Ethical Crisis Response and Digital Integration: Emergency Mental Health Service Utilization Among Homeless and Crisis-Affected Populations

Abstract

Introduction:
This study examines emergency mental health service utilization among individuals experiencing homelessness and/or a mental health crisis in Dallas, Texas, with a focus on ethical crisis response and the potential for digital mental health integration. Homeless individuals disproportionately rely on law enforcement and emergency departments during crises due to systemic barriers, limited outpatient access, and shelter restrictions. These reactive models often fail to deliver sustained care and raise ethical concerns around autonomy, coercion, and fragmentation.

Methods:
Using a mixed methods design, the study pursued three aims:

Aim 1: Identify patterns and predictors of emergency service use through analysis of 911 call volume, environmental factors (e.g., shelter accessibility, time of day), and emergency department diversion rates.

Aim 2: Examine ethical and operational dimensions of current crisis response models, comparing law enforcement-led interventions with mobile crisis units.

Aim 3: Evaluate system-level interventions, including the feasibility of shelter-based digital mental health services such as telehealth and coordinated care programs.
Quantitative data were drawn from 1,215 mental health-related service calls logged between July and September 2025 across Dallas police divisions (CH1–CH7) and crisis response teams. Qualitative insights were gathered through semi-structured interviews with shelter residents.

Results:
Police divisions handled over 70% of responses, while crisis teams accounted for less than 30%, confirming law enforcement’s dominant role. Referral sources were largely system-driven: 66% of calls were self-assigned by crisis teams, and 32% were dispatched by police, with minimal direct access or self-referral by homeless individuals or those in a mental health crisis. Disposition outcomes revealed fragmentation: 50% were unable to locate, 24% disregarded, 10% refused assessment, and only 9% received police coverage and did not receive services. Just 0.6% of cases were diverted from ER/hospital, underscoring the lack of alternatives to institutional care. Only 4% of calls occurred at night, suggesting underreporting or inaccessibility during overnight hours.

Implications:
Findings highlight critical gaps in ethical crisis response, particularly around efficiency, autonomy, and unmet mental health needs. The data supports the development of shelter-based, technology-enabled interventions to reduce reliance on law enforcement and emergency departments. This research contributes to the evolving field of digital social work by advocating for scalable, trauma-informed, and community-centered models that promote sustained mental health support for homeless populations and vulnerable populations experiencing a mental health crisis.