New Audit: Comptroller Finds Over a Third of Eligible Mental Health Calls Did Not Get a B-HEARD Team Response for Untracked Reasons

Today in a new audit, New York City Comptroller Brad Lander exposed that tens of thousands of mental health calls were never routed to the Behavioral Health Emergency Assistance Response Division (B-HEARD) pilot program, as they were supposed to be. Rather than sending police officers to a scene with an emotional distressed person without weapons or imminent risk of harm, B-HEARD is a program designed to better connect individuals in crisis to mental health services: a Health and Hospitals (H+H) mental health professional alongside two Fire Department of New York (FDNY) paramedics. In Fiscal Years 2022-2024, 911 assessed 37,113 calls as eligible for a B-HEARD response. Of these calls, 13,042 calls deemed eligible for B-HEARD (35%) failed to receive program services, with no reason provided. In addition, B-HEARD was not dispatched to 14,200 eligible calls that came in overnight between 1 a.m. to 9 a.m.  

“Tens of thousands of New Yorkers experiencing mental health crises needed help that the Adams Administration promised to provide, but failed to deliver,” said Comptroller Brad Lander. “Despite claiming this was a public safety priority, the Adams Administration consistently failed to connect B-HEARD teams to people in crisis or track the program’s outcomes. Without better management, capacity, and rigorous evaluation, New York City’s public safety will remain off track, endangering the lives of people in crisis, officers, families, and neighborhoods.” 

Launched in 2021, B-HEARD is a “heath-centered” response designed to respond to 911 mental health calls with two FDNY EMTs and a H+H mental health professional to reduce use of police resources, increase connection to community-based care, and reduce unnecessary transport to hospitals, for individuals with no imminent risk of harm to self or known weapons involved, with the goal to route these calls to a B-HEARD team. B-HEARD teams currently operate seven days a week from 9 a.m. to 1 a.m. in certain parts of Manhattan, the Bronx, South Brooklyn and Western Queens, covering a total of 31-of-78 police precincts, including subway stations. 

Of the 96,291 mental health calls from within the pilot areas and hours of operation between FY22-24, 59,178 calls (over 60%) were considered “ineligible” for a B-HEARD response because calls were considered potentially dangerous, were ineligible because a mental health professional was already at the scene, or were unable to be triaged because FDNY EMS did not take the call or all necessary information could not be collected about the person in distress. Some calls deemed ineligible for B-HEARD might have been eligible calls. Of the remaining 37,113 calls assessed as eligible for a B-HEARD response, 24,071 (65%) resulted in 911 dispatching a B-HEARD team, but over 13,000 calls did not result in a dispatched B-HEARD team. In addition, 14,200 eligible calls came in outside the program’s hours of operation. While participants rated their experience highly when asked, the audit found a troubling lack of data collection and performance measurement records—creating critical barriers to assessing the effectiveness of the pilot program in both the short- and long-term. 

Other findings: 

1. During FY22, only 55% of the calls that B-HEARD teams responded to resulted in a mental health assessment of the patient, then decreased to 31% in FY23 and 25% in FY24. 

1. During FY24, B-HEARD made contact with patients during just 50% of the calls B-HEARD teams attended. The decreasing assessments show B-HEARD is not meeting one of their program standards. Program administrators attributed the infrequency of contact to the fact that patients leave the scene or refuse contact. But administrators did not track this data and therefore the Comptroller’s Office cannot confirm. 

1. Despite the program goal of limiting unnecessary transports to hospitals, the auditors’ review of data published by the Mayor’s Office of Community Mental Health (OCMH) found a decline in the percentage of patients transported to community based care—from 10% between July 1 and December 31, 2022 to 6% between January 1 and June 30, 2023—and an 8% increase in the number of people taken instead to a hospital over the same period. 

In January, Comptroller Lander released Safer For All: A Plan to End Street Homelessness for People with Serious Mental Illness in NYC, an in-depth look at the crisis of people with serious mental illness cycling between the city’s streets, subways, hospitals, and jails—including the B-HEARD program. The Comptroller re-upped calls to rethink the City’s mental health crisis response framework, incorporating best practices from the CAHOOTS program in Eugene, Oregon. Operating 24/7 for over 30 years until last month, CAHOOTS provided a citywide response to mental health crises, handling 100% of 911 calls related to mental health with police joining the response team in cases where individuals present an immediate danger (which comprise less than 1% of cases in Oregon). CAHOOTS focused heavily on serving vulnerable populations with approximately 60% of its calls involving unhoused individuals and 30% addressing serious mental illnesses. Unlike B-HEARD, CAHOOTS was the default response, deploying civilian crisis workers, such as mental health practitioners and EMTs in every case, and limiting a police co-response to situations that involve a weapon or imminent threat. This approach significantly increased the likelihood that individuals will be connected with mental health services and reduced the likelihood of law enforcement escalation during mental health crises, saving the local government an average of $8.5 million each year. 

The Comptroller also backed advocates’ calls for a baseline allocation of $4.5 million to improve compensation and resourcing for Peer Specialists to increase the capacity and reach of the City’s mental health crisis response teams including the B-HEARD staff. Today’s audit findings underscore the calls from advocates to properly staff and resource the B-HEARD program to address the critical gap in the mental health professional staffing. 

“As my office has argued for five years, mental health crises deserve a mental health response – not a criminal one. The principles at the core of B-HEARD are strong, but this audit makes clear that the program must be much stronger. Underinvestment, delayed responses, a lack of clear data tracking, and a hesitancy to dispatch vital peer-based responders have limited the effectiveness of the approach. Five years ago, I called for a heath-centered model of response, and unfortunately, in the time since, we’ve gone backward in many ways. I thank the Comptroller for his focus on this issue, and hope that this audit spurs renewed effort and investment in a response system that treats the core of the crisis so many are facing,” said Public Advocate Jumaane Williams. 

“B-HEARD is a program with the potential to change and save lives — if we give it the resources it needs at every stage,” said Council Member Tiffany Cabán. “The Comptroller’s report affirms that B-HEARD is understaffed and under-resourced. That peers are not part of B-HEARD dispatch teams. That outcomes are not being tracked. That important data is not being tracked. And critically, that there are not enough community care centers to treat patients after B-HEARD intervention. The efficacy of this program hinges on our city’s commitment to building out a long-term infrastructure of support. Without continuity of care, places where the B-HEARD teams can actually take their patients for treatment, B-HEARD will remain a lonely point of intervention in a broken system.” 

“The Comptroller’s report reaffirms the concerns repeatedly raised by the Progressive Caucus about the shortcomings of B-HEARD,” said Council Member Sandy Nurse, Co-Chair of the New York City Council Progressive Caucus. “B-HEARD is understaffed, under-resourced and does not operate beyond four hours a day, resulting in a program that cannot provide the best possible care to New Yorkers in crisis. We urge the administration to heed these recommendations, including training and hiring 60 peer specialists to work within the mental health crisis response network in New York City.”   

“When a neighbor is in crisis, our emergency response system must be rooted in care, not punishment. The B-HEARD audit makes clear that too many calls go unanswered because the system is not adequately built out to meet the demand. Every emergency response should include the option for trained mental health professionals and peers to assist, and our communities deserve a citywide program that protects people in their most vulnerable moments,” said Council Member Carlina Rivera. 

“The Comptroller’s audit puts data behind what we have been told all along by New Yorkers trying to utilize B-HEARD services—they are inaccessible, unhelpful, and inadequate,” said Jordyn Rosenthal, Director of Advocacy at Community Access. “We are grateful to Comptroller Lander and his team for putting forth this audit and corresponding recommendations for reform. As we have advocated for years, the City must ensure meaningful inclusion of peers in its emergency mental health response system. That can start this year by including a baseline $4.5 million to ensure competitive compensation for peer specialists to staff crisis response teams, including–crucially–B-HEARD.” 

“The findings of this audit make clear what many New Yorkers already know—far too many people in crisis are still not receiving the care they need. B-HEARD was launched with a bold promise, but this report reveals serious gaps in execution. We must expand the program citywide, ensure 24/7 coverage, and fairly compensate Peer Specialists whose lived experience is essential to building trust. We thank Comptroller Lander for bringing critical attention to this issue,” said Maggie Mortali, CEO of NAMI-NYC, helping families and individuals affected by mental health challenges for over 40 years.

“New York Lawyers for the Public Interest is grateful for the extensive work undertaken by the New York City Office of the Comptroller in auditing the City’s B-HEARD, a program about which NYLPI has been critical, even before it was established without any input from affected individuals,” said Ruth Lowenkron, Disability Justice Program Director at New York Lawyers for the Public Interest.  “B-HEARD needs to include peers – those with lived mental health experience – be available 24/7, be available City-wide, and greatly improve its response time.  With 21 people killed at the hands of NYC police in the last ten years alone, the time for a true non-police, health-driven response is long overdue.”

“The Comptroller’s audit confirms that the City’s B-HEARD mental health crisis response pilot is falling short in its mission to deliver individuals in crisis the care that they deserve,” said Pascale Leone, Executive Director, the Supportive Housing Network of New York. “Urgent improvements are needed, beginning with adding peers to response teams. It is critical that the City commit a baseline of $4.5 million in funding to support peer-led, compassionate, and community-centered care through B-HEARD.”

Read the full audit here: https://comptroller.nyc.gov/reports/audit-of-the-behavioral-health-emergency-assistance-response-divisions-effectiveness-in-responding-to-individuals-with-mental-health-crises-and-meeting-its-goals/

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