Alliance Alert: Two new reports outline significant last-minute changes to New York City’s B-HEARD crisis response program, announced by Mayor Adams just weeks before leaving office. While the Alliance agrees that B-HEARD needs improvements and expansion, the changes proposed by the outgoing administration do not reflect national best practices and risk moving the program further away from what works.
Across the country, the most effective crisis response models, including CAHOOTS (Eugene, OR) and STAR (Denver, CO), pair EMTs with peers and behavioral health specialists, not with traditional clinical staff alone. Research and decades of on-the-ground experience show that mental health crises are best addressed with de-escalation, trauma-informed support, and lived-experience leadership, not with clinical hierarchy or quasi-law enforcement frameworks.
Mayor Adams’ plan to remove FDNY EMTs and instead rely on nurses, social workers, and ambulance drivers misses the mark, especially given that:
- Peers are not included, despite repeated calls from advocates and people with lived experience.
- EMTs play a critical role in recognizing and addressing medical needs during crises.
- The new model sharply diverges from the evidence-based Daniel’s Law approach, which pairs EMTs with peers and trained behavioral health responders.
The Alliance continues to urge NYC leaders to build a peer-driven, trauma-informed, non-police crisis response system, as envisioned in Daniel’s Law and supported by national best practice.
Encouragingly, Mayor-elect Zohran Mamdani’s transition team has signaled that these late-stage changes will not derail his administration’s commitment to expanding and transforming B-HEARD within a new Department of Community Safety. His plan rightly centers peers, expands service to all neighborhoods, and aligns with the Daniel’s Law model that New Yorkers overwhelmingly support.
For B-HEARD to truly help New Yorkers in crisis, it must:
- Include peers as integral and co-equal members of every response team
- Pair peers with EMTs and behavioral health professionals
- Operate citywide, 24/7
- Be grounded in voluntary, person-centered support—not coercion or policing
The Alliance will continue to advocate for a crisis response system that treats people with dignity, reduces harm, and reflects decades of evidence showing that peers save lives. We look forward to working with the incoming administration to ensure B-HEARD fulfills its promise and follows the proven Daniel’s Law model that New Yorkers deserve.
Adams Reveals New Model for NYC Mental Health Crisis Response
By Katelyn Cordero and Maya Kaufman | Politico | November 17, 2025
New York City Mayor Eric Adams is set to remove the FDNY’s EMS division from a city program that sends health care workers to respond to some mental health emergencies, weeks before leaving office, POLITICO Pro’s Maya Kaufman reports.
The program, known as B-HEARD, will have three-person teams of nurses, social workers and ambulance drivers to handle nonviolent, mental health-related 911 calls under the new model announced Friday. Those teams were previously staffed by two EMS workers from the FDNY and one social worker from the city’s Health + Hospitals.
The redesign is aimed at allowing the program to expand more quickly, as it will circumvent recruitment and retention issues plaguing the FDNY’s EMS division, city officials said. The new model will also address the city’s increasingly long emergency response times by freeing up some FDNY ambulances and EMTs, officials said.
NYC Health + Hospitals President and CEO Mitchell Katz said the change was the result of conversations he had over the summer with the FDNY about B-HEARD’s staffing challenges.
“The program cannot be expanded, cannot go to more neighborhoods because there are not more EMTs to hire,” Katz told reporters during a briefing Friday.
“We will now be able to expand the program as the city needs it because we will be able to hire the workforce,” he added.
The city’s announcement, unveiled in the final weeks of the Adams administration, was met with skepticism by union leaders and mental health advocates who have followed B-HEARD’s evolution since former Mayor Bill de Blasio launched the initiative as a pilot in 2021.
The redesign also appears to contradict best practices for similar kinds of crisis response initiatives. CAHOOTS, an often-cited model out of the small city of Eugene, Oregon, sends behavioral health workers and EMTs to respond to crises. Similarly, Denver’s STAR program uses behavioral health clinicians and paramedics to engage individuals experiencing mental health distress.
Henry Garrido, executive director of District Council 37, the umbrella organization for the unions that represent the vast majority of FDNY’s EMS workers, said any changes to B-HEARD should be at the discretion of Mayor-elect Zohran Mamdani and his chosen fire commissioner.
“This idea’s out of left field,” said Jordyn Rosenthal, director of advocacy for Community Access, a mental health organization that has pressed for peer counselors to be added to B-HEARD teams.
Dora Pekec, a spokesperson for Mamdani’s transition team, expressed confidence that he would still be able to fulfill his campaign pledge to expand and overhaul B-HEARD as part of a new Department of Community Safety.
Adams Overhauls Mental Health Crisis Program Weeks before Mamdani Takes Office
By Amanda D’Ambrosio | Crain’s Health Pulse | November 14, 2025
Mayor Eric Adams is remodeling a fraught crisis response pilot program that sends clinical workers to mental health-related 911 calls instead of police. The move comes weeks before Mayor-elect Zohran Mamdani, who has pledged to overhaul the program, takes office.
Adams said Friday that the behavioral health emergency assistance response division, known as B-Heard, will be entirely staffed and operated by New York City Health + Hospitals — a departure from the current model, which is jointly run by H+H and the Fire Department. Under the new iteration of B-Heard, which has struggled due to staffing challenges and stagnant funding, the public hospital system will staff each team with a nurse, a social worker and an ambulance driver. Current teams consist of two FDNY EMTs and a social worker.
EMTs that were previously assigned to B-Heard teams will move to other emergency units, the mayor’s office said.
“This new model for B-Heard will allow our FDNY EMTs the opportunity to focus further on other emergency response units as part of our city’s efforts to improve ambulance response times and use our resources more efficiently, while still addressing mental health emergencies we continue to see playing out in our city,” Adams said in a statement. The new model is expected to begin in the spring of 2026.
The changes come as Mamdani prepares to take office in January. Mamdani has his own vision to overhaul the crisis response program, which includes moving it under a new $1 billion agency known as the Department of Community Safety, staffing teams with peer counselors and placing them in every city neighborhood. B-Heard only serves 31 of the city’s 78 police precincts.
It is not clear how the changes to B-Heard would affect Mamdani’s plans for the program. Dora Pekec, a spokeswoman for Mamdani, said “we remain confident that Mayor-elect Zohran Mamdani will implement his full vision for B-Heard within the Department of Community Safety so we can finally meet our city’s dire mental health crisis head-on and deliver excellent public safety for all New Yorkers.”
H+H President and CEO Dr. Mitchell Katz said during a press briefing Friday that he believes the new model will align with the incoming administration’s priorities.
“I think it fits quite well, because it’s a professional health response,” Katz said. He said the new model will help the program increase the number of calls it responds to, as the current model is hindered by EMT staffing shortages. H+H plans to hire 31 nurses, 31 ambulance drivers and eight supervisors under the new B-Heard model, said Jason Hansman, senior behavioral health communications advisor at H+H.
The pilot program has struggled since its inception. Former Mayor Bill de Blasio launched B-Heard as a pilot in 2021 to reduce police responses to mental health crises, part of a movement to stop treating mental illness as a public safety concern. But since then, B-Heard has experienced staffing issues due to a shortage of EMTs and stagnant city funding. Adams pledged to expand the program citywide, but put those plans on hold due to budget challenges. The city budget allocated $35.7 million to B-Heard in the 2025 fiscal year.
The hurdles have raised questions about the program’s effectiveness. Between 2022 and 2024, B-Heard failed to respond to a third of eligible mental health-related 911 calls – roughly 13,000 – in the neighborhoods it serves, according to an audit released in May by City Comptroller Brad Lander. Responses were limited in part because the program does not operate around-the-clock, the audit said. B-Heard teams are not active between 1 a.m. and 9 a.m.
City Hall said that B-Heard has responded to 35,000 mental health calls since its launch in 2021.
Katz said in a statement that the public hospital system is “unwavering” in its commitment to B-Heard.
“We are grateful to our outstanding partners in the program’s first iteration, and we look forward to continuing its evolution as we serve New Yorkers in mental health crisis,” Katz said.
This story has been updated with a statement from Mamdani’s transition team.