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Can the new mental health crisis hotline deliver on its promise in Los Angeles County?

Can the new mental health crisis hotline deliver on its promise in Los Angeles County?

Picture of Lila Seidman
(Photo by Patrick T. FALLON/AFP via Getty Images)
(Photo by Patrick T. FALLON/AFP via Getty Images)

The mid-July launch of 988 – a national mental health crisis hotline – spurred an outcry among some activists who warned that calls could trigger unwanted police response. Their fears aren’t completely unfounded: Though the hotline is separate from 911, crisis counselors may relay information to police in dire situations, such as when a caller’s life is in imminent danger.

Their fears aren’t completely unfounded: Though the hotline is separate from 911, crisis counselors do relay information to police in dire situations, such as when a caller’s life is in imminent danger. This represents a small percentage of 988 calls, texts and chats, with the majority of crises are resolved without any officers dispatched. But it still means an estimated 6,850 of the 137,000 contacts that Didi Hirsch Mental Health Services, which helms the crisis call response for much of Southern California, led to involvement of law enforcement or other emergency response.

That’s significant when one considers the population. People struggling with serious mental illness are at much higher risk of being shot and killed by police. It’s estimated one in four victims of police killings suffer from psychological issues or are otherwise mentally atypical. It’s incumbent on the architects of 988 to ensure that this promising service provides all callers with the help they need.

The long-term vision for 988 is to reimagine the national crisis response system and divert those in the throws of a mental health crisis from jails to hospitals. The Lifeline is just the first step, providing a compassionate ear to call. In time, it aims to include someone to show up, such as mobile crisis teams, and somewhere to go, including crisis stabilization programs.

As of now, this vision remains mostly aspirational.

“This is a work in progress,” Wesolowski said. “It’s going to take many years.”

Los Angeles County has made efforts to pave the wave for a 988-type system, but gaps remain. 

County officials have adopted a “care first, jails last” agenda that aims to provide treatment instead of incarceration for those with mental illness whenever possible. Yet tens and thousands of people in psychological distress continue to languish behind bars and on the streets.

Even with the county Department of Mental Health recently fortifying its mobile crisis response, several dozen teams are tasked with servicing a population upward of 10 million. A board and care owner in Sylmar said he no longer requests the teams because of wait times that can stretch beyond 24 hours, opting instead to call police.

With the support of the 2022 USC Data Fellowship, I will dig into data detailing every leg of the 988 system in Los Angeles County — someone to call, someone to respond in person and somewhere to go — to break down what happens when calls arrive at the lifeline.

Rounding up and analyzing this data will shed light on whether the system is delivering on its promise to divert calls away from law enforcement and provide better care. This will provide clarity to the conversation, as well as accountability in uncovering where the system is failing to help people in crisis.

As of now, there’s so much we don’t know. A new study published in the journal Psychiatric Services found the effectiveness of mental health hotlines, including their impact on high-risk communities, was rarely studied, according a review of research of U.S. phone, text and chat hotlines published between January 2012 and December 2021. As it stands, there’s limited evidence to support the connection between using the lines and caller outcomes.  

Filling in those research gaps could ensure the longevity of the crisis system.

It’s more difficult to get crisis services reimbursed if there isn’t evidence to show they work, according to Matthew Goldman, medical director of comprehensive crisis services at the San Francisco Department of Public Health.

“These questions need to be examined more rigorously,” Goldman said in an interview with #CrisisTalk before 988 launched. “So when we look back in five years and tell the 988 story and justify its continued existence, we can say exactly how it made a difference.” In a recent interview, he said there’s a pressing need to study the new services.

Numbers and stats alone can’t convey how a person struggling with a mental health crisis feels after they speak to a 988 counselor or what it’s like to wait for help to arrive. To breathe life into the data, I am reaching out to Los Angeles residents who have used the crisis services, including through an online survey that will launch in the coming weeks.

These voices will offer critical insight into parts of the crisis system that the other data can’t convey. Listening — and weaving their stories into the series — can guide the development an equitable system that meets the needs of some of the most vulnerable residents.

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This post has been updated.

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