The man lay shirtless on a red couch, clutching a screwdriver and a crack pipe. He warily eyed the visitors shuffling into his dark living room.
“What’s going on?” asked one, social worker Jessica Laube.
“Fuckin’ up,” he said. “Every goddamn day, fuckin’ up.”
He already knew Laube and her two colleagues, peer-support specialist Sammetta Cutler and paramedic Allison Casey. The three wore the teal T-shirts of the Durham Community Safety Department’s 10-month-old HEART program, which dispatches unarmed responders to low-risk 911 calls police once handled.
They’d been to his house many times before and were familiar enough that he asked them to tidy up—pick up clothes off the floor, find the TV remote. But he was still suspicious.
“Why you sitting so close together?” he snapped at Laube and Cutler.
When he gets high, he gets paranoid and imagines intruders lurking in his home. So he calls 911—and keeps calling. He’d already called several times this April morning. He’s one of HEART’s most frequent “neighbors,” to use the program’s term.
Cutler was frustrated. The man had recently—finally—checked into rehab, but he walked out within a week.
“You want to be paranoid,” Cutler said, sounding not unlike an exasperated parent. “Because if you didn’t, you wouldn’t pick up. I’ve been there, done that.”
Her job is to connect with people in crisis. “It took 16 years for me to get clean,” Cutler told him. “It’s not easy, but it can be done. Because I did it, and if I did it, you can do it, too.”
“I really do hate it,” the man said. “Every day, I do the same bullshit.”
“It doesn’t have to be this way,” Laube said.
“It don’t, but easier said than done.”
“Well, the next time you go, stay your ass there,” Cutler said. “It’s that simple.”
He did go back, but he didn’t stay. Five days later, he called 911 35 times, Cutler told me with a sigh.
But he’s still alive. Part of HEART’s role is to reduce potentially dangerous interactions between law enforcement and people with mental health or substance abuse issues. Durham officers have killed eight people since 2013, at least three of whom were in crisis. A few months ago, a young officer had fatally shot this particular man’s dog while responding to a 911 call.
“We only had three buckets to put 911 calls: police, fire, and EMS,” said Durham Community Safety Director Ryan Smith. “But there’s a whole bunch of other reasons people call 911. And a lot of those calls have historically been sorted into the police bucket.
“A lot of those calls we can safely and appropriately respond to without sending law enforcement—without sending, you know, someone armed with a weapon.”
Durham established the Community Safety Department on July 1, 2021, 13 months after George Floyd’s murder sparked a national movement to defund police departments. Reform efforts were already breaking against the rocks of rising crime, and the Durham City Council’s plan to eliminate vacant police positions to fund this new effort became a flashpoint in acrimonious fall elections.
But the department inched forward, launching its flagship program—the Holistic Empathetic Assistance Response Team, or HEART—on June 28, 2022. There is no other like it in North Carolina.
HEART is still in a pilot phase, with its teams covering only a third of the city for about half of the day. But the program has already diverted more than 2,000 911 calls from law enforcement—about seven per day—and Durham officials appear to consider it an unequivocal success. There’s no longer a debate about whether it should grow. As City Manager Wanda Page prepares to propose her budget to the city council on May 15, the question is how big, how quickly—and how to pay for it.
A citywide, 24/7 expansion would require significantly increasing the department’s $4.8 million budget—no small lift for a fast-growing city with pressing needs, yawning economic disparities, and a stubbornly high murder rate.
Though 20 percent of police department positions are unfilled, Durham is unlikely to raid the police budget to expand HEART. Even in North Carolina’s most progressive city, defunding the police is politically toxic.
“People get really intense about the idea of taking anything away from the cops,” said Council Member Jillian Johnson.
Johnson, who previously advocated reducing police funding, now says she doesn’t care where HEART’s money comes from, only that it comes. Other officials—including Smith and Police Chief Patrice Andrews—are careful to portray the police and HEART as complementary, not competitive.
“What we’ve demonstrated in Durham is you can do this work with integrity, with the purpose for which it was envisioned, and you can do that work in a way that does not have to be antagonistic with law enforcement,” Smith said.
Mark-Anthony Middleton, Durham’s mayor pro tem, said the narrative of the police versus HEART “has existed more in the political arena, for those who want to create tension, than it has in the actual working arena of those departments.”
Activists have held rallies to support the program. “Expand the HEART Program” yard signs have popped up across the city.
The Community Safety Department has marketed itself as well, hosting an open house in City Hall and screening a documentary touting its work to a packed downtown theater. But its promotional campaign seems less about lobbying for funding than evangelism.
Though young—“building the plane as we fly it” is a common refrain—HEART ranks among the country’s most ambitious alternative response programs. It will also be the most intensely studied, as research teams from Duke University’s Cook Center for Social Equity and the Research Triangle Institute (RTI) track the program’s first three years. HEART’s public dashboard also provides detailed statistics on their work.
Anise Vance, assistant director of Community Safety and formerly the city’s chief data officer, says HEART is a demonstration project not only for the state, but the country.
“You can have a nonviolent, holistic response to public safety that is effective and that keeps your workers safe as well as the folks in your community,” Johnson said. “And people in the community will support it.”
Eugene, Oregon, launched the first unarmed response program in 1989. By 2019, CAHOOTS—Crisis Assistance Helping Out on the Street—was handling 10 percent of 911 calls that would have gone to law enforcement. It saved the city about $14 million in emergency medical services.
The idea quickly spread after George Floyd’s death. Since 2020, at least 19 of the country’s 50 largest jurisdictions have established unarmed response programs, according to the Brennan Center for Justice.
Durham was already moving in that direction; in 2019, the city council created a task force to develop “viable alternatives to policing.” Amid demands to slash DPD funding a year later, city officials promised to form the Community Safety Department. The council’s progressive bloc said they’d shift funds from 60 vacant police positions to jumpstart the new department.
But in May 2021, with homicides rising and residents calling for more cops, the council agreed to eliminate only five police vacancies.
Middleton argued that transferring more positions would have been “theater.”
“We can create positions out of thin air if we want,” he said. “And my question was, why would we want to place [Community Safety], in its infancy, in the same position that we criticize the police department for being—and that’s having a bunch of unfilled positions—just for the sake of political posturing, so we can go say to the country, we’re defunding the police?”
Indeed, it’s not clear how Community Safety would have accommodated 60 additional people when Smith hadn’t figured out what it would look like.
Something like Eugene’s CAHOOTS, which sends a social worker and medic to low-risk calls, was one of many possible options. So were co-response models partnering police with mental health professionals that are standard in the United Kingdom and Canada.
Atlanta’s program reaches out to individuals experiencing homelessness, addiction, or mental health issues. San Francisco’s HOME Team provides services to repeat 911 callers. Tucson, Arizona, separates 911 calls related to mental health issues from the rest.
To Smith, these programs were pieces of a larger idea. So he and his team divided HEART into four segments: community response, which is the unarmed crisis teams; co-response, which pairs a police officer and mental health clinician; crisis call diversion, in which a clinician in the 911 center assesses mental health-related calls; and care navigation, which follows up with the people HEART teams encounter.
Only Albuquerque, New Mexico’s program is as expansive.
They also set out to determine which calls HEART’s responders should take: suicide threats, welfare checks, public intoxication, behavioral health problems, and trespassing, yes. Anything with a weapon or threat of violence, no.
Smith tweaked the response model in ways both subtle and significant. HEART staffers work for the city, rather than a private contractor—a common practice—so they can’t refuse calls that fall within the program’s criteria. HEART’s responders are also dispatched to more types of calls than teams in many similar programs, and they can enter people’s homes, which some cities prohibit.
Importantly, Smith added peer-support specialists to community response teams, which have often comprised two members. The specialists include people in recovery or who have lived unhoused in Durham and understand social service systems that often seem opaque and inaccessible. That’s been essential to building trust, he said.
“One thing our residents want when someone replies to a 911 call, they want someone who knows the community well, who may have relevant lived experience,” Smith said. “They have a deep level of empathy and understand what this is like.”
There was never any doubt that Smith would be the Community Safety Department’s first director.
As head of Durham’s Innovation Team, Smith spearheaded projects to expunge criminal records, restore suspended driver’s licenses, and help people with criminal histories secure jobs. He also coordinated the city’s response to the pandemic. His reputation for grounding ambitious policies in data suited a progressive, technocratic government.
But Smith was cautious about navigating the political terrain. After he became director in July 2021, he declined my request for access to report on the department as it took shape. “I was very nervous about the prospect of having someone in the room. It felt like it was a time of great scrutiny,” he explained to his staff of 25 during a weekly meeting last month.
That’s no longer a concern. After all, Smith had invited me to this meeting.
Just shy of its first birthday, HEART is both a fixture and an outlier in City Hall. It’s a family of idealists within a bureaucracy. They’ve developed their own language and customs, adopting Smith’s fondness for multi-colored Post-It notes that line the office’s walls, some with information about support services, others containing aspirational notes about HEART’s future.
Every team member is assigned a bird nickname: Smith is “Chief Chickadee,” Vance is “Pigeon,” and Laube is “Flamingo.”
The names originated when Smith was designing the organizational chart and felt uncomfortable with titles like “Clinical Manager 1” and “Clinical Manager 2”—too hierarchical. Someone suggested “Sparrow” and “Dove” as placeholders. When they hired the positions, the nicknames stuck. As the department grew, the bird theme was part of the culture.
Using the word “neighbor” was more deliberate. “The common words that we hear often in this area are ‘clients’ or ‘consumers,’” Smith said. “None of those felt right to us. Someone brought forward the suggestion of ‘neighbor,’ and it just felt like it embodied the spirit of the work and how we want to be thinking about it.”
That concept drives HEART’s hiring, he added.
“What many, maybe all of us, have experienced in life is, we’re walking downtown, we see someone in crisis and the instinct is to go to the other side of the street, stay away,” Smith said. “What we’re looking for are people who will draw near to people at that moment of crisis—that sense of physical proximity, of not othering or judging or being afraid. That, to me, is what is embodied by the term ‘neighbor.’”
The children’s book All Are Neighbors perched on the front desk emphasizes the point. The stack of bulletproof vests in a nearby closet emphasizes how serious their work can be.
So far, no responders have been harmed. (Laube and Casey said they once had to dive behind a HEART minivan to avoid a drive-by shooting, but it wasn’t related to their call.) Responders rarely have to radio for emergency backup, and they’ve reported feeling safe after 99 percent of calls—one of many data points the program collects after each dispatch.
While Durham Police Chief Andrews has publicly and privately supported HEART, she admitted that many patrol officers were initially skeptical, believing they’d have to constantly rescue amateurs. Some also chafed over the political fights that accompanied the program’s creation.
“There was this cloud that hung over the Community Safety Department,” Andrews said during a panel discussion in April. More recently, she added, “I’ve heard officers on the radio asking for HEART. So there is that change.”
“Now that we have a track record, more and more officers are seeing the value in it,” Smith told me. “Those are calls they would have had to go to that they don’t have to go to.”
In the program’s first 10 months, HEART teams have responded to calls for service more than 5,600 times, including follow-ups. But they’re only scratching the surface of what the program could do. Each day, one community response team covers downtown and East Durham from 10 a.m. to 9 p.m. Three co-response units work that same territory during weekday business hours.
Program data say that a fully staffed HEART, operating citywide and all day, could have fielded 27,711 calls through May 1.
At a February budget retreat, Durham City Council Member Jillian Johnson proposed taking HEART citywide, 24/7—a more aggressive expansion than even Smith envisioned.
“I won’t say there’s anything that we couldn’t do,” Smith told me. “But I will say the expectation that in a year’s time, you can be a fully staffed 24/7 agency would be an exceptionally high lift.”
Johnson’s proposal had no price tag, but five of seven council members declared it a top priority.
It was one of many priorities, however. Council members made $44 million worth of requests for this year’s budget—up from $2 million in 2022—including a $10 million “Marshall Plan” to transform the long-neglected Hayti neighborhood, which Middleton said would be fully funded in the city manager’s budget proposal. And Durham’s property taxes are already high, which limits the potential for new revenue.
As HEART takes on more police responsibilities, Johnson thinks the police budget is a logical source of funds. Middleton says they should cross that bridge when the data suggest it’s necessary.
Other cities have avoided funding conflicts because their programs are new and small, said Gabriela Solis, the Alternative 911 Emergency Response project leader at the Harvard Kennedy School’s Government Performance Lab. The lab has helped 17 jurisdictions, including Durham, establish programs in the last two years.
In the absence of tension over scarce resources, alternative response programs have won widespread support—including from the police.
“There’s a strong consensus that the current system is really not adequately meeting the needs of residents in crisis,” Solis said. “Also, for the most part, we’ve seen that the police chiefs or sheriffs we’re working with, they understand that they don’t need to be the default response to a lot of calls.”
A few cities established dedicated funding sources for unarmed responders—a sales tax in Denver, for example. But most programs are growing cautiously, Solis said.
Cities where they’re expanding quickly are also spending big on their police. Durham’s closest analog, Albuquerque, allocated $11.8 million to its Community Safety Department this year, a 52 percent increase from 2022, while also boosting its police budget by $32 million.
It’s unclear how sustainable that approach will be over the long term.
As programs around the country mature, Smith believes that making HEART’s data public and inviting scrutiny from outside researchers will help develop best practices.
“We want to be the best-evaluated program in the country,” he said. “Because we think it’s important to build an evidence base to understand what’s working and what’s not.”
Smith doesn’t think HEART needs to wait for the results of those evaluations to expand.
“What we can already demonstrate in our pilot is there’s a number of calls that we have been sending trained, armed law enforcement officers to that can be safely diverted with at least similar outcomes,” he said.
The studies will help them fine-tune their work, Smith continued. But he thinks they’ve answered the core questions. And given critical staffing shortages among Durham’s police and paramedics, he said, “if we can scale up this force and relieve that pressure, that’s something that we ought to immediately do.”
Several North Carolina cities have dipped their toes into the alternative-response waters: Greensboro has co-responders but is considering adding crisis teams. Apex, in Wake County, is considering a program. A crisis team inside Charlotte’s police department responds to mental-health-related 911 calls. Raleigh police have a mental health unit, though it primarily follows up after cops encounter an individual in crisis.
None has taken it as far as Durham. That’s another reason for publishing information on HEART’s calls: If Durham can show that its program improves outcomes, saves law enforcement resources, and improves public safety, more cities will follow suit.
“Durham is already seen as a national model, and other cities are just flocking here,” said Steve Schewel, who was Durham’s mayor when the Community Safety Department was created.
Page, the city manager, did not respond to interview requests. It remains to be seen how large an expansion she’ll propose for HEART next week, or how a city council fractured by personality conflicts and allegations of corruption will react. Diplomatically, Smith said his department will grow “at the pace that is deemed appropriate by city leadership, and the pace that we can fund because there’s a lot of competing priorities.”
But Community Safety is the only city department with a yard-sign campaign worthy of a well-known politician; hundreds line streets and intersections around Durham. Smith finds that gratifying.
“The people that we live with, the neighbors that we serve, hear what we are doing, have interacted with us and would like to see that be made more available,” he said. “That’s a good indicator. It’s not the only one that matters. But those yard signs are great.”
Clarification: The budget for a citywide expansion has been updated to better reflect the costs of different programs.
Jeffrey Billman reports on politics and the law for The Assembly. He is the former editor-in-chief of INDY Week in Durham. Email him at firstname.lastname@example.org.