911 Call Centers Unprepared for Mental Health, Substance Use Crises

Emergency call centers don’t have what they need to handle mental health and substance use crises, according to a survey by the Pew Charitable Trusts.

“When it comes to responding to behavioral health crisis calls, 911 call centers are really the lynchpin to the success,” said Tracy Velázquez, Pew’s lead researcher on the report. “Our report suggests some missing resources to respond appropriately.”

About two-thirds of responding centers (25 out of 37) said call-takers and dispatchers at their call center didn’t have any specialized behavioral health crisis training, citing staff turnover and budget issues as barriers. Notably, call centers in areas with predominantly white populations were more likely to have training.

“This can impact how they handle calls, whether they can correctly identify whether the calls involve behavioral health crisis, and who gets dispatched to handle the call,” noted Velázquez in a webinar Tuesday that accompanied the release of the research.

Nearly one in five 911 call centers (seven of 37 respondents) said that they had no specialized resources to handle such behavioral health crises, whether that meant trained people in-house or in the community. Most of these centers were in rural areas.

What most did have access to was crisis-trained law enforcement officers; 24 out of 37 respondents said these were available at least some of the time.

“While there has been growing attention to and data on law enforcement’s response to behavioral health crisis, we know far less about what happens before they are dispatched,” Velázquez said.

Her group worked with the National Emergency Number Association to contact call centers nationwide, resulting in 37 centers across 27 states providing responses to a questionnaire. “The response rate (16%) is not surprising given the nature of 911 operations, where call centers are often understaffed,” the report noted.

While these responses “can’t be considered nationally representative, they provide a much needed window into the state of 911 call center behavioral health crisis response in the United States,” Velázquez said.

Lack of resources is a local issue, noted Pew event panelist April Heinze, of the National Emergency Number Association and a former dispatcher herself. “If there is a local behavioral health team, 911 would definitely send it. They work with the entities they have access to, but they can’t create entities if they’re not available.”

Perhaps the best place to start is with making sure 911 call center staff have the training they need around behavioral health crises, argued Debra Pinals, MD, director of the program in psychiatry, law, and ethics at the University of Michigan Medical School in Ann Arbor, who also spoke at the event.

With the COVID pandemic, some 40% of Americans have reported experiencing depression, anxiety, or another mental illness, so the timing couldn’t be better, added Steven Eliason, MBA, of the University of Utah Hospitals and Clinics and a state legislator in Utah.

He argued that the states need to act as a control center to coordinate a very disjointed system of emergency response to behavioral health crises, especially with the Federal Communications Commission’s mandate to establish 988 as the National Suicide Prevention Hotline number.

The major cellular service carriers have already implemented sending calls to the new number for 95% of the population; however, states have until July 16, 2022, to ensure that all 988 calls connect to suicide prevention and mental health crisis counselors.

“Through the lens of COVID-19, we saw exactly how disjointed our systems actually were,” said Pinals. “Often the community just didn’t know which number to call and for what reason. … We have siloed systems in terms of our behavioral health system and our medical system.”

The demands on those systems are going to jump, with at least a tripling in call volume projected over the next several years after the number begins to be promoted in 2022.

Eliason urged states to move immediately on preparing for the shift by providing resources and setting up protocols, including how 911 dispatchers can transfer calls to 988. “It’s going to happen whether states are ready or not.”

“The numbers are staggering in how many of the crisis intervention calls are handled simply by a phone call with the appropriate trained personnel,” said Heinze. “If the 911 centers do not have that appropriately trained personnel at their disposal, then it would be very beneficial if they could offload those calls to 988 and allow them to handle that crisis intervention.”

She was skeptical that all the pieces would be in place by the July 2022 deadline for call forwarding from 911 to 988 or for other innovative aspects, like texting to 988 or geolocation data being provided to 988 for active crisis response. “All of those aspects are going to have to be worked out.”

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