death.
RL: Ryan knows he and his department can’t do this alone.
They need the community nonprofits, the treatment centers, the shelters.
It’s going to take building the same kinds of alliances Ryan helped forge between HEART and Durham police.
Remember HEART’s bonding thing where everyone on staff gets a bird nickname?
Ryan’s, you may recall, is Chickadee. This is what chickadees do — build alliances to solve problems.
RS: you know, I didn’t realize that at first. I thought it was just kind of a cute throwaway name, like, oh, the chickadee, it’s just tiny little bird. I thought people were having fun with it. And as I learned more about the chickadee. Yeah, it felt like it fit really well.
RL: For Call to Mind, I’m Ryan Levi.
AD: Thank you for listening to Call to Mind: The Fifth Branch, a broadcast special from American Public Media’s initiative to foster new conversations about mental health.
Call to Mind: The Fifth Branch was produced by Tradeoffs.
Original reporting for The Fifth Branch full podcast series was completed by Tradeoffs in partnership with The Marshall Project and funding support from Just Trust and the Sozosei Foundation.
The Fifth Branch was reported by Ryan Levi, with help from Marc Maximov, and edited by Cate Cahan and Dan Gorenstein. It was mixed by Andrew Parrella and Cedric Wilson. Additional support from Kathryn Dugal, Shannon Crane and Jessica Silverman. The executive editor of Tradeoffs is Dan Gorenstein.
Music in this episode comes from Blue Dot Sessions and Epidemic Sound.
Call to Mind’s senior editor is Stephen Smith.
Our technical director is Alex Simpson.
And Jessica Bari is our senior producer.
I’m your host, Angela Davis.
Thank you for joining us for Call to Mind: The Fifth Branch – from APM American Public Media.
DG: To hear more of Call to Mind’s reporting on mental health, check the listings of your local public radio station … you can subscribe to Call to Mind wherever you get your podcasts.
All three episodes of the Fifth Branch, plus pictures from Durham and more can be found at tradeoffs.org/thefifthbranch.
I’m Dan Gorenstein, this is Tradeoffs.