Baltimore rethinks emergency response
After a decade of investigations, public-health initiatives and uneven progress, the city is proposing a new emergency service. Its purpose reaches beyond who answers a 9-1-1 call.
Baltimore is proposing another way for its emergency system to answer a call for help.
The Department of Neighborhood Safety would establish alternative emergency response as a municipal responsibility, alongside police and fire/emergency medical services. Trained teams could respond to selected situations, with arrangements for screening calls, requesting other emergency services and connecting residents with continuing assistance.
The legislation advanced with amendments on October 26. The Council record lists it for a final-passage vote on November 9. It has not yet been enacted.
Behind that proposal lies a decade of uncomfortable examination: unmet health needs, experiments in prevention, and evidence that progress in one part of the system does not guarantee progress in another.
Baltimore has repeatedly had to confront what its institutions do to people, what they fail to provide, and what residents need instead. The proposed department is the latest attempt to turn those examinations into a lasting public service.
The city behind the emergency calls
Baltimore City, a jurisdiction separate from surrounding Baltimore County, had 585,708 residents in the 2020 census. The Census Bureau’s July 2025 estimate puts its population at approximately 570,000, continuing a long decline.
About 59% of residents are Black. Roughly one in five lives in poverty. Median household income was US$62,177 in the 2020–2024 estimates, expressed in 2024 dollars.
Those averages conceal substantial inequalities. A study of 2018–2019 mortality data published in JAMA Network Open found a 7.6-year life-expectancy gap between Baltimore’s non-Hispanic Black and White populations. Injuries accounted for approximately 29% of that difference; circulatory diseases were another major contributor.
The conditions confronting emergency responders include chronic illness, trauma, housing insecurity, substance use and barriers to continuing care. They overlap within individual lives and neighbourhoods.
A diagnosis the city could not set aside
The death of Freddie Gray after injuries sustained in police custody in 2015 formed the immediate background to the federal investigation that opened that year.
On August 10, 2016, the U.S. Department of Justice published its findings. Investigators identified unconstitutional stops, searches and arrests, discriminatory enforcement against Black residents, excessive force and unlawful treatment of people with mental-health disabilities. They also documented failures in supervision, training and support for officers.
The federal court entered a consent decree on April 7, 2017, establishing enforceable obligations, independent monitoring and continuing public scrutiny.
One provision would become particularly important to the pathway toward alternative response.
Paragraph 97 required an examination of gaps in behavioural-health services. The questions reached beyond police response: what precipitated a crisis, which services could have prevented it, why police became involved and how another crisis might be avoided.
Supported housing, case management, crisis care and substance-use services were part of that examination.
The reform process was requiring Baltimore to look beyond the encounter itself.
Reform amid further betrayals
The work proceeded through additional institutional failures.
Federal prosecutions exposed members of the police department’s Gun Trace Task Force committing robberies, distributing drugs and falsifying records. Court cases documented crimes committed with police authority and equipment.
Former mayor Catherine Pugh pleaded guilty to federal conspiracy and tax charges and was sentenced to three years in prison in February 2020.
These events are part of the context in which residents were being asked to trust new plans and promises. The people pursuing reform were doing so while public institutions continued to give communities reasons for distrust.
Examining what happens before and after a crisis
The December 2019 Public Behavioral Health System Gap Analysis combined administrative data, stakeholder interviews and discussions with people who had experienced police contact during behavioural-health crises.
Its findings reached well beyond dispatch.
Available data suggested some gains in independent living and reduced institutional involvement, but persistent difficulty improving functioning, perceived recovery and employment. The report also identified inconsistent deployment of officers with specialist crisis training.
A training program could exist without reliably producing the intended response. A person could receive services without gaining the stability those services were meant to support.
Baltimore’s emerging challenge was to connect those separate pieces.
The Elijah Cummings Healing City Act, signed in February 2020, established a municipal commitment to trauma-informed practice.
That December, Mayor Brandon Scott created the Mayor’s Office of Neighborhood Safety and Engagement, known as MONSE. It replaced and expanded the Mayor’s Office of Criminal Justice, with responsibilities for coordination, prevention, intervention and accountability across agencies and community partners.
In 2021, the city began a behavioural-health 911 diversion pilot and rolled out its five-year Comprehensive Violence Prevention Plan.
The diversion arrangements allowed eligible callers to be connected directly to crisis clinicians. Mobile assistance could follow when needed, with escalation to conventional emergency services when circumstances required.
Progress that can be examined
Other initiatives were developing alongside the crisis-response work.
Baltimore’s Group Violence Reduction Strategy began in the Western District in January 2022, combining offers of support with focused enforcement. An early evaluation described by University of Pennsylvania researchers estimated approximately 25% fewer homicides and shootings in that district during the first 18 months than would otherwise have occurred.
That finding concerned a specific intervention, location and period. It cannot explain the city’s entire trajectory.
For 2025, police reported 133 homicides and 311 nonfatal shootings, substantial reductions from the preceding year. The department revised its historical homicide reporting, assigning cases to the year of the original incident rather than the later death or classification. Its year-end comparison incorporates those revisions.
Yet improvement in gun violence did not mean the crisis-response pathway was working reliably.
A Baltimore Sun investigation, republished by Firehouse in July 2025, found that behavioural-health diversions had declined despite increasing behavioural-health calls.
The city had created an alternative. It was struggling to ensure people actually reached it.
Another Baltimore story
At 1600 Guilford Avenue in Greenmount West, a different kind of institutional rebuilding has been taking place.
The building used as a school location in the fourth season of The Wire now houses Baltimore Montessori Public Charter School. The Guardian documented that connection in 2017.
Its founding predates this decade. According to the school’s history, volunteers reclaimed the neglected building and opened the school in 2008 with 168 children.
Its current equity page describes approximately 600 students from 26 Baltimore City ZIP codes, with about 55% from economically disadvantaged families. Admission uses a lottery when applications exceed places, with specified preferences.
The school also began an equity audit in 2018 and adopted an equity statement in 2022. Its own account recognizes that assembling a diverse student body is only a beginning.
It is a parallel story, separate from the emergency-services reforms: residents reclaiming an institution, building another possibility and continuing to examine who benefits from it.
What Durham puts into practice
For an operating example of another emergency-response model, Baltimore officials have looked to Durham, North Carolina.
Durham established its Community Safety Department in 2021. Its HEART service—Holistic Empathetic Assistance Response Teams—offers several responses: clinicians embedded in 911, unarmed community teams, clinician–police co-response and a newer clinician–EMT involuntary-commitment response pilot.
The community-team model combines a clinician, a peer support specialist and an emergency medical technician (EMT). Medical assessment remains part of the response, including recognition of physical illness that may initially appear to be a behavioural-health problem.
Stabilization services within the department provide connections to continuing assistance, including care navigation and support for people with frequent emergency-service involvement.
A 2026 RTI evaluation, using July 2022–June 2025 data, compared eligible incidents receiving HEART responses with similar calls handled by police.
Unarmed community-team dispatch was associated with fewer arrests, citations and offence reports. Teams spent longer on scene and were more likely to transport people for several call categories. Estimated immediate response costs were higher overall.
The study was quasi-experimental, not randomized. It does not establish long-term recovery or citywide crime reduction.
Durham supplies evidence of a different response in operation, along with tradeoffs Baltimore would have to address.
Giving the work a permanent home
Baltimore’s Council Bill 26-0221 would establish a Department of Neighborhood Safety with alternative response among its mandatory duties.
Its definition reaches beyond behavioural-health checks to include emergency telemedicine access and continuity of care after a health emergency. It requires integration with 911 and an agreement with police and fire covering call screening, routing, escalation and information sharing.
Fire Chief James Wallace’s October 8 submission strongly supports the bill with amendments. He identifies both the potential to preserve emergency-unit availability and the opportunity to address recurring callers’ underlying needs.
The Police Department also supports it with amendments.
Fire union representatives have raised concerns about calls that become dangerous after initially being described as nonviolent. In Baltimore Sun reporting republished by Government Technology, Local 964 president Josh Fannon said the administration had assured him it would begin cautiously, using dual dispatch. The detailed dispatch arrangements remain to be established.
The operating model and sustainable financing remain unfinished. The Finance Department warns of potentially substantial recurring costs. Its model projects exhaustion of the broader opioid restitution fund by fiscal 2032 when existing commitments and the department’s phase-in are combined. Estimates of offsetting police or fire savings are unavailable.
In written testimony filed for the October 14 hearing, the Baltimore Harm Reduction Coalition supports the proposal while asking where people will go afterward and whether departmental funding could weaken community organizations providing essential services.
Those questions belong at the centre of implementation.
For Baltimore, the next test is whether the work of the past decade can become a service that residents can depend on: appropriate expertise when the call arrives, another responder when circumstances change, and useful assistance after the immediate crisis ends.
