BALTIMORE — In March in a McDonald’s parking lot off a busy street, mental health clinician Michala Williams met a 38-year-old woman in a car.

“So, you called the police for help?” Williams asked the woman, who was sobbing uncontrollably and said she sometimes thinks about harming herself.

She told Williams she has children ranging from age 2 to 22, she was dealing with health issues, and that her fiancé had recently been jailed. She felt so overwhelmed she couldn’t eat.

The woman, who asked not to be named so that she could freely discuss her mental health, explained she’d tried to get help the previous month by driving to the hospital but got pulled over on the way because her car registration had expired.

“I don’t care if I get pulled over,” she said. “But I was saying, ‘I don’t know what to do. I just want to go to the hospital.’”

The officer arrested her for acting erratically, so instead of going to the hospital she went to jail.

“I had to sit inside of a cold cell. I couldn’t use the bathroom or anything,” the woman said.

On the day she met Williams, she’d decided to call 911. The dispatcher recognized the woman didn’t need a police response but instead needed one of Baltimore’s mobile crisis teams, which send a clinician and a peer counselor to meet people in mental health distress.

By the end of an hourlong conversation, Williams set the woman up with referrals to a psychiatrist, a therapist, legal help, and a case manager to determine if her child with autism was eligible for government services.

“She’s been through a lot of trauma, and no one is going to deny that,” Williams said. “But I now have to take all of that and decide, ‘OK, here’s steps 1, 2, and 3,’ because we got to find a little bit of sliver of something to give her some hope that there’s help out here.”

For years, the mobile crisis teams, which are overseen by , a nonprofit that acts as the city’s mental health department, have diverted calls from police to mental health professionals. However, the units have a limited scope, focused on people in mental health crises.

Now Baltimore is tapping into some of the roughly $400 million from opioid-related legal settlements to build out a broader service to operate around the clock and respond to other kinds of crises when police aren’t needed.

Baltimore logged to 911 in 2024, but tens of thousands of them didn’t require traditional emergency services, like police, firefighters, or EMTs, according to , an expert in community safety at Georgetown Law.

Instead, the calls were about, for example, a homeless person who fell asleep in a store, a person who seemed confused in a public park, and someone who was yelling at passersby on the street.

Such calls “don’t require a badge, a gun, and handcuffs to resolve,” Duckett said.

Often those people end up in jail instead of getting the help they need, he said. A study that when a non-law enforcement team responded to 911 calls in Durham, North Carolina, it resulted in fewer arrests than when police responded — especially for callers who were Black, men, or ages 25-39. Police responses can also lead to trauma for that person or a less satisfactory outcome than another community service response would produce, Duckett said. The idea behind the Baltimore mobile crisis teams — and the new service — is to find out what people in crisis may need and how to connect them to those resources instead of arresting them.

From 2021 to 2025, Baltimore’s homicide rate decreased by 60%, setting records for the drop in violence. But at the same time, drug overdoses made national records, as about 1,000 people here each year from 2020 to 2023.

In 2018, Baltimore opted out of a global settlement that other jurisdictions made with opioid makers and distributors and instead sued them independently. As the opioid-related lawsuits were settled, city officials decided that the settlement awards it receives must be spent on drug-related harms — or on services that help prevent addiction, such as housing support, healthcare, and education.

One seeks to directly address overdoses by placing boxes of the overdose reversal drug naloxone at every subway stop. Expanding 911 services is part of a larger strategy to beef up city services, with $15 million in settlement funds allocated so far, according to Sara Whaley, Baltimore’s director of overdose response. Whaley hopes the expansion will help the city think differently about how it responds to residents in crisis — regardless of why they’re calling 911.

She views the calls as an opportunity to help solve a problem rather than be punitive. “What are the wraparound services and support that can help prevent them from being involved in this, in that emergency system?” she said.

For example, the person falling asleep in a store may need connection to community housing. The goal is to reduce violence, get people proper resources, and avoid the cycle of incarcerating people dealing with poverty, addiction, and mental health.

, executive director of the Health Lab at the University of Chicago, of services like these. She said they offer peace of mind for callers that “they’re going to be met with the right response at the right time.”

“We also see responders themselves feeling like they have a better toolbox in their ability to pursue actual resolution to these calls,” she said.

To expand its system, Baltimore looked to cities — including Durham — that have adopted similar models to reroute callers who don’t need emergency responders.

Durham’s diversion program is called the , or HEART. The program estimates it has diverted more than 12,000 calls in four years. It said police backup was needed for only 0.02% of those calls and that response times have improved for all types of 911 calls.

Durham has of the HEART calls, showing that nonpolice responders in Durham have helped with everything from finding housing for a woman fleeing domestic violence to setting up medical appointments for a homeless veteran.

In one case, a hotel manager called 911 asking for help finding a blind man housing for the night, since the hotel didn’t have accessible rooms available. The HEART responders booked him a room and the next day provided a ride to meet with an organization that could help secure housing.

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With abortion now restricted or illegal in 22 states, jurisdictions like Maryland have become a destination for patients from as close as neighboring West Virginia to as far as Texas.

With a staff of six, the helps patients who need to travel pay for bus or plane tickets, lodging in Maryland, and sometimes meals. The fund spends about a million dollars a year on that support. Calls to its confidential helpline have increased by 50%-60% every year since Roe v. Wade was overturned, said Lynn McCann-Yeh, the fund’s co-director.

The fund disburses aid as people call in. Often, the weekly allotment is depleted after just one or two days.

“Sometimes that means that our helpline is closing within 24 to 48 hours at the start of the week, because there’s just too much demand for the amount of resources that we have,” McCann-Yeh said. “There are many, many more dozens of callers each week that are just getting a voicemail message saying that we’ve run out of support.”

To help, the Maryland Legislature turned to a pot of money established under the 2010 Affordable Care Act. Under the law, states could decide to require insurance plans sold on the ACA “marketplaces” to cover abortion. The plans were required to charge a minimum fee of $1 a month on every plan bought through the marketplace.

That money was then put into an account that would help pay when insured patients received abortion care.

The state accounts were necessary because of the federal Hyde Amendment, which restricts the U.S. government from paying for abortions, except in cases involving rape, incest, or severe medical risk to the patient.

Because the federal government partially subsidizes insurance plans sold through the ACA marketplaces, commercial insurers had to use their money to pay the monthly fee for each policyholder.

“Insurers have quietly complied with the ACA special rules resulting in these segregated accounts that have millions of dollars in them intended for abortion coverage,” said Cat Duffy, a policy analyst for the National Health Law Program.

Over time, the accumulated fees in such accounts have outstripped the withdrawals for abortion care for women on those insurance plans. Maryland’s account has grown to $25 million and takes in about $3 million each year.

Maryland passed a new law that allows the state health department to tap those funds and allocate up to $2.5 million a year in grants to organizations operating in Maryland that offer abortion assistance. Those groups can use the money for traveling patients, low-income patients in Maryland, or people without insurance.

“We know that we will be able to use those funds wisely and to make sure that we’re not turning away any patient due to their inability to pay,” said Ramsie Monk, the director of development at the Women’s Health Center of Maryland on the border with West Virginia.

Without assistance from abortion funds, many of the patients would not be able to pay for their care, says Diane Horvath, an OB-GYN at Partners in Abortion Care, in College Park, Maryland. Unlike some other health centers, which offer abortion only up to 16 weeks of pregnancy, Partners in Abortion Care can provide an abortion later in pregnancy. Those procedures are more complicated and more expensive.

More than 90% of the patients at Partners in Abortion Care receive financial assistance through various abortion funds.

“I would say a typical patient that we see probably every week is somebody who’s already got at least one child, they’re working a job that doesn’t offer substantial leave for medical care, it may not offer health insurance, or the insurance it offers doesn’t cover abortion, particularly when they’re coming from out of state and they’re struggling and living paycheck to paycheck,” Horvath said.

The new law passed this spring and took effect July 1. The first tranche of money is set to be transferred from the ACA fund to the state health department by the fall.

Since the Supreme Court overturned Roe in 2022, states where abortion remains legal, like Maryland, have seen an increase in abortion procedures, including for patients who can’t get a legal abortion in their home state. Many need financial assistance for the procedure or to cover travel costs from other states, lodging, and related expenses while they recover.

That financial aid is often provided by local and regional abortion funds, such as the nonprofit Baltimore Abortion Fund.

As more patients travel to Maryland, and some abortion funds exhaust their resources, clinics that provide abortions in Maryland are feeling financial pressure to serve traveling patients, as well as uninsured and low-income Marylanders seeking care.

Clinicians in Maryland performed about 39,000 abortions last year, a 28% increase from 2020, according to the , a nonprofit focused on sexual health research.

Maryland’s move to tap the ACA fund represents an innovative solution for states that have opened their doors to out-of-state patients but are grappling with the logistics and costs of the increased clinical demand in a post-Roe landscape.

“This bill is super important for Maryland; we’re making sure our clinics stay open,” said Maryland state Del. Lesley Lopez, a Democrat who sponsored the bill. “Maryland has been a leader on a lot of reproductive bills for the past 30 years, and so in that way, this bill fits into that legacy. It’s also nationally significant, because there’s 25 or 26 other states that can take this model and run with it. We’re looking for California, Illinois, New York, those bigger states that are sitting on potentially hundreds of millions of dollars to take what we’ve done here in Maryland and implement it there.”

Anti-abortion groups in Maryland opposed the bill, saying that the new law will force some insurance consumers to pay for procedures they may disagree with.

“This bill uses insurance premiums from insured women to abort the children of uninsured women,” Laura Bogley, executive director of Maryland Right to Life, on March 6.

“Many of those uninsured women are non-Maryland residents who are trafficked into the state for late-term abortions that are restricted by other states.”

The bill’s supporters deny that traveling patients are being trafficked when they are traveling of their own volition in search of health care.

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