Creating an effective behavioral health emergency response system

Click here to access Criminal Legal System Diversion: Creating an Effective Behavioral Health Emergency Service System

We know that the involvement of police can escalate a behavioral health crisis, causing fear or triggering trauma reactions. Yet individuals experiencing a crisis and their families often find themselves with nowhere to turn but 911.

Our emergency response system works well for health emergencies, fires, and criminal activity. But behavioral health emergencies are not well-handled by an ambulance, a fire truck, or a police officer. In fact, a 2016 Boston Globe investigation reported that nearly half of people shot and killed by police in Massachusetts have a mental health condition.

Fortunately, there is much we can do to address this challenge. Most of these solutions already are being used successfully in communities around the country. They include:

1. Invest in the behavioral health and social services people need to prevent crisis altogether. Behavioral health parity would prevent insurance companies from restricting access to care to improve their bottom line. Improving access to a range of support options, including non-clinical services like peer support and "living room" model services, would provide people with support they want when they need it to help avoid crisis. Affordable housing for all would mean no one is prevented from getting care because they don’t have a place to live. And addressing other social determinants of health like food and financial security would help people to have the space to heal.

2. Provide alternatives to calling 911. By 2022, Massachusetts and other states must implement 988, a national hotline that can provide support for people experiencing a behavioral health crisis. If implemented effectively, 988 operators could dispatch non-police support such as mobile crisis intervention teams of behavioral health professionals and peer support. Importantly, a robust crisis services system also could provide real-time appointment scheduling, healthcare navigation, and social services navigation to avoid the need for a police response or hospitalization.

3. Ensure that calling 911 in a behavioral health crisis leads to help. People who call 911 shouldn't see their loved ones arrested or harmed. MAMH is advocating to change 911 answering scripts to identify behavioral health crisis calls and divert to 988 or another "front door" to services. If an in-person response is needed, where possible the responder would be a social worker or other person specially trained to support behavioral health crisis. In instances where police are needed, they would be accompanied by a "co-responder" behavioral health professional - and trained to verbally de-escalate situations without using force.

A June 15, 2021 Boston Globe editorial supported establishing jail diversion facilities where patients can receive urgent crisis stabilization services in less restrictive settings than jails or emergency rooms. The editorial called on the legislature to provide at least $1 million to fund a Middlesex County Restoration Center.

For more information, about these approaches, please see our new Issue Brief, Criminal Legal System Diversion: Creating a Behavioral Health Emergency Service System.