When 911 calls in Ames, Iowa, signal a mental health crisis, the first responders are no longer only police or paramedics. Increasingly, they are members of Alternative Response for Community Health, a program pairing a social worker with a paramedic to deliver stabilization, connection and compassionate care without sirens or flashing lights.
Christina Mayfield, MSN, RN, director of behavioral health services at Mary Greeley Medical Center in Ames, said the idea was born from a paramedic who noticed that in “a lot of the cases the ambulances were called to behavioral health crises, and maybe didn’t need the ambulance or the police. Everybody sometimes made the situation that much worse.”
Inspired by a similar program in a larger city, the hospital’s team tested a six-month pilot that proved its worth, she said.
Since its launch in October 2022, ARCH has evolved from a pilot project into a central pillar of the community’s crisis response system, Ms. Mayfield said. Its aim is to reduce unnecessary emergency department visits and jail stays while connecting individuals to long-term support. For hospital and police leaders alike, the benefits include fewer avoidable calls, stronger community trust and improved safety outcomes, she said.
ARCH has prevented more than 100 police calls in a single month, freeing officers for other urgent duties and reducing emergency department strain, Ms. Mayfield said. The program also avoids significant costs for hospitals and law enforcement, though it lacks direct reimbursement pathways. Sustaining operations depends heavily on philanthropic and cross-sector partnerships.
“This saves money in the long run,” Ms. Mayfield said. “People are not going to jail or to the emergency departments most of the time. … You can prove the need by showing how many ED visits were avoided and how many police calls were avoided.”
While originally reactive through 911 dispatch, ARCH has expanded into proactive outreach, meeting people in libraries, shelters and community spaces to build trust and address crises before they escalate.
“[ARCH workers] have that relationship to ease the burden of that crisis,” Ms. Mayfield said. “The trust they build with some of these patients that call the police or 911 has really made a difference in the amount of calls we get, which decreased.”
Residents and clinics now request ARCH directly, bypassing 911, which underscores growing community confidence in the program, she said.
Collaboration with local homeless outreach teams has also positioned ARCH as a key player in addressing social determinants of health, particularly for the city’s unhoused population.
“Meeting people where they are and leading them to where they need to go to be their best selves is huge,” Ms. Mayfield said. “It’s huge for not only the hospital because we avoid emergency rooms, not only the police, because we avoid jail visits, but also the community.”
Challenges remain as the program is not yet operational 24/7, and coverage gaps persist during peak evening and early morning hours. Expansion requires sustainable funding, and leaders are working with police and community partners to secure additional support, she said.
