For mental health crises, calling 988—albeit incomplete—is better than calling 911

On a Wednesday afternoon in August, five telephone operators were waiting for a call with Alameda Crisis Support Services in Oakland. It’s a volunteer’s second day, and the 24th year for another volunteer. They sit in green office chairs, except for Lynsey Parikadan, this pink supervisor, who sits on the sofa she used to sleep on when she worked “all night” – from 4 a.m. to noon.

Volunteers work on a crisis line at Alameda County Crisis Support Services in Oakland, California on Wednesday, August 3, 2022. Photo: Florence Middleton

Now, due to the pandemic, most crisis responders are working from home. The bright room is quiet, apart from quiet conversations and BART’s league train. Then, the phone rings.

Linsey Parecadan serves as a shift leader in Alameda County Crisis Support Services. Oakland, CA, Wednesday, August 3, 2022. Photo: Florence Middleton

In the two weeks after applying 988 as the national suicide prevention hotline number, the average weekly call to Alameda CSS, one of the 988 call centers in the Bay Area, increased about 30 percent. The average daily talk time has also gone up, hovering around 8 hours and 45 minutes. However, at the same time, social media has been inundated with concerns about the involvement of the police mental health hotline and questions about how it is working.

If you read nothing else in this article, then be it: In cases of a mental health crisis, 988 is safer to call than 911. You will be connected to trained mental health responders. However, for about 0.67 percent of all calls to Alameda CSS, or 30 percent of “high risk” calls, know that law enforcement is likely to step in. This occurs with or without consent in cases of “imminent danger,” or when someone is likely to die soon, according to the call center. Nationally, that number is slightly higher: Lifeline reports that about 2 percent of calls to 988 involve emergency services.

Stay away from cancer care

As it currently exists, the American health care system is designed to address mental health crises through cancer “care”, or psychological responses that monitor and police. Stories of law enforcement intimidating, harming, or killing during a crisis—or of people involuntarily being admitted to hospital or within institutions—demonstrate the violence inherent in this approach. It also exposes the flaws of health policy that prioritizes the power and control of peer-led care intervention. As is often the case, marginalized groups are more vulnerable to harm. a recent study It found that blacks were three times more likely to be involuntarily admitted to psychiatric hospitals than their white peers.

Naomi, a volunteer, listens carefully to a caller on a crisis line in Oakland, California on Wednesday, August 3, 2022. Photo: Florence Middleton

Callers, mental health professionals, and suicide scientists all stress that police should not respond to mental health crises. But in most areas, including Alameda County, there are no 24/7 alternatives yet. In Auckland, only two mobile crisis response teams, the Community Assessment and Transportation Team (CATT) and the Auckland Mobile Assistance Community Responders (MACRO), operate seven days a week. Both work from 7 am to 11 pm. “It’s not enough,” Barikadan said.

advertisements

Volunteers working in the crisis center are equipped with stress balls and phone numbers to refer callers to other support services. Oakland, CA, Wednesday, August 3, 2022. Photo: Florence Middleton

When the CATT responds to crises, officers join doctors on site. MACRO, according to its April 9-July 15 impact report, “completed” 99 percent of its calls. Three calls – or .001 percent of the total – were diverted to the police.

Suicide Specialist Dr. Emily Krebs Tweet concerns about 988Tell El Tecolote That to really prioritize safety, there should be “programs completely separate from law enforcement”.

At Alameda CSS, telephone operators are aware of the dangers of police intervention and many envision a system in which mental health professionals and peers respond to crises instead. But until this system is established – and should be, urgently – the most they can do is avoid the police, and train new operators to avoid them as well. The risk of engaging police, especially when callers are of colour, is introduced into the training, but “discussing police intervention from this perspective is not enough,” Parikadan said. “We talk about it a lot [especially] After the BLM movement…[but] This is all new. We have a long way to go.”

“Our teammates are very sensitive to the police force. Therefore, we are working very hard not to involve the police in our crisis line calls,” said Binh O, operations officer at Alameda CSS, El Tecolote. “Anyone can hold a pill in their hand and shake it in my ear and I can hear it – that doesn’t warrant calling the police yet… We will explore every option to help that person stay safe before we even consider calling the police.” According to Au, Alameda CSS only calls the police when someone dies — when responders hear an attempt has been made, or the caller becomes unresponsive after talking about the attempt.

The former Crisis Line Manager, Binh Au, currently oversees operations at Alameda County Crisis Support Services. Oakland, CA, Wednesday, August 3, 2022. Photo: Florence Middleton

When Yolanda Carcamo, a shift supervisor at Alameda CSS, calls the police because the caller is in imminent danger of death, she holds her breath. “I’m scared too,” she said. “It’s a moment to hold your breath so you know this person is safe from this attempt but also that this person you sent back will treat them in a safe manner.”

David, a volunteer, attends his second day of crisis hotline training in Oakland, California on Wednesday, August 3, 2022. Photo: Florence Middleton

CSS operators stay on the phone with the person in crisis, and make sure the police know that mental health responders are on the line, that the person is in a mental health crisis, that they are not dangerous, and that they do not have a weapon. Yet they know that sending officers puts people at risk. We have to be as “loud” as possible, Carcamo said.

Te Yang has volunteered with the Crisis Center for nearly 4 years and is currently working as a volunteer coordinator. Oakland, CA, Wednesday, August 3, 2022. Photo: Florence Middleton

Consent and emergency care

Consent or disapproval also plays a role in body care, although the lines of consent can be blurred when someone doesn’t feel like they have options. People are asking for law enforcement health checks, but what does it mean to agree to have the police in your home during a crisis when there is no alternative 24/7? And how could non-consensual, life-saving emergency responses be less dangerous?

For Krebs and other critical suicidal scholars, “Any hotline or resource that engages in active nonsensory rescue is a cancerous system that cannot be trusted.” And while Au asserts that CSS “will do everything we can…to collaborate with this person and put together a security plan that we can both agree on,” in the end, preventing death is the center’s priority. Kulwa Apara, CSS Spanish text line supervisor, said that “when a person reaches out, it is by nature saying that there are few who would like to get through this loop… We want to keep the person alive because they may feel hopeful tomorrow.”

Alameda County Crisis Support Services assigns specific rooms to provide personalized advice. Oakland, CA, Wednesday, August 3, 2022. Photo: Florence Middleton

Although posts on social media have stated that the 988 has location tracking capabilities, Au said that Alameda CSS, at least, does not use geolocation. “We won’t be able to find you unless you give us your address…. In practice, geolocation is not a thing at this time, and if it becomes a thing, we will tell the community, because we think that’s part of the consent piece,” he said. El Tecolote. In fact, when callers call 988, they are not directed to the call center closest to their location, but to the call center closest to their area code area. If someone recently moved to the Bay Area from Texas, for example, their call will be answered by someone in Texas. Area code-based communications mean that for many, the response won’t be translated: responders won’t know what resources are nearby.

Michelle Alas Molina, director of policy at Generation Up, a student-led advocacy group in California, saw graphics about geolocation and police engagement 988 on Instagram. “Social media can … leave out bits and pieces of important information,” she said. “I realize 988 is not a perfect solution – it still probably has to do with the police and the cancer system – but people know 911 and when people are in crisis, they call 911. What I hope will come out of 988 is a renewed force for unconditional, non-cancerous responses to mental health crises” .

“I realize 988 is not a perfect solution – it still probably has to do with the police and the cancer system – but people know 911 and when people are in crisis, they call 911. What I hope will come out of 988 is a renewed force for unconditional, non-cancerous responses to mental health crises” .

Michelle Alas Molina, Director of Policy at Generation Up

A systematic approach to suicide prevention

see also


Lack of access to health care, lack of affordable housing, and a minimum wage that does not reflect inflation are all factors that determine access to care. And when we think about mental health, we need to think about all of these things. “Preventing suicide” [is]…Give places to live, access to food, proper insurance, Carcamo said. “You can’t avoid these thoughts if people don’t have access to health insurance, get fresh meals, and are worried about where they are going to sleep from night to night.”

“At the end of the day, a lot of our mental health distress is released because poverty is so painful. And there is a lot of poverty in Alameda County.”

Kulwa Apara, Spanish Script Font Supervisor for Crisis Support Services

Nearly a fifth of calls to Alameda CSS last year explicitly identified basic needs (housing, employment, homelessness, food, etc…) or health (insurance coverage, illness) as the reason for the call. “At the end of the day, a lot of our mental health distress is released because poverty is so appalling,” Abara said. El Tecolote. “There is a lot of poverty in Alameda County.”

As advocates continue to work toward safer and more inclusive mental health care systems, 988 are a valuable resource to know. “If someone needs to talk to them, the 988 is still a better option than the 911,” Krebs said. And “With the 988 turning around what was initially pledged, which includes increasing funding for local crisis centers and mobilizing more non-police mental health care units, I believe (or hope) that it will become safer.”

Life lines that do not include the police:

through the lifeline (For transgender people, transgender people, and gender issues).

black line (According to the BlackLine website, they are a hotline that is “oriented towards the Black, Black LGBTQI, Brown, Native and Muslim community. However, no one will be excluded from the hotline.”)

For more information about the 988 Alameda call center, visit https://988alamedacounty.org/.

To apply to work at Alameda CSS, which is actively recruiting people of color and Spanish speakers, visit https://www.crisissupport.org/get-involved/.

Read more about the 988 here: https://eltecolote.org/content/en/988-a-step-towards-transforming-mental-healthcare-in-california/