911, the spinal cord for a sick body politic

Introducing a limited series on 911, including its role in the expansion of policing and its centrality in developing a new, care-based first response system nation wide.

A spinal cord both dispatches and receives nervous signals. Allow me to extend this analogy to the 911 system, first launched in 1968, and the deeply ill body that is U.S. society.

Signals going out: Who is dispatched?

Its signals are sent out to the limited societal responses — in most cases, police, fire and ambulance services — designed to deliver either enforcement or care.

Because the options around care responses are limited — deployment of fire engines and ambulance, often together, to extinguish fires and rush people to the hospital — much that is ambiguous is shunted over to police. Police are sent out for many non-criminal matters.

The police are the default for 911 calls that don’t fit fire or ambulance responses

That’s not to say that fire departments haven’t adapted in myriad ways to meet wide-ranging medical and mental health needs combined with poverty and homelessness, but this involves extensive and expensive systems built to meet time-sensitive crises. Adaptations to fire departments have not become the 911 default for ambiguous situations the way police have.

In other words, when in doubt, the U.S. deploys enforcement over care. Both can be responses to notions around safety, akin to how war and diplomacy are used.

The root of the word “emergency” is emerge, emergent. Something is happening in real time; without intervention, the outcome could be bad, but sometimes the intervention doesn’t improve the outcome. Sometimes that intervention makes matters worse, particularly because enforcement responders (police) are dispatched instead of care responders.

Damon Lamarr Johnson, experiencing a mental health crisis, died after officers pinned him to the ground face down last month in Portland, Ore.

There are many tragic examples, including just last month in Portland. Damon Lamarr Johnson, experiencing a mental health crisis, died after officers pinned him to the ground face down. It is excruciatingly sad that Johnson, in clear distress, yelled “I surrender” as the police pushed him down, his breathing slowing. Paramedics arrived and administered CPR, but it was too late; he died at the hospital.

These are the consequences, over and tragically over, of a 911 system that sends people trained in enforcement to matters that need entirely different responses.

Signals coming in: What does 911 reveal about what is missing or broken?

At the same time, 911’s incoming signals reveal a great deal about the body’s injuries — our healthcare system, housing, more. Recently when I shadowed HEART responders in Durham, crisis responder Emma Post put it this way:

“This work brings up a lot of aspects where [I know] it doesn’t have to be that way, where people’s trauma is connected to the larger system,” Post reflected.

In a series of upcoming dispatches about shadowing Dayton, Ohio, responders, I’ll address some of these massive gaps in basic U.S. care that include housing and healthcare. The idea around “supportive housing” — a right to housing coupled with services to meet other needs — addresses what often instead results in a 911 call.

A 911 system skewed to enforcement means that homelessness is worsened by legal engangements

I first grew focused on 911 in 2019 when Bob Cozzie — currently the director of public safety in Portland, and then the director of the bureau over Portland’s 911 system — invited me to sit-in at the Portland call center and listen to calls. He had told me that his call takers were besieged with calls for which they didn’t have a good response, and many of these were calls about homelessness. Indeed, I witnessed this — and the moral injury that comes with responding to people for whom there is no adequate response.

In fact, I was one of those people who called 911 for a related reason — although specifically to request ambulance service. While I worked at Street Roots, I called 911 for several people who suspected heart attacks or strokes that were exacerbated by their homelessness.

One day in either 2018 or 2019, I called for a man who worked as a vendor who felt he was having a heart attack. The 911 call taker was familiar with this man, and he dispatched a particular firefighter and medic, Tremaine Clayton, who at the time led the CHAT program. That program has changed over time, but in 2019 it was focused on following up with people who repeatedly called 911. The CHAT responders helped them connect with what they might actually need, if that was possible. Clayton had told led me that often, “the emergency is homelessness.”

I worked with both Bob Cozzie and Tremaine Clayton on building Portland Street Response. Along with others, including Jo Ann Hardesty who was recently elected to city council, they were the right people at the right time. Tremaine, in fact, also volunteered with the White Bird Rock Medicine program at the Oregon Country Fair, one of the origins of CAHOOTS, an inspiration for Portland Street Response and many other alternative response programs around the country. (I recently wrote about this for the Nation).

Back up even further to July 2018, and it was my — and others — concern for why so many unhoused people were arrested in Portland. In the summer of 2018, Rebecca Woolington and Melissa Lewis reported that over half of all Portland arrests were of unhoused people the year before (that number held steady through 2020, the last year measured); and early in 2019, Katie Shepherd reported that Portland 911 received a call for an “unwanted person” every 15 minutes and, combined with “welfare checks,” accounted for half of all the calls where police were dispatched.

These two articles proved to be a radical experience of learning for me, and the foundation for a much longer journey into building Portland Street Response and learning about other, similar response programs that could be dispatched by 911.

We need to better options on who to send out — and communities are building those options

I’m on a journey to understand how we create a better emergency response than police for all these issues that need care, and not enforcement. A close look at 911 is key.

Please watch for upcoming columns that include

• How the story of 911’s racist origins has driven policing in the United States (Don’t want to wait? Read the groundbreaking research of Katrina Feldcamp and S. Rebecca Neusteter)

• My ride-along with Dayton Mediation Response Unit, including stories about how a portion of 911 calls are about frayed relationships, often exacerbated by scarce resources

• How people wield 911 as a weapon against other people (which I previously wrote about after shadowing the Durham, N.C. HEART team.

• How 911 is deployed by people who need timely responses that they can’t find from the systems that should actually serve them

There’s so much to learn about society from how 911 is used — how the U.S. has institutionalized problem-solving using violent means, and how much of what is expressed as an emergency in this nation needs to be met with a right to housing and a right to healthcare.