911 and Behavioral Health: Building Coordinated Call Handling Systems

Local government sits at the operational center of emergency and crisis response systems. Counties in 48 states and the District of Columbia operate, fund and manage thousands of the nation's public safety answering points (PSAPs), or 911 call centers. PSAPs handle more than 240 million 911 calls annually, including an estimated 24 million behavioral health-related calls.

Counties are building coordinated 911 call handling systems to manage the high volume of behavioral health-related calls and to meet new requirements following the launch of the 988 Suicide and Crisis Lifeline. This work reflects a shared goal across public safety and behavioral health systems: connecting individuals in crisis to the right care while directing emergency resources where they are needed most.

This brief highlights the innovative approaches counties are employing to improve outcomes for behavioral health-related 911 calls and to strengthen the broader behavioral health crisis response system.

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Below are excerpts from the full brief.

Boone County, Mo.

Population: 183,610

In 2024, Boone County Joint Communications and Cornerstone (formerly Burrell Behavioral Health), operator of the regional 988 center, established a formal partnership to improve responses to behavioral health-related 911 calls and reduce strain on 911 telecommunicators. Together, they developed a protocol to guide telecommunicators in redirecting lower-acuity behavioral health calls to specialized crisis support instead of dispatching emergency services.

Ramsey County, Minn.

Population: 552,352

In 2022, Ramsey County launched the Appropriate Response Initiative to expand response options to behavioral health-related 911 calls and reduce reliance on the criminal justice system. The Ramsey County Emergency Communications Center partnered with the county's Social Services Department to embed social workers directly into the 911 call center, allowing most behavioral health-related calls to be resolved internally. Since May 2023, telecommunicators have transferred more than 10,200 calls to embedded social workers, with 78% resolved over the phone and only 10% requiring a traditional law enforcement response.

Henrico County, Va.

Population: 334,389

Henrico County developed a structured approach to behavioral health-related 911 call handling through local implementation of Virginia's statewide Marcus Alert System. The county integrated a four-level behavioral health triage framework into its Emergency Medical Dispatch platform, allowing calls to be classified by acuity and matched with the most appropriate response. From July 2024 through June 2025, the county processed 1,588 calls through the Marcus Alert framework.