Cities around the country have been testing programs in recent years to send mental health professionals instead of police to some emergency calls. But a survey of 911 call centers suggests the people answering the phone may not have the resources to handle those crises.
A survey published Tuesday by Pew Charitable Trusts of more than three dozen emergency call centers found few have staff trained to handle behavioral health crises. Most centers also did not have access to mental health professionals who can help with the calls or first responders in the field trained to handle such crises.
"For a lot of people, the first contact they have when they're in crisis is this person at that 911 call center," said Tiffany Russell, Pew Charitable Trusts' project director for mental health and justice partnerships.
"It's really important that that first line of contact is properly trained and they have the resources or at least have the knowledge of how to connect that person to the resources that can provide them with a better response."
Pew's survey included responses from 37 calls centers in 27 states. The report said the low response rate – researchers sent the survey to more than 230 call centers – is evidence of the strained resources call centers are already facing. The data also overrepresent areas with predominately white populations.
Still, the results provide a snapshot of what people experience every day across the country when they seek help for a mental health crisis: That it often isn't there, said Angela Kimball, national director of government relations, policy and advocacy at the National Alliance on Mental Illness, which was not involved in the research.
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Call centers lack uniform training for mental health calls
About two-thirds of responding call centers said their call-takers and dispatchers had not received specialized behavioral health crisis training.
Call centers don't have one national standard for how to respond to emergency calls. That also rings true for behavioral health crises, with call-takers often relying on experience rather than a formal training or script for identifying a mental health crisis, the report said.
Calls to 911 for a mental health crisis can take a variety of forms, Russell said, from someone directly stating they or someone else is experiencing a crisis, to someone calling to report suspicious activity. Because the calls can present in such wide range, it highlights the need for more training to identify them, she said.
While most of the surveyed call centers said they could dispatch police officers trained in crisis intervention some of the time, fewer than 1 in 5 said they had access to professionals other than police with similar training to respond to mental health emergencies. Only about 2 in 5 centers said they had access to mobile crisis response teams of trained police and clinicians paired.
"Millions of people every year experience a mental health crisis, and they deserve to have a response that is not a law enforcement response," Kimball said.
Access to mental health care resources can vary widely across the United States. The survey found that compared to urban areas, rural 911 call centers were more likely to lack access to behavioral health clinicians to guide the call or connect patients to care.
In some larger cities, like New York, pilot programs are in place to completely remove police officers from some mental health emergency calls, instead pairing social workers with EMTs. Call operators in the New York's pilot program are to be trained to dispatch the alternative response teams instead of police when there is no weapon or "imminent risk of violence."
According to data released Friday by New York on the pilot program's first three months, fewer than half of people were taken to a hospital when the nonpolice teams responded to the call, compared with 86% during a traditional response. But 911 operators still routed fewer than a quarter of calls to the teams. The goal is to have half routed to them, the city said.
Meanwhile, the FCC is requiring phone providers to route all calls to 988 to the National Suicide Prevention Lifeline by July. The lifeline can provide both suicide prevention and mental health crisis services.
But it will take time for the public to transition away from calling for 911 in certain situations, highlighting the need for further training at 911 centers, Russell said.
More data needed to better mental health responses, experts say
Kimball said another worrying sign in the survey was the lack of data that 911 call centers reported.
While most of the surveyed call centers said they recorded that a crisis call occurred in their system, the methods varied greatly. Some centers said the limited dispatch codes or ways of flagging a behavioral health call could lead to an inappropriate response in the field.
Fewer than half the centers updated call information as details evolved or recorded the outcome of the crisis calls, and none of the respondents said they reported their crisis call data to the public or policymakers.
That's a problem, Russell explained, because without reporting that data, lawmakers may not be able to quantify the extent of behavioral health crises in their communities and in turn may not provide funding to other aspects of mental health care beyond crisis response.
"It's really hard to make a case for additional resources or for more funding for something if you're not able to clearly articulate what the problem is," she said.
Still, a number of call centers in the survey said they were creating protocols to address these issues and indicated a desire to learn how to better answer these calls.
"The hope here is that people are starting to really recognize and name mental health crises. And they want a different response," Kimball said. "So now it is really up to our country to invest in that different response."
This article originally appeared on USA TODAY: 911 operators not prepared to handle mental health crisis calls: Study