Managing Mental Health Crisis

Audrey Fraizer

Audrey Fraizer

Case Exit

It’s no secret: People experiencing serious mental health conditions and substance abuse issues leave themselves open to fatal consequences in confrontations with law enforcement. Conflicts arise from misinterpretation, misunderstandings, and the consequent inability to adequately address the situation and render the proper assistance.

The dilemma goes beyond the perception of an individual’s crisis. Referring to appropriate mental health resources—and following up on progress—takes time and resources that already-strained law enforcement agencies, especially those from smaller departments, don’t always have.

The responsibility, however, does not fall solely in the lap of field law enforcement. After all, the request for help—and initiating field response—begins in emergency dispatch. Yet, like a response down the chain, bottlenecks in every link of public safety can get in the way of helping.

The individual at the communication center is not to blame. For the most part, 911 emergency dispatchers are not equipped to manage the caller and direct an appropriate response. At least, these are the findings of a recent Pew Charitable Trust questionnaire focusing on how 911 centers identify, respond to, and track and report on behavioral health crisis emergencies:

There is a relative lack of information about how call centers manage these emergencies, fueled by the disjointed nature of more than 5,000 separate 911 call centers, each with its own standards for training staff, call-handling and dispatch protocols, and data management and reporting systems.1

The Pew Charitable Trust collaborated with the National Emergency Number Association (NENA) to develop and distribute the online questionnaire to 233 centers. Results reflect the responding 37 agencies (from 27 states), and while not considered nationally representative, key insights emerged from this analysis that provides a rare look into behavioral health crisis system resources for 911 call centers in diverse communities across 27 states in the U.S.2

Here are the themes highlighted from the research and examples (we provide) of the efforts to move forward.

1. Few responding call centers have staff with behavioral health crisis training to inform how they navigate 911 calls and dispatch responses. While many law enforcement agencies have taken steps to improve officer responses to mental health emergencies, most responding call centers indicated their telecommunicators have not received specialized behavioral health crisis training.

New Mexico’s solution: State law mandates 20 hours of mental health training for telecommunicators.3
1. Eight hours of Mental Health First Aid (MHFA)
2. Eight hours of Agency for Persons with Disabilities (APD)-created curriculum
          a. Includes 1 hour of intellectual and developmental disability (IDD) /autism spectrum instruction
          b. National Alliance on Mental Illness (NAMI) peer panel with individuals who have lived experience
3. Four hours of scenario-based training
          a. One scenario includes a caller living with autism spectrum disorder

2. Respondents indicated they had limited options to dispatch specialized responses to crisis calls. Less than half of the responding agencies said more comprehensive mobile crisis response teams (MCTs)—which include police officers, clinicians, social workers, and other field responders—were available in their area.

Missoula, Montana’s, solution: As of November 2020, a behavioral distress call to 911 in Missoula, Montana (USA), sends a special crew assigned to emergency mental health situations. It’s one of six mobile crisis response initiatives in Montana, and four more local governments in Montana applied for state grants this year to form teams.4

3. Some respondents did not indicate that their 911 call center and service area had any specialized resources to address mental health or substance use-related emergencies. Results suggest that how 911 responds to a behavioral health crisis depends on where it is occurring. Most of these responding call centers without specialized resources served primarily rural areas, meaning that disparities may be greater in these types of communities.

Ohio’s solution: The addendum to the Crisis Intervention Law Enforcement Policy Guide (CIT-focused) is designed to assist public safety telecommunicators (PSTs) and those responsible for leading/managing emergency communication centers with the construction and publication of policies and procedures to process and handle service calls involving persons in crisis. 5

4. Many respondents recognized the need to improve 911’s responses to behavioral health emergencies and are working to improve their systems or expressed a desire to do so. Several respondents mentioned wanting to strengthen their behavioral health responses, but also pointed to various impediments to improvement, including budget constraints, access to training, availability of appropriate health services and transportation to those facilities, and staffing shortages and turnover.

Arizona’s solution: Dispatchers in the Phoenix Police Department (PPD) Communications Bureau can refer eligible 911 calls to Crisis Response Network (CRN), a nonprofit organization providing crisis call center services across the state. A case study describes how Medicaid funding in Arizona supports Phoenix police collaboration with crisis care providers to connect more people to treatment, including a co-response pilot and efforts to divert crisis-related 911 calls to the crisis system rather than sending the police.6

Caller’s perspective

NAMI looks at the issue from a caller’s perspective, a what to do when calling 911 because of a behavioral health crisis: Share all the information you can with your 911 operator. Tell the dispatcher that your loved one is having a mental health crisis and explain her mental health history and/or diagnosis. If the police who arrive aren't aware that a mental health crisis is occurring, they cannot handle the situation appropriately. Many communities have crisis intervention team (CIT) programs that train police officers to handle and respond safely to psychiatric crisis calls. Not every police officer is trained in a CIT program, but you should ask for a CIT officer if possible.7

In general, the questionnaire led to recommending reforms that include federal legislation to support the creation of a national crisis-specific call number (988), state funding to expand community crisis response options, and the development of model frameworks for community crisis response systems.8


1 “New Research Suggests 911 Call Centers Lack Resources to Handle Behavioral Health Crisis.” Pew Charitable Trust. 2021; 21 Oct.. https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/10/new-research-suggests-911-call-centers-lack-resources-to-handle-behavioral-health-crises (accessed Nov. 2, 2021). 

2 See note 1.

3 Simera R, Heil P, Tucker A, Melendrez B, Smuts R, Pang S. “Transforming Dispatch and Crisis Response Services: Meeting Challenges with Innovations.” The Academic Training to Inform Police Responses. 2021; March 2. https://www.theiacp.org/sites/default/files/MHIDD/Dispatch-Crisis-Response.pdf.

4 “In a mental health crisis, a 911 call now brings a mixed team of helpers – and maybe no cops.” PBS News Hour. 2021; June 14. https://www.pbs.org/newshour/health/in-mental-health-crises-a-911-call-now-brings-a-mixed-team-of-helpers-and-maybe-no-cops (accessed Nov. 2, 2021).

5  “Crisis Intervention Law Enforcement Policy Guide: Public Safety Telecommunicators Addendum.” Ohio Criminal Justice Coordinating Center of Excellence. https://www.neomed.edu/wp-content/uploads/PSTs-Addendum-to-LE-CIT-Policy-Guide.pdf (accessed Nov. 2, 2021).

6 Beck J, Reuland M, Pope L. “Crisis Care and Diverting 911 Calls to Crisis Lines.” Vera Behavioral Health Crisis Alternatives. 2020; November. https://www.vera.org/behavioral-health-crisis-alternatives/robust-crisis-care-and-diverting-911-calls-to-crisis-lines (accessed Nov. 2, 2021).

7 “Calling 911 and Talking to Police.” National Alliance on Mental Illness. https://www.nami.org/Your-Journey/Family-Members-and-Caregivers/Calling-911-and-Talking-with-Police (accessed Nov. 2, 2021).

8 See note 1.