The 988 Crisis Lifeline Offers Help Instead of HandcuffsJuly 26, 2022
As of July 16, people across the country can now dial 988 to connect to the 988 Suicide and Crisis Lifeline, a national network of crisis call centers. The 988 lifeline connects people in crisis, and those concerned for a loved one, to trained crisis counselors providing free, confidential support for thoughts of suicide, a mental health or substance use crisis, or any other kind of emotional distress. This is a long overdue resource, and it marks one step toward mental health advocates’ vision that people in crisis receive help, not handcuffs.
A mental health crisis is not a crime, but until recently, police were the only available resource to respond in most communities. Far too often, a police response to a mental health crisis results in a quick escalation, especially if the person in crisis is confused and unable to process their commands. This can lead to people being treated as noncompliant rather than having symptoms of an illness. Especially in communities of color, people experiencing severe symptoms have long endured needless trauma, incarceration, and loss of life rather than getting needed mental health treatment.
About one in five fatal police shootings between 2015 and 2022 involved a person with a mental illness, and an estimated 44% of people in local jails and 37% of people in prison have a mental health condition. And 2 million times each year, people with mental illness are booked into our nation’s jails. Studies have shown that Black people living with a serious mental illness such as schizophrenia, bipolar disorder, and other psychotic disorders are more likely to be incarcerated and do not receive adequate mental health care and supports essential for their recovery.
Given these dire statistics, individuals with a mental health condition and their loved ones can fear calling 911 during a mental health crisis. For Black people faced with a mental health crisis, this fear is compounded by the structural racism of our criminal justice system and unconscious bias leading to the overrepresentation of Black people incarcerated in jails and prisons. In June, the National Alliance on Mental Illness (NAMI), released a survey on public expectations around 988 and crisis response, conducted by Ipsos, which found a majority of Black U.S. adults (85%) say they would be afraid the police may hurt their loved ones or themselves while responding to a mental health crisis. This is significantly higher than the concerns of the general population (64%), and an 11% increase over results from last year.
As an adult and pediatric psychiatrist practicing at Boston Medical Center, the region’s largest safety net hospital, families have vocalized this fear to me: “Dr. Crawford, I don’t know what to do. My 13-year-old son is seen as a Black man, not just as a child in crisis. We all know how the police respond to them.”
I would find myself on the phone with parents, strategizing about what they should say when they call 911 during a crisis and how to greet police officers when they arrive to the scene, telling them to repeatedly state that their loved one is experiencing a mental health crisis. While providing this guidance, I often experience anxiety about how the interaction will ultimately go down since previous encounters have demonstrated that the patient may be met with handcuffs because our communities don’t provide a supportive, trauma-informed therapeutic response.
Black people should not live in fear of reaching out for help to access lifesaving treatment for a mental health condition, especially since care is already so hard to come by. Unfortunately, Black people often receive poorer quality of care and lack access to culturally competent care, and despite the need, only one in three Black adults with mental illness receive treatment. Any delay in access to acute mental health care can be devastating. For example, untreated symptoms of psychosis and suicidal thoughts can worsen and result in significant functional impairment and ultimately death.
More than four in five Americans believe that when someone is in a mental health or suicide crisis, they should receive a mental health response — not a police response. Yet, families and individuals often have to weigh the risks before calling for help. Is it more dangerous to risk a police interaction during an acute mental health crisis as a Black person or to remain in the community untreated? No one should ever have to consider this dilemma. Our priority must be connecting people experiencing a mental health crisis with mental health services, without delay.
NAMI’s June survey on 988 also found that, while there is broad public support for building a crisis system, only 4% of U.S. adults were at least somewhat familiar with 988. Unlike calling 911, 988 is the intervention. Estimates show that 80% to 98% of calls can be resolved over the phone, and likely reduce the need for in-person crisis responses. However, in cases where the situation isn’t resolved over the phone, improved next-steps are critical. Over the next year, creating more community-based mental health services is needed to improve equitable access to a standard of care for crisis services that includes 24/7 local 988 call centers, mobile crisis teams staffed by mental health professionals when an in-person response is needed, and crisis stabilization options. Together, these services can help end the revolving door of emergency department visits, hospitalization, arrests, incarceration, and homelessness.
Living with a mental illness is no more a crime then living with diabetes. Every person in crisis and their families should receive a humane, mental health-based response that treats them with dignity and connects them to appropriate and timely care. 988 is a major step forward in making this vision a reality, giving many a sense of hope — but we have more work to do.
As a lifesaving number, 988 is an important step toward improving access to care for communities of color during a mental health crisis. As medical providers, it’s important to inform patients about crisis resources. People need to know there are options available in their community and 988 has the potential to change lives — given that every second counts in a crisis.
Christine M. Crawford, MD, MPH, is an outpatient child and adolescent psychiatrist based in Boston, an assistant professor of Psychiatry at Boston University School of Medicine, and the associate medical director at the National Alliance on Mental Illness. Hannah Wesolowski, MPA, is chief advocacy officer at the National Alliance on Mental Illness.