- An increasing number of cities are experiencing that police fail to send 911 calls about mental health.
- Many 911 call centers said in a new survey that they do not have the training to handle mental health calls.
- Experts said the data highlights the reality millions of Americans face when they call 911 in a crisis.
Cities across the country have been testing programs in recent years to send mental health professionals instead of the police for some emergency calls. But a survey of 911 call centers suggests that people who answer the phone may not have the resources to deal with those crises.
A survey published by the Pew Charitable Trusts of more than 36 emergency call centers found that few had staff trained in dealing with behavioral health crises. Most centers also did not have access to mental health professionals who could help with calls or first responders in the field trained to deal with such crises.
“For a lot of people, their first contact when they are in a crisis is this person at the 911 call center,” said Tiffany Russell, director of the Pew Charitable Trusts for Mental Health and Justice Partnerships.
“It’s really important that this first line of communication be properly trained and that they have the resources or at least the knowledge of how to connect this person with resources that can give them a better response.”
The Pew survey included responses from 37 call centers in 27 states. The low response rate – the researchers sent the survey to more than 230 call centers – is evidence of the stressful resources that call centers are already facing, the report said. The data also over-represents the predominantly white areas.
However, the findings offer a glimpse into what people experience every day across the country when they seek help in a mental health crisis: said Angela Kimball, National Director of Government Relations, Policy and Advocacy at National. Alliance on Mental Illness, which was not involved in the research.
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Call centers lack standardized training for mental health calls
About two-thirds of responding call centers said that call takers and dispatchers did not receive specialized behavioral health crisis training.
Call centers do not have a single national standard for how to respond to emergency calls. This is also true of behavioral health crises, where call recipients often rely on experience rather than formal training or a scenario to identify a mental health crisis, according to the report.
Russell said calls to 911 for a mental health crisis can take a variety of forms, from someone directly stating that they or someone else is in a crisis, to someone calling to report suspicious activity. She said that because calls can be made in such a wide range, it highlights the need for more training to identify them.
While most call centers surveyed said they could send police officers trained in crisis intervention on occasion, fewer than 1 in 5 said they had access to professionals other than police who had similar training to respond to mental health emergencies. About 2 in 5 centers said they had access to mobile crisis response teams made up of trained police and doctors.
“Millions of people each year experience a mental health crisis, and they deserve to have a response that is not a response to law enforcement,” Kimball said.
Access to mental health care resources can vary greatly across the United States. The survey found that compared to urban areas, 911 call centers in rural areas were more likely to lack access to behavioral health clinicians to direct the call or connect patients to care.
In some major cities, such as New York, there are pilot programs in place to completely remove police officers from some mental health emergency calls, instead of pairing social workers with emergency medical teams. Call operators in the New York pilot program will be trained to dispatch alternate response teams rather than police when there is no weapon or “imminent risk of violence.”
According to data released Friday by New York in the first three months of the pilot, less than half of people were hospitalized when unconditioned teams responded to the call, compared to 86% during the conventional response. But 911 operators still route less than a quarter of calls to teams. The city said the goal was for them to be routed halfway.
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Meanwhile, the FCC is requiring phone providers to route all 988 calls to the National Suicide Prevention Lifeline by July. Lifeline can provide suicide and mental health crisis prevention services.
It will take time for the public to move away from calling 911 in certain situations, Russell said, highlighting the need for more training at 911 centers.
Experts say more data is needed to improve mental health responses
Another worrying sign in the survey, Kimball said, was the lack of data reported by the 911 call center.
While most of the call centers surveyed said they recorded a crisis call occurring in their system, methods varied widely. Some centers have said that limited transmission codes or methods for reporting a behavioral health call can lead to an inappropriate response in the field.
Less than half of the centers updated contact information as details developed or recorded crisis call outcomes, and none of the respondents said they reported crisis call data to the public or policy makers.
This is a problem, Russell explained, because without reporting that data, lawmakers may not be able to determine the extent of behavioral health crises in their communities, and therefore may not provide funding for other aspects of mental health care after crisis response.
“It’s really hard to make an argument for additional resources or more funding for something if you’re not able to explain what the problem is,” she said.
However, a number of call centers in the survey said they are creating protocols to address these issues and indicated they would like to know how to best respond to these calls.
“The hope here is that people will start recognizing and naming mental health crises,” Kimball said. “And they want a different response.” “So it’s now up to our country to invest in that different response.”