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Friday, April 1, 2022

Implementing The 988 Hotline: A Critical Window To Decriminalize Mental Health

P. Krass, E. Dalton, M. Candon, S. Doupnik
Health Affairs
Originally posted 25 FEB 22

Here is an excerpt:

Decriminalization Of Mental Health

The 988 hotline holds incredible promise toward decriminalizing the response to mental health emergencies. Currently, if an individual is experiencing a mental health crisis, they, their caregivers, and bystanders have few options beyond calling 911. As a result, roughly one in 10 individuals with mental health disorders have interacted with law enforcement prior to receiving psychiatric care, and 10 percent of police calls are for mental health emergencies. When police arrive, if they determine an acute safety risk, they transport the individual in crisis for further psychiatric assessment, most commonly at a medical emergency department. This almost always takes place in a police vehicle, many times in handcuffs, a scenario that contradicts central tenets of trauma-informed mental health care. In the worst-case scenario, confrontation with police results in injury or death. Adverse outcomes during response to mental health emergencies are more than 10-fold more likely for individuals with mental health conditions than for individuals without, and are disproportionately experienced by people of color. This consequence was tragically highlighted by the death of Walter Wallace, Jr., who was killed by police while experiencing a mental health emergency in October 2021.

Ideally, the new 988 number would activate an entirely different cascade of events. An individual in crisis, their family member, or even a bystander will be able to immediately reach a trained crisis counselor who can provide phone-based triage, support, and local resources. If needed, the counselor can activate a mobile mental health crisis team that will arrive on site to de-escalate; provide brief therapeutic interventions; either refer for close outpatient follow up or transport the individual for further psychiatric evaluation; and even offer food, drink, and hygiene supplies.
Rather than forcing families to call 911 for any type of help—regardless of criminal activity—the 988 line will allow individuals to access mental health crisis support without involving law enforcement. This approach can empower families to self-advocate for the right level of mental health care—including avoiding unnecessary medical emergency department visits, which are not typically designed to handle mental health crises and can further traumatize individuals and their families—and to initiate psychiatric assessment and treatment sooner. 911 dispatchers will also be able to re-route calls to 988 when appropriate, allowing law enforcement personnel to spend more time on their primary role of ensuring public safety. Finally, the 988 number will help offer a middle option for individuals who need rapid linkage to care, including rapid psychiatric evaluation and initiation of treatment, but do not yet meet criteria for crisis. This is a crucial service given current difficulties in accessing timely, in-network outpatient mental health care.