How Communities Can Improve Responses to Behavioral Health Emergencies

People call 911 for many types of emergencies: a heart attack, an exploded gas line, an assault, a teenager expressing suicidal thoughts. Local 911 systems have become adept at managing the physical emergencies, coordinating medical, fire, and police teams on the fly. But 911 call centers and the first responders they dispatch are under increasing pressure to improve how they handle behavioral health crises—situations typically driven by mental health and substance use disorders.

Some people experiencing these crises need urgent hospitalization and are taken to an emergency department. Others pose public safety risks and require police responses, which may lead to arrest and transport to a local jail. But overcrowded emergency departments and jails are all too often used as a default for the majority of behavioral health crises, which often could be more appropriately handled by specialized first responders beyond the typical police-only response.

In recent years, government agencies, advocacy groups, and policymakers have been rethinking how to navigate these crisis calls, generating unprecedented momentum to improve emergency responses.  Local communities have tried novel approaches and expanded existing alternatives to police-only responses. Critical research and guidance have anchored this collective effort. And in October 2020, President Donald Trump signed bipartisan legislation to shift an existing national suicide prevention hotline to the simpler three-digit number: 988.

But the resulting cascade of emerging research, guidelines, and approaches—on top of the practical challenges of coordinating the new 988 number with existing emergency call operations—can be overwhelming for local officials charged with making improvements. The Pew Charitable Trusts has identified key questions local decision-makers can consider when prioritizing areas of focus. Those questions are centered on three overarching goals Pew identified by collecting the opinions and perspectives of a range of public officials and national experts, along with an informal review of publicly available resources:

1. Improve call centers’ ability to identify and navigate behavioral health crises.
2. Modify responses to those calls in a way that prioritizes the health and safety of people in crisis and the first responders, bystanders, and others involved in the emergency.
3. Connect people in distress to mental health and substance use services when needed.

A series of fact sheets, collected here, will explore these questions as well as offer resources to inform dialogues between local officials and key stakeholders.