State of Mind

The New National Mental Health Crisis Line Is Coming. Who Will Respond to the Calls?

An ornamental door knocker.
Photo illustration by Slate. Photo by Getty Images Plus.

Welcome to State of Mind, a new section from Slate and Arizona State University dedicated to exploring mental health. Follow us on Twitter.

One of the earliest memories from my childhood is of watching my sister, Julie, attempt to die by suicide during a mental health crisis. I sat in the back of my mother’s un-air conditioned Ford Windstar the summer sun baking me like a pernil al horno. My WCW T-shirt was damp, my upper-lip sweat mixed with the tang of a fruit pop Ma had purchased me from the bodega. Mango. My favorite.

Advertisement

My mother had driven to check on Julie, who had moved in with a guy I could only assume was a bad egg. I’m not sure why she brought me, given the intensity of the moment. She encouraged Julie to break up with him, threatening to cut off financial support. Julie—who was later diagnosed with schizophrenia—went into hysterics. She cried. She paced. She laid herself down on the train tracks that separates the “good part of town” (the south side) from the “bad part of town” (the north side), where Julie now lived.

Advertisement
Advertisement
Advertisement

I was 6 years old.

Twenty-four years later, I would return to my childhood home in rural Central Pennsylvania to help take care of my sister. My hometown is the type where a traffic jam is caused by a wide farm tractor or an Amish horse and buggy. Some folks call it Pennsyltucky.

Advertisement
Advertisement

By then, Julie’s mental health had seriously deteriorated. She heard voices. She heard a man in the attic. She trespassed on a neighbors’ property several times to interrogate them about captive children. The police were called. Not once—more than 10 times in a little under a year. They knew my family’s address and Julie by name. Some people in law enforcement might call her a “frequent flier.”

Police relationships with communities of color are often fraught. Throw mental illness into the mix and things are even worse. People experiencing a mental health crisis are 16 times more likely to be met with deadly force and make up half of police fatalities. This, of course, complicated things for my parents. No one ever wants to call crisis hotlines or police on their child. Doubly so if that mentally ill child is a person of color in a largely white community.

Advertisement
Advertisement

Yet we were lucky. Despite being a family of color, we retained a privilege that came in handy in our frequent interactions with local small-town police. Before we moved to Pennsylvania, my father was an officer with the NYPD. Local officers were in awe of his career, and whenever they were called to a scene involving my sister, they handled the situation with a delicacy and patience often not afforded to others.

One officer interacted with my family so much he provided his private cellphone for future emergencies. No matter the time, if my sister was having a manic episode, we called this officer directly to help my elderly parents navigate a spiraling situation. With one call my parents could circumvent 911 and crisis hotlines. He would show up where my sister was, a familiar face to help de-escalate the crisis.

Advertisement
Advertisement
Advertisement
Advertisement

My sister’s manic episodes make her prone to blackouts. She was once found several hundred miles away in Delaware speaking to herself and dehydrated. In another episode she was caught trespassing on property in a gated community 15 minutes away from our family home. Responding officers immediately recognized her not as Julie, but as my father’s daughter. They would later drive her home to my parents. When the same thing happened two weeks later, officers called my parents and stayed with Julie until my mother picked her up.

Advertisement
Advertisement

Officers giving such grace is almost unheard-of in communities of color. Thankfully Julie was never arrested, and no charges were ever filed. My family is lucky that my father’s profession offered Julie some protection. But that shouldn’t be necessary.

Advertisement

A recent poll by the National Alliance on Mental Illness found that 72 percent of Americans believe mental health counselors—not police officers—should respond to such crises. The poll also found 60 percent of participants are afraid law enforcement would hurt a loved one with almost half saying they wouldn’t feel safe calling 911. Much like we’d rather have a doctor perform the Heimlich maneuver at a restaurant than a waiter, so too is the American public hesitant to have a cop play psychologist. Sure, law enforcement officers may have some de-escalation training, but they are no specialists.

Thankfully, one solution to crisis responses is on the way. In 2020, Congress agreed to replace the national suicide hotline with a far simpler 988. The Biden administration has committed $280 million to fund both the hotline and 24/7 staff increases for states. But that’s not nearly enough money. Only four states have passed legislative funding to support their 988 call centers. Customers in these states will see fees from 24 to 80 cents on their phone bills to help support the infrastructure 988 needs.

Advertisement
Advertisement
Advertisement

But most states, even those that will have funding for their 988 centers, do not have funding for qualified crisis responders. This raises a critical question: When someone eventually does call the new 988 hotline, who will show up at the door?

The Substance Abuse and Mental Health Services Administration states that ideally, crisis responders would be licensed and credentialed clinicians and that law enforcement accompaniment should be a last resort unless special circumstances requires it. It also emphasizes the need for crisis planning and follow-up check-ins to make sure people are actually connected to needed services when things have calmed down.

This not only is a moral responsibility but a fiscal one as well. Properly funded and supported crisis intervention teams save municipalities from hemorrhaging taxpayer money. In Louisville, Kentucky, over a nine-year period, the crisis intervention team program saved the city more than $1 million by diverting citizens experiencing mental health crises from jails to behavioral health facilities. Detroit found that incarcerating an individual came to the cost of more than $30,000 per year, while providing outpatient mental health care cost just $10,000 per year. Simply put, municipalities are retraumatizing communities with criminal justice system contact when it is neither appropriate nor beneficial.

Advertisement
Advertisement
Advertisement

Americans agree that our mental health response system needs a revamp. 988 provides the historic opportunity to do so. All families deserve a mental health system that is responsive in a tailored manner like the support my family received, regardless of whether they have an “in” with local responders. Instead, it should be grounded in equitable access and compassion.
A poorly funded 988 system may only parallel the inequitable systems we already have in place.

​​If you need to talk, or if you or someone you know is experiencing suicidal thoughts, text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255.

State of Mind is a partnership of Slate and Arizona State University that offers a practical look at our mental health system—and how to make it better.

Advertisement