What EMS Leaders Need to Know About Building Mental Health Response Units

Emergency calls related to mental health now account for at least one in five 9-1-1 calls in the United States. These calls entail unique challenges. Often, a misguided or inadequate response to someone experiencing a psychiatric crisis can escalate the situation, lead to unnecessary arrest or hospitalization, create safety risks for responders and families, and sometimes end in tragedy.

In 2021 in the U.S. alone, more than 100 people were killed during police responses to calls involving mental health concerns or erratic behavior, and about 12% of police officers killed in the line of duty each year are shot while responding to individuals experiencing a mental health crisis.

At Magen David Adom, Israel's national emergency medical service, we launched a dedicated mental health response unit in partnership with the Ministry of Health and the wider medical system. That experience has reinforced a simple but important lesson: Psychiatric emergencies are fundamentally different from cardiac events, strokes, or other physical injuries. They require specialized clinical expertise, different communication strategies, and a response model designed around de-escalation and assessment rather than rapid transport alone. 

Emergency response agencies across the U.S. are reaching the same conclusion as awareness grows about the number of people who face mental health challenges or who are at risk for facing them. More than 40 cities now operate some form of specialized mental health units, and many others are exploring similar models. While every community is different, we’ve found that successful programs all start with the right model, the right team, and the right training.

Start With the Right Model

For decades, emergency responders have measured success largely by how quickly a patient can be moved to the next stage of care. While transportation remains important, it should not be the primary goal of a mental health response. 

Just as paramedics don’t wait until a patient reaches the hospital before treating severe bleeding, responders shouldn’t wait until a patient reaches a psychiatric facility before beginning mental health care. The most effective programs are built around providing meaningful intervention at the scene. That may include crisis assessment, medication review, de-escalation, safety planning, and then determining the most appropriate next step for care. 

Build the Right Team

Behavioral health emergencies often involve complex clinical, psychological, and social factors that require expertise beyond traditional emergency medicine. Effective mental health response teams should include a range of professionals, including specially trained paramedics, nurses, psychiatrists, psychologists, social workers, or other behavioral health specialists, depending on local resources.

This expertise can change the trajectory of a call. One of our recent cases illustrates why: Our mental health emergency response team was called to assist a man with a history of schizophrenia who had threatened his parents with a knife and was refusing help. Upon arrival, MDA’s psychiatric consultant assessed him and determined that his condition was likely caused by a problem with his medication and that he needed a more formal psychiatric evaluation in a hospital setting. 

Drawing on specialized mental health training and psychiatric support, the team was able to build a bridge with the patient. They spoke with him, helped him feel safe, clearly explained his options, and calmly answered his questions. As trust developed, the patient ultimately agreed to voluntary transport for psychiatric evaluation. By empowering him to take an active role in his own care, the team resolved the situation safely without restraints or sedation, allowing him to receive appropriate treatment while preserving his dignity. 

This was not an isolated case. During MDA's pilot program, specialized mental health teams reduced the use of forced sedation and physical restraints while also lowering unnecessary psychiatric hospitalizations, demonstrating the value of embedding mental health expertise directly into emergency response.

Integrate Mental Health Into Dispatch

It’s not just the responders who need specialized training. Mental health experts should also be integrated into the emergency communications center. Calls involving psychiatric symptoms, suicidal ideation, severe emotional distress, or behavioral disturbances should be assessed differently than other medical calls. 

When mental health specialists participate at the dispatch stage, agencies are far more likely to send the right resources from the outset. 

Prioritize Communication Training

Many agencies assume that the most important training is teaching responders how to identify mental illness. While that knowledge is essential, it’s only the starting point.

The most valuable training often centers on communication.

Patients experiencing a psychiatric crisis may be frightened, confused, paranoid, disorganized, or overwhelmed. Responders must learn how to communicate in ways that reduce anxiety rather than increase it. They must know how to build trust quickly, explain options clearly, avoid unnecessary confrontation, and maintain safety without escalating the situation. 

How to Measure Success

Traditional EMS performance measures focus on response times, transport intervals, and operational efficiency. While those metrics remain important, they don’t fully capture the success of a mental health response program.

Agencies that invest in building mental health units should also examine outcomes such as reductions in involuntary transports, decreased use of restraints and sedation, fewer unnecessary psychiatric admissions, successful referrals to ongoing care, and overall patient safety outcomes. Ultimately, the goal is to ensure that people experiencing a psychiatric crisis receive the most appropriate care possible while preserving safety, dignity, and clinical effectiveness.

As behavioral health needs continue to grow, specialized mental health response teams will become an increasingly important part of emergency care systems worldwide. The question is no longer whether psychiatric emergencies deserve a specialized response. The question is how quickly agencies can build systems capable of delivering one.