If you or someone you love deals with severe mental illness, it can feel daunting to know how to get help, especially in a crisis situation. It's common for therapists or other professionals to advise their clients to call 911 for assistance in case of emergency. But the response from 911 can be very different depending on the type of emergency - and, too often - the skin color of the person in distress.
Calling 911 is such an engrained response for many of us. And it’s appropriate and necessary in many situations. After all, calling 911 for a heart attack can result in a life-saving response from medical personnel and an ambulance ride to the hospital. Calling 911 when your house is burning down brings the fire department to the rescue. But in the case of a mental health crisis, calling 911 can have disastrous results. Too often, the police sent to the scene are untrained in responding to mental health concerns, and can unnecessarily escalate the situation, leading to traumatic and at times even fatal outcomes for the person who they were sent to help. While many mental health professionals and advocacy organizations realize that calling the police can be traumatic or pose additional risks for people in emotional distress, the outcomes are often worst for those who are Black.
The Risks of Police Responding to Mental Health Calls, Especially for People of Color
As communities of color are painfully aware, calling the police in any circumstance can be a high-risk proposition. With distressing regularity, encounters with the police have been injurious or fatal for people of color, even if they or their family members are the ones asking for help, and no matter how compliant, calm, deferential, innocent, or unarmed they may be. The list of unarmed Black Americans killed by police continues to grow longer and longer, which should make us wary of assuming that 911 is the appropriate blanket approach for every person and situation -- especially when mental health is involved.
When people of color are experiencing a mental health crisis (e.g., suicidality, symptoms of psychosis or mania, paranoid delusions, or other erratic or aggressive behaviors that are likely to trigger alarm in responding officers) they are in much greater danger of being harmed or killed by police than White people experiencing similar crises. Even without an untreated mental illness, Black people are already 3 to 6 times more likely to be killed by police than White people, depending on the region where they live - and adding a mental health crisis into the mix can make for an even more deadly combination.
According to one study, people with untreated mental illnesses are 16 times more likely to be killed in encounters with police. So we can see that for Black individuals suffering from a mental health emergency, the odds of a fatal encounter increase exponentially. One does not need to look far to find stories of Black people from all across the United States who were killed by police sent to respond to a mental health situation, as demonstrated by the deaths of Charleena Lyles, Reginald Thomas Jr., Deborah Danner, Miles Hall, Daniel Prude, Walter Wallace, and many others.
And even when no one has been killed, there are all-too-real horror stories of mental health crises that almost ended fatally, such as the story of Randy Evans, a 28 year-old Black Arizona man whose mother called 911 on his behalf during a manic episode. Although she had called 911 for him previously, she was alarmed to see that this time, police arrived in riot gear, after dispatch apparently confused her son's name with that of a wanted felon. Even as she attempted repeatedly to clarify his identity and mental health history with dispatch and the responding officers, she was threatened with arrest by an officer who said her attempts to help were "obstructing" their efforts, and the officers pointed assault rifles and tazers at her and her son in the midst of an already traumatic situation.
For the Black community, it has been said that calling 911 can be the equivalent of a death sentence. One woman describes her hesitations about calling 911 on behalf of her sister Erica who was experiencing a psychotic episode, aware of the potentially deadly ramifications. She instead convinced her sister to go with her to the ER to be evaluated for inpatient psychiatric treatment, and reportedly remains glad that she did. With the scarcity of adequate community mental health options in recent decades, police have increasingly borne the brunt of responding to mental health emergencies, too often with lethal results.
Treating Mental Health Concerns with Mental Health Solutions
There is a growing and overdue outcry for mental health crises across the country to be handled not by law enforcement but by trained mental health personnel. Unfortunately we are still far from a reality where viable alternatives exist for all communities and are readily accessible nation-wide, but with the close of the year 2020, rapid changes have been developing.
In New York City, a pilot program was announced in November that would send mental health responders instead of police to respond to 911 calls that could be mental health emergencies, modeled after the innovative CAHOOTS program being used in Eugene, Oregon. Other cities across the U.S. are beginning to adopt similar models.
Across California, efforts to shift mental health response away from police continue to gain traction, with the creation of new pilot programs to send trained counselors, medical technicians, and other non-law-enforcement personnel to respond to mental health crises. In October, LA's City Council voted unanimously to begin developing an unarmed crisis response team that will be equipped to respond to some non-violent 911 calls.
Some police departments have already developed unique programs that offer a more mental health-aware approach. For example, the H.O.P.E. program in Pasadena, CA, which has been praised by local mental health practitioners, offers a cooperative law enforcement and mental health response for those affected by homelessness and addiction, connecting people in distress with resources to help them out of crisis.
But we still have a long way to go in providing adequate mental health resources for those in crisis.
Alternatives to 911
What can you do for someone experiencing a genuine mental health crisis? Instead of calling 911 as a first step, here are the top three resources you may want to consider, recommended by Mental Health America:
1. Mobile Crisis Response Teams: According to Mental Health America, "Mobile Crisis Response Teams should be the first point of contact in calls regarding mental health crises. Made up of mental health professionals, community health workers, and/or peers, these teams have the knowledge and skills to respond and refer individuals in crisis to the appropriate resources. They work closely with police, crisis services, and communities to support individuals and their families in navigating systems and supports. With specialized knowledge and the ability to engage people who may be at risk for “wellness checks,” access to Mobile Crisis Response Teams can help prevent crises and avoid unnecessary hospitalization, police interactions, and arrests. The best of these models contain peers who can most effectively empathize with and engage the individual in crisis."
In Los Angeles County:
Psychiatric Mobile Response Teams (PMRT) are run by the LA County Department of Mental Health. These consist of "LACDMH clinicians designated to perform evaluations for involuntary detention of individuals determined to be at risk of harming themselves or others, or who are unable to provide food, clothing or shelter for themselves. PMRT enables successful triage of each situation involving mentally ill, violent or high-risk individuals. PMRTs also receive community calls that do not rise to the level of direct services; in these situations staff provide information, referrals and other kinds of alternative support." (source: LACDMH).
Psychiatric Emergency Teams (PET) are "mobile response teams based in and operated by psychiatric hospitals approved by the Department of Mental Health to initiate applications for 5150 and 5585 evaluations. Team members are licensed mental health clinicians. PET operates similar to PMRT and provides additional resources in specific geographical regions." (source: LACDMH)
A caveat, however, must be included with regard to these specialized teams. Due to high demand and limited availability, wait times for these teams can be long - up to several hours or more. Depending on the severity and urgency of the crisis, PMRT, PET or other specialized teams may not be able to respond in time to help. In these cases, calling 911 may be your only option.
If you have time to wait, call the LA County Department of Mental Health Help Line at (800) 854-7771 to get connected to specialized 24/7 help in Los Angeles county.
2. Peer-Run Crisis Respite: "In contrast to the unnecessary hospitalization and missed opportunities for connecting to services that occur in emergency rooms, crisis respite services are tailored specifically to the need of consumers experiencing crises. Peer-run crisis programs are places where people can to connect with peers with lived experience of mental health conditions, in an environment that promotes autonomy and empathy and provides people with the hope and resources to move in their recovery. This includes linking people in recovery to ongoing community-based services." (source: Mental Health America Position Statement 59)
3. Psychiatric Urgent Care Clinics: "Psychiatric urgent care clinics are the same as other urgent care clinics, but are specially trained to attend to mental health and substance use needs. [They offer] a place for individuals to go and receive immediate attention, avoiding a potential crisis. By making pre-crisis services available like any other health care services it makes mental health crisis avoidance accessible and normative." (source: Mental Health America Position Statement 59)
For a list of psychiatric urgent care clinics in LA County, click here, or this list of psychiatric crisis services from the LA County Department of Mental Health.
Hotline Resources
Besides calling the LA County DMH 24-Hour Help Line (800) 854-7771), you may find some of the following national hotlines helpful as well. Each may be able to help you locate emergency services and resources in your area:
National Alliance on Mental Illness (NAMI) HelpLine: 1-800-950-NAMI (6264) (note their operating hours are Mon- Fri, 10am–6 pm Eastern time):
National Suicide Prevention Lifeline (24 hrs): 1-800-273-8255
National Domestic Violence Hotline (24 hrs): 1-800-799-SAFE (7233)
Going to the ER
If it is safe to do so and the above options are unavailable to you, you can bring your loved one to a nearby Emergency Room for a psychiatric evaluation. Here is one psychiatric social worker's helpful account of what happens when you go to the ER for a psychological emergency. While not a perfect solution (ERs can be noisy, chaotic, prone to treating all psychiatric complaints in a similar way, and subject to long waits, among other limitations), it may be far less traumatic for someone to willingly go with you to the ER than to be responded to by police, whose response to a mental health emergency (at least in Los Angeles) will likely include handcuffing of the person in distress, which can be disorienting and alarming for someone already in distress, and has the potential to escalate into a violent encounter.
If you decide to go the route of the ER, this article has some helpful pointers about what to expect and offers practical ways to prepare yourself or your loved one for the visit. If your loved one is admitted for treatment at the ER or another psychiatric facility, it may be a good idea to also contact the person's mental health care provider (e.g., psychiatrist, therapist) for emergency assistance with crisis intervention.
If You Have to Call 911
With all of the risks involved, there may still be situations where calling 911 during a mental health crisis is unavoidable, necessary, or the best available option under the constraints you face. If so, consider the following steps to help mitigate potential harm to the person in distress.
First, see these helpful Guidelines for Effective Communication with 911 Dispatch from the National Alliance on Mental Illness (NAMI). They recommend staying calm, calling 911 out of earshot of the person in distress if possible, and requesting a CIT Officer to be dispatched (CIT means "crisis intervention team," and refers to an officer trained in responding to mental health emergencies and other crises). While on the phone with dispatch, you can also request an evaluation for a 5150 (that is, involuntary confinement/hospitalization for someone who is a danger to self or others or who is "gravely disabled"). Use a landline if you can, or if calling from a cell phone, use your local emergency police number (look it up now and save it in your contact list for future reference). Explain your relationship to the person and why they are in danger, being as specific as you can.
Although still not a guarantee of safety, it is important to explain the nature of the mental health situation both to dispatch and to any officers who arrive at the scene, since dispatch may only communicate an abbreviated version of the facts to first responders.
NAMI suggests using these situation-specific scripts for what to say to 911 dispatch depending on the type of emergency you're calling about, whether it's:
- Suicide/overdose attempt
- Threat to self (with weapon)
- Threat to others (with weapon)
- Threat of violence (but NO weapon)
- Gravely disabled (with NO weapon), i.e., the mental health condition is severe enough that the person is refusing basic necessities such as food, essential hygiene, or cannot stay safely in the home until they get back on their medication.
Additional Resource Guides
You can also research whether additional, alternative resources exist in your local community. Below you'll find some of the most-referenced resource guides from NAMI that you can use now to begin identifying affordable mental health services and crisis resources in your area:
NAMI National Resource Directory
Ways to Prepare Now
Think about what you can do now to prepare for an emergency. Put a list of emergency numbers and contacts in your phone, including the hotlines listed above, as well as your loved one's physician and mental health care provider. Have plans in place for who will watch the kids or the dog if you have to transport your loved one to psychiatric urgent care or the ER, and have their insurance information handy. Check out this guide from HuffPost which offers some additional guidance and resources to consider as alternatives to calling 911, and know what the options in your area are ahead of time. Practice what you would say on the phone with police dispatch if you ever needed to call 911, using the suggested NAMI scripts.
It's also never too early to prevent a mental health emergency by speaking with a psychiatrist or your primary care doctor for help with medication, or by reaching out to a therapist to begin counseling/therapy to begin treating the underlying causes of distress. There are plenty of online directories you can use to search for a therapist, filtered by criteria of your choosing, including Therapy Den, PsychologyToday, Open Path Collective (for low-fee therapy), Therapy for Black Girls (women, too), and Therapy for Black Men.
Life gives us enough challenges to shoulder. Worrying about how to navigate a mental health crisis on your own - and stay alive through it - should not have to be one of them.
This blog post is for informational purposes only and cannot be used to give medical advice or guidance tailored to your exact situation. The author is not responsible for the content of linked articles or any changes made to them in the future. Please use your best judgment as to what fits your own circumstances.