Over 50 years ago, Chapel Hill became one of the first cities in the country to send clinicians along with police officers to respond to people experiencing a mental health–related crisis.
In May 2024, the city expanded this approach, launching a pilot program that dispatches mental health specialists to respond to incidents without police. The team also includes a peer support specialist—someone with their own lived experience with mental health struggles to respond to calls.
During its first year, the Crisis Assistance, Response, and Engagement team—or CARE—has had great success, responding to almost 1,300 events and significantly reducing the number of arrests and forced hospitalizations that would have occurred with traditional police response, according to the Chapel Hill Police Department, which oversees the program.
City leaders hope to expand CARE’s hours of operation and geographic reach to neighboring jurisdictions like Carrboro. But long-term funding for the program remains uncertain amid widespread federal cutbacks to mental health support services.
“There’s really a need for folks who are peer support, who are medically mental health trained in our communities, our neighbors’ communities, all across the country,” says Heather Palmateer, a crisis counselor on the CARE team.
A history of holistic response
Since the 1970s, Chapel Hill’s Crisis Unit has been partnering police officers with clinicians to address emergencies involving a mental health component.
While it was originally envisioned to address juvenile and family altercations, the team quickly grew to be an integral part of the police department, responding to everything from domestic abuse and stalking to behavioral health concerns.
Following the George Floyd protests and police reform movement of 2020, Chapel Hill began envisioning another model, one where practitioners would respond to mental health emergencies in lieu of law enforcement.
“We know there’s research that traditional public safety, fire, EMS, and law enforcement are not the best approach to mental health cases,” says Kirby Saunders, director of Orange County Emergency Services, which routes all 911 calls in the county.
Traditional first responders lack the resources and training necessary to properly deescalate these types of calls, Saunders says. Police and 911 call operators’ priorities are to stabilize the caller and transport them to an appropriate care facility, which doesn’t resolve the root of the problem, he says.
“We [began] looking more holistically at building resources and capabilities to meet the individual, where they may be, when they may be in need, with a more holistic approach,” says Saunders.
The town council organized a community task force to improve racial equity and identify corresponding gaps in behavioral health care and public safety.
The result was the creation of CARE: a four-person mobile crisis unit embedded within the police department that offers deescalation techniques and trauma-informed support during mental health crises.
Sarah Belcher, who oversees the Chapel Hill Crisis Unit and CARE, says that 98 percent of the calls they have responded to in the last year did not result in arrest or hospitalization. The program provides more “natural, community-based support,” Belcher says.
Addressing mental health with lived experience
Cities nationwide have instituted non-police alternate response programs, but Chapel Hill is among the relatively small number that includes practitioners with their own lived experience with mental health challenges to respond to people in crisis.
Jennifer Melvin acts as CARE’s peer support specialist. She knows well what it’s like to be on the other side of the phone calls she answers everyday.
“When someone shows up that’s actually been through what you’ve been through, or knows about it and can assist you with it, [it] makes you more relaxed and more willing to receive help,” says Melvin.
Melvin has battled depression since she was a teenager. After surviving an abusive relationship and sexual assault, she developed PTSD from the experience, which she says later led to addiction.
After 17 years in recovery, Melvin wants to be the resource she wishes she’d had.
“I love helping people because I’ve been in [the] place where you feel lost, unheard, you can’t move,” says Melvin. “The reason I think I can assist people with what they’re really going through is because I understand.”
The CARE team also includes two crisis counselors—one of whom is embedded in the Orange County 911 call center, to help identify CARE-eligible calls—and an EMT. All members respond to calls Monday through Friday, 8:00 a.m.–4:30 p.m.
Over the past year, the close-knit team—and its now distinct white mobile crisis van and blue logo—has become somewhat of a fixture in Chapel Hill.
“When they see us coming, they walk straight up to us and just want to talk,” says Melvin.
“We build a lot of rapport with the people we deal with and we talk to them with ease.”
Palmateer is a registered clinical social worker experienced in deescalation techniques. As one one of the crisis counselors, she often witnesses what might be the most challenging moment in a person’s life.
“We see folks in a very vulnerable place,” she says. What keeps her going when the job gets overwhelming are “the moments where you can really feel when it’s clicked with someone, and you know that you’ve gained their trust.”
Responding to crisis
When a request comes into the 911 call center, the call taker will ask a specific set of questions, known as “call determinants,” to establish if the call has a mental health component and doesn’t appear to have the potential for violence.
If it meets the criteria, CARE will be dispatched.
Orange County uses about 60 different call types to classify an emergency call and corresponding police dispatch protocol. Only three of these call types are CARE eligible.
Because the program is in its pilot period until May 2026, Saunders says call takers are still learning the protocol and getting accustomed to dispatching CARE. In the interim period, CARE also engages in self-dispatch, listening in to 911 calls that may have mental health–related components and responding accordingly.
“Unfortunately, there’s not a real easy way to build a protocol to tell our telecommunicators ‘Do this, if this,’” says Saunders. “We’re working through a lot of activities to encourage and build relationships and an understanding of what the clinician can do.”
The team averages about 100 calls a month, according to internal data, a substantial response for the size of the community.
Of the 1,300 incident responses CARE fielded in its first year, only about 4 percent of events required hospital transport for behavioral health care and 3 percent transport for a medical emergency.
“At the end of the day, that’s four or five or 200 less people that had to call for an ambulance or be taken to the emergency department,” says Saunders. “That’s 200 other chances that someone else needed [assistance] and they had the resources available quicker.”
Saunders says the success of the team has allowed the city to divert more resources toward other emergency assistance efforts, which in turn has supported CARE’s effectiveness as a unit.
“They’re the best of the best in their line of work,” says Saunders. CARE is shining a “bigger light” on the barriers and challenges people experience on a daily basis, which helps both normalize and reinforce the importance of mental health awareness, he adds.
Funding remains a concern
With the initial success of the program, supervisors are looking to expand CARE’s coverage countywide next year.
“In the pilot stage, we’re only serving the town of Chapel Hill, but moving forward, our goals are to see this program grow out,” says Belcher. “We are right now having conversations with another local agency, the Carrboro Police Department, to start that extension.”
Expansion is ultimately dependent on securing future state funding.
For the past year, CARE has been supported by a $580,000 grant from the North Carolina Department of Health and Human Services, much of that federally allocated.
City officials are concerned about where future funding will come from, with national federal cutbacks to mental health care causing the closure of several long-standing alternate response programs across the county.
“Certainly there’s a risk, given what is happening in Washington, that we are all a bit on edge over,” says Saunders. “When the rug is pulled out from programs that impact local communities, local communities are going to be forced to make very difficult financial decisions.”
To help support future investment, the UNC School of Government’s Criminal Justice Innovation Lab is completing an evaluation of the pilot program. The report will quantify specific benchmarks of success and compare the results to other alternate response programs in the area—like Durham’s HEART initiative.
“The state is not going to be able to sustain this program for an indefinite period of time,” says Saunders. “But this gives us an opportunity to evaluate the need, the demand, the opportunities, and the impacts that this team and resource can have to justify investments in the future.”
Orange County is also building a crisis diversion facility for individuals experiencing behavioral health crises, who normally would be diverted to a hospital or jail.
In April, commissioners approved the purchase agreement for the property that will serve as the future site, furthering the county’s efforts to build out comprehensive behavioral health services.
Programs like CARE are oftentimes one of the only ways individuals in need can get this kind of treatment without the consequences that can come with a traditional law enforcement response.
“There’s very few resources to solve the problem, and that has been our only resource,” says Saunders. “We know that handcuffs and hospitals aren’t the solution for most people when they’re in crisis.”
If you or someone you know is facing a mental health crisis, immediately call, text, or chat with the 988 Suicide and Crisis Lifeline or dial 911 for emergency support.
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