Bright colored posters tell people to reach out for help if they are struggling, but ask anyone who has been in that situation and they’ll tell you it’s not that simple. When a national crisis lifeline went live in the United States earlier this year, many rejoiced, but others voiced concerns for its potential connections to the police.

In 2001, the Substance Abuse and Mental Health Services Administration (SAMHSA) established the first national crisis line in the country: 800-273-8255. Under the National Suicide Hotline Designation Act of 2020, the number was merged into a government funded program, 988. 

With the expansion of its services, SAMHSA published the National Guidelines for Behavioral Health Crisis Care, in which a three pillar framework is outlined: people need somewhere to call, someone to respond, and somewhere to go. The lifeline is the first of these pillars.

Given the history of police involvement in crisis services, however, it’s understandable that people are afraid, especially since 988 was modeled after 911.

A recent study found that between twenty-five and fifty percent of those involved in fatal police shootings have untreated mental illnesses, making them sixteen times more likely to be killed than those without. While this is often a result of inexperience or prejudice, violence exists even under the co-response model, in which police departments partner with clinicians in crisis cases.

The new lifeline insists that its purpose is to prevent people from coming in contact with police during a crisis, hence the separation of numbers. Trained counselors work with callers to find personalized solutions, such as outpatient resources or follow up calls, with inpatient being a last resort. Up to eighty percent of crises can be resolved over the phone alone.

For situations that need in-person care, SAMHSA suggests the establishment of mobile crisis teams (MCTs) to fulfill the second pillar of its plan. One of the most successful of these programs is Oregon’s Crisis Assistance Helping Out On The Streets (CAHOOTS), which sends an unarmed EMT and crisis worker in an emergency rather than law enforcement. 

As this program is not currently national, many locations still invest in co-response programs rather than MCTs, despite the latter being the cheaper option. While MCTs would also work closely with police departments, they would provide a much needed barrier between those with untreated illnesses and reactive officers. 

Those who need additional support will be sent to crisis stabilization facilities, the third pillar of the framework. An alternative to the ER, people will be sent here before being transferred elsewhere. Currently, all mental health services are disconnected, and not enough places help people make a detailed plan of action, so people “slip through the cracks”. These facilities aim to solve that.

The current system is set up to retraumatize those already struggling. An over-reliance on law enforcement in crisis services has heightened the situation, not only in violence, but in the aftermath: organizations like SAMHSA are created, but they are so underfunded that people have to fight to get costly resources. Staff are overworked, patients are triggered, families begin to struggle, and everyone is left in greater need of crisis services than they were before.

There are even problems with post-crisis services. Involuntary inpatient treatment is overused and fails to prioritize less invasive options. Lack of communication between facilities is also present in outpatient therapies, leaving clients scrambling to get medications refilled or to find a new provider once discharged.

It’s concerning, to say the least.

It’s clear that the crisis system in the United States is incomplete, but people cannot afford to wait. 988 is a valuable resource, but there are still dangers, especially in communities where law enforcement is the primary method of crisis care. Prevention is the best practice right now, but in the event of an emergency, risks need to be taken. 

Despite remaining issues, 988 is a huge step forward in national crisis services. SAMHSA’s three pillar plan shows great promise, people just need to keep fighting a little while longer.