If you or someone you know is struggling with a mental health crisis, call or text 988 for free confidential support. In an emergency, call 911.
Lilly is in the ninth hour of her 12-hour shift when she hears a “beep” in her headset — another call from a Travis County resident seeking help from 911. It is her seventh call of the day.
“My name’s Lilly, and I’m a mental health specialist with 911,” she answers. “What’s going on today?”
In her mid-20s, Lilly is one of the clinicians who fields mental health-related calls at Austin’s Combined Transportation, Emergency and Communications Center, a large compound-like facility near the Mueller neighborhood.
In early 2021, Austin altered its 911 answering script to include a mental health option — a first for any municipality in the country, according to Austin city staff. Initial call takers now read out four options when answering phones: “Do you need police, fire, EMS or mental health services?”
Callers who ask for mental health services are transferred to a call center clinician like Lilly. They are also known as the C3 team.
Last summer, a team of KUT producers spent 24 hours with the team as they answered calls from vulnerable Austin residents. That day is chronicled in full on the latest episode of KUT’s 24 Hours podcast. This is a window into the evening hours of Lilly’s shift.
The call
After 10 months on the job, Lilly has become accustomed to speaking with people in crisis. Some callers express thoughts of suicide. Some are experiencing a panic attack or symptoms of psychosis. Others are simply lonely.
“Starting out, it's pretty scary and intense, because you don't know what's going to come on the line,” Lilly says.
Tonight, a man named Robert is on the line, calling from a Walmart. He tells Lilly he is looking for a respite bed where he can stay the night. He plans to travel out of town to visit family in a few days — but until then, he has nowhere to sleep.
The caller also tells Lilly he’s been having thoughts of suicide, and she wants to assess whether he has an immediate plan to harm himself. Her voice remains calm and even-keeled.
“Do you plan on burning yourself today? Do you have something with you that could hurt you?”
“Do you plan on burning yourself today?” she asks. “Do you have something with you that could hurt you?”
After each question, Lilly pauses and considers Robert’s answers. Once she is satisfied that he doesn't have an immediate plan for self-harm, she has an idea of how to help. She wants to direct him to Integral Care’s Psychiatric Emergency Services walk-in clinic on Airport Boulevard. Staff may be able to offer a bed and treat any urgent mental health needs.
“I don't have a way to provide transportation, but I can give you the address,” Lilly tells him. “Do you have access to the bus?”
Lilly pulls up a map on her computer, finds Robert’s location and tells him how to catch the bus from the nearest bus stop. She ends the call, telling Robert to call back if he needs additional help.
“He was saying that he was needing somewhere to sleep and wash his clothes, but then he started mentioning thoughts of suicidal ideation,” Lilly says, recapping the call. “But they’re only thoughts — there wasn't any plan or intent. So that's why I felt safe enough to offer PES as a resource.”
Gauging a response
Sometimes, a caller’s need is more urgent. In those cases, Lilly can send a mobile crisis outreach team, which she says might be asked to check in on the caller within a day or to respond to within an hour.
If help is needed immediately, the call would go back to police. C3’s goal, however, is to avoid a police response when there is no threat to public safety. Austin implemented the C3 team after a 2018 report found that, among the 15 largest U.S. metro areas, Austin had the highest per capita rate of fatal police shootings involving a person in a mental health crisis.
The City of Austin and Integral Care, the public mental health authority for Austin-Travis County, began ramping up the crisis call diversion program in 2019, before mental health services were added to the 911 call script two years later.
Integral Care reports that C3 handled 4,849 calls last year and was able to successfully divert 87% — meaning no police response was needed.
"A lot of calls, they just need someone to listen to them, and they'll start to feel better."
APD officers also have the option to tag in the C3 team while they are responding to a call if they think mental health assistance is needed. Then, a clinician speaks to the caller over the phone and tries to deescalate and meet their needs without a police response. Last year, police response was canceled in 286 cases like this where the C3 team intervened, according to Integral Care.
Many calls don’t result in a physical response. C3 may connect people with a follow-up appointment through Integral Care or direct them to other resources.
C3 members were able to resolve around 40% of calls last year simply by offering emotional support. Some of these calls came from “familiar callers” — people who frequently call 911 when feeling distressed, often due to a chronic mental health condition. C3 has an individualized plan in place for familiar callers that sometimes includes following up with their regular mental health provider.
“A lot of calls, they just need someone to listen to them, and they'll start to feel better,” Lilly says. “It goes a long way when someone listens to them and a family member isn't, you know, dismissing them, or calling them crazy or something. Or maybe they don’t have anyone at all.”
Lilly says she also tries to let these callers know about Integral Care’s 24-hour helpline (512-472-4357), a hotline for residents who need to talk or find mental health resources. Sometimes C3 also lets callers know about 988, the National Suicide & Crisis Lifeline.
Winding down
When there is a lull and Lilly has finished documenting calls, she uses the downtime to study and do class work. She’s working toward a master’s degree in professional counseling.
“I've always pictured myself having my own office and talking just to individual clients, so the thought that I'd be working at 911 really never crossed my mind, but I'd say I like it,” she says. “You definitely need crisis experience when you’re in the mental health field, and this is a great way to do it.”
Before 911, Lilly did case work, where she was able to form ongoing, in-person relationships with patients. She says she had to develop a certain “grit” to make the transition to crisis work.
“There's still calls that I get where they kind of hit me a little different,” she says. “You just have to learn how to, I guess, compartmentalize and bracket your ‘humanness’ sometimes.”
Lilly's last call of the day is from Patrick, who says he is distressed because his car was repossessed. He’s hesitant to answer Lilly’s safety-related questions, afraid he will say something that results in a psychiatric hospitalization.
“I don't have the power to hospitalize you,” Lilly tells him. “It would just be if you said, like, you had intent to end your life, and I'd have to transfer you back [to police]. That's how it works through 911.”
Patrick eventually accepts Lilly’s offer to give him the Integral Care helpline number so he can speak with someone at length.
“He was just frustrated, and he's going through a lot — like he was in a hit and run, his car got towed, and he's probably going through other things he didn't say,” Lilly says.
Before she ends her shift, Lilly receives a message from the staff at PES: Her earlier caller, Robert, has arrived at the clinic.
Matt Largey, Mose Buchele, Greta Díaz González Vázquez, Maya Fawaz and Audrey McGlinchy contributed to this story.
These events are included in the latest episode of 24 Hours in Austin, a podcast that looks at what a day in the life of Austin sounds like. Listen in the player above or wherever you get your podcasts.
