Getting 911 right for mental health emergencies

IF YOU’VE EVER called 911 for a medical crisis, you likely received the response you expected and needed. An ambulance with trained emergency medical technicians arrived to assist, with competence and compassion in your home and on the way to the hospital.

If you’ve called 911 for a mental health emergency, however, the response likely fell far short of expectations – and maybe fatally so. Assistance for a psychiatric crisis usually arrives in the form of a team of police officers, many of whom do not have the information or skills they need to provide support.

In fact, police intervention often escalates the situation, causing trauma and lasting harm. For example, a person in crisis may be frightened by police uniforms and flashing lights, growing agitated. They may be unable to follow police instructions. These behaviors often are interpreted as aggression by police officers, who are trained to use tasers, guns, and restraints to promote safety.

As a result, many encounters end with the use of force, too often leading to arrest, injury, and even death. Nearly half of people shot and killed by police in Massachusetts have a mental health condition, according to a 2016 Boston Globe investigation. Nationally, people with untreated mental health conditions are 16 times more likely than the general public to be killed by police.

Yet for many Massachusetts families, 911 remains the only viable option to address mental health emergencies. Without access to earlier, less intensive interventions, desperate family members call 911 as a last resort to getting help. Other bystanders also may call 911 as a catch-all emergency phone number, not knowing how to access other, more appropriate support.

The long-term solution is meaningful investment in behavioral health treatment and social supports, like housing, to prevent crisis and intervene early. When emergency interventions are needed, proven approaches such as the clinical co-responder model, in which trained mental health providers respond with police to crisis calls, can support de-escalation and minimize the use of force.

In addition, since we know that the presence of police can escalate conflict even in the best of circumstances, the time is now to invest in alternatives to police response. These alternatives, such as sending trained mental health providers instead of police whenever possible, have been used successfully in other communities in the US and could be replicated across the Commonwealth. In many instances, these providers use their own lived experiences with behavioral health issues to offer meaningful support.

A simple, important step we can take right now is to reform how we implement 911. Legislation currently under consideration would support communities in updating 911 protocols, scripts, and codes to better identify behavioral health crises. The bill also would provide crisis intervention and diversion training for 911 dispatchers and establish formal working agreements between Community Behavioral Health Centers’ crisis teams and 911 administrators. In addition, the state’s 911 Commission would be expanded to include mental health professionals and people with lived experience.

Rep. Brandy Fluker Oakley and Sen. Julian Cyr sponsored this 911 bill in the House and Senate, with oral testimony delivered last week. Important, foundational steps to reform 911 today bring us closer to much-needed systemic change and a safer way to find help when it’s needed.

Danna Mauch is president and CEO of the Massachusetts Association for Mental Health.