Three Things To Read This Week
This week’s edition of Safer Cities focuses on the continuum of mental health crisis care starting from when a person calls for help; to the dispatching of a mobile crisis team; through placement of a person in a crisis stabilization center.
1. Mental Health Crisis Line Updates Across The Country.
How Local Government Can Help Push A Much Needed Emergency Crisis Call Fix. Senator Thom Tillis (R-NC) and Senator Alex Padilla (D-CA) are co-sponsors of a bill in the U.S. Senate that would require “calls and messages to the [988] lifeline to be routed by the call center geographically nearest to the caller, rather than by area code, [to] ensure a quicker response by mental health professionals.” Though the bill would require the Federal Communications Commission to “route calls based on the proximity of the caller to the call center,” the bill clarifies that a “caller’s specific location should not be revealed or discernible.”
This change is needed because, as Steve Scauzillo explains for the Los Angeles Daily News, the reliance on “using the cell phone caller’s area code — which is often not the area code where the person lives” means that their call is routed to “health technicians out of their county, or even out of state, instead of sending their call to the nearest clinic where they can receive hands-on treatment.” Getting the call to a mental health professional in the right geographic region is critical because that person “would be familiar with county resources and could send a mobile treatment team if needed.”
In Los Angeles County, the Board of Supervisors voted to endorse the federal bill earlier this month in order to “make sure that anyone who calls 9-8-8 from within Los Angeles County will be routed to the County call center, making sure they get the response they need, including in-person mobile crisis teams when appropriate.” Thus, L.A. County “will send a letter of support to the Senate, [and has pledged] to fight for the bill’s passage.” This show of support from elected officials at the local level is helpful to convey to Members of Congress that this bill is important and worthy of being prioritized for a vote this year.
In addition to geo-locating calls to 988, the Padilla / Tillis bill would require “carriers to allow calls and texts to 9-8-8 even if the plan is inactive or the carrier is experiencing service interruptions or failures, just as they currently do for 911 calls.” It would also require “multi-line systems like hotel and office phones to support the direct dialing of 9-8-8; rather than requiring a caller to dial 9 or another number before dialing 9-8-8.”9-8-8 Crisis Call Takers Want More Training. “An estimated 10,000 to 11,000 counselors work at more than 200 call centers nationwide, fielding calls from people experiencing anxiety, depression, or suicidal thoughts,” Colleen Deguzman writes in Popular Science. The article centers around an organization called Crisis Crowd, which works on “empowering and enabling connections among crisis hotline staff.”
Crisis Crowd conducted a survey of crisis call center staff to learn about challenges and opportunities in the profession. The need for more—and more specialized—training is a major theme in the responses. Here are three examples:“Some counselors said they had received training only in talking to people experiencing suicidal thoughts and not how to deal with other mental health issues, such as anxiety attacks, substance intoxication and withdrawal, and mood disorders.”
“[Some counselors] reported having finished their training without ever getting the opportunity to hear a trained counselor handle a call or to see how a trained chat counselor approached a real chat conversation.”
“Others were never engaged in full-conversation role-plays in their training, and first experienced what it was like to conduct a crisis conversation when they went on shift for the first time, to help real people in real crisis.”
Taking a step back, “most counselors in the survey—including all who were dissatisfied with their on-the-job training—received that training in four weeks or less.” Beyond the initial training, “many counselors are not offered any form of continuing education over their months or years of service … Others, in contrast, receive ongoing learning every week.”
These results strongly suggest the need for more—and more rigorous—training and continuing education for crisis call takers.
Policymakers should consider implementing training that includes:
Coverage of a “wide range of calls of varying levels of intensity” that call takers are likely to receive;
The opportunity to “listen to real crisis calls or read transcripts of real crisis chats,” and
The chance to “role-play simulated crisis calls and chats as part of their training.”
“Vibrant Emotional Health, the company that administers 988, recently created online, self-paced training courses for crisis counselors, [which are] designed to assist local centers in delivering training and supporting crisis counselor skill development.” But this is also an important area where local officials should help set minimum content, duration, and quality guidelines.
Using Phone Bill Fees To Fund 988 Crisis Line. For Oregon Public Broadcasting, Nathan Wilk reports on a “new tax on Oregon’s phone bills… an additional 40 cents per phone line each month and another 40 cents when purchasing a prepaid plan… [that is] providing money for the state’s 988 suicide prevention and crisis line… that’s expected to generate $33 million for the state by mid-2025.” When the 988 services are fully funded, “leftover tax revenue will go towards Oregon’s mobile response teams.” Oregon, according to the National Alliance on Mental Illness, is one of just “eight states that have enacted legislation to sustain 988 through phone fees.” Meanwhile, a new poll suggests that voters in Alabama want their state to become the ninth. For AL.com, Mike Cason reports that “a survey of 620 Alabama voters” conducted by the “polling firm Cygnal” showed that most voters supported a proposal to add a “50-cent user fee” to phone bills to support 988—once they were given information about what the crisis center does.
2. New Mobile Crisis Teams Launch.
In Ohio, the City of Akron has launched the Summit County Outreach Team, or SCOUT, a first-of-its-kind team in the state “comprised of specially trained first responders, [who] work to de-escalate mental health crises,” Lindsay Buckingham reports for WKYC, Akron’s local NBC affiliate. Deputy Mayor for Public Safety Clarence Tucker explained to the Akron Beacon Journal that the unit provides “immediate intervention and support as an alternative to potential incarceration… ‘many times, when we respond to psychiatric calls, the options are not great. Not every [response] needs to go to jail. They might just need help.’”
In Montana, Republican Governor Greg Gianforte approved roughly $8 million in funding for statewide expansion of mobile crisis response—$7.5 million “will be available to mobile crisis response and crisis receiving and stabilization services… [so that] providers will be able… to divert patients from local emergency rooms, jails and state-run health facilities,” Seaborn Larson reports for The Bozeman Daily Chronicle. The additional $500,000 in state funding will be used to “create a crisis worker curriculum and certification course to help ‘meet the increasing demand for highly trained behavioral health crisis professionals in Montana.’”
3. More Cities Providing People In Crisis With A Safe Place To Stay—And Keeping Them Out Of Jail Or The Emergency Room.
First responders need somewhere to take a person in crisis. Consider, for example, a person suffering from an acute mental illness or a person who is intoxicated and needs to sober up. That “place” tends to be an emergency room or a jail cell, depending on the situation. Neither option is optimal in most situations because neither place is designed to either address the root cause of why the person is in crisis or help ensure that the person does not cycle back through with the same problem over and over again.
But a growing number of cities provide first responders with a more suitable option for dropping off a person in crisis. Crisis stabilization centers provide rapid “substance use disorder and behavioral health support” and also connect people to long-term services. New crisis stabilization centers opened in recent weeks in six cities including Juneau, Alaska; Fort Collins, Colorado; Syracuse, New York; and Scranton, Pennsylvania. In central Pennsylvania three counties—Cumberland, Dauphin and Perry—banded together to open a center. And Linn County, Iowa opened one, too.
Here is a quick glimpse at three of the new crisis stabilization centers launching around the country:
Colorado’s “New Crisis Center [Is] A Local Alternative To Jail Or The Hospital.” For KUNC, Fort Collins’ local NPR affiliate, Leigh Paterson reports on a recently opened Fort Collins “crisis center [providing] short-term care for residents who are struggling with serious mental health or addiction issues.” With a goal of stopping the use of “emergency rooms and our jails and law enforcement as the first door for mental health,” the center provides: “withdrawal management,” “[a unit that] allows people to safely stop using drugs or alcohol [and] the crisis stabilization,” and “a unit [that] provides short-term inpatient care for individuals in acute psychiatric crisis."
The center is open to all “Larimer County residents of all ages regardless of their ability to pay.” And, Fort Collins Police Sergeant Andrew Leslie told the news station he’s “hopeful” the center will provide “not just the immediate crisis care” but also “fill the gap” between short and long-term care for a wide-range of county residents across demographic differences:
“[M]ental health issues touch way more people and way more demographics than people realize. It’s not just a certain group. I’ve seen it from someone who just comes into town and is experiencing homelessness all the way to somebody who is a well-established business owner with multiple houses. Mental health issues are so impactful for all of them.”
Alaska’s New Youth Stabilization Center “Reduces Reliance On Law Enforcement And Emergency Rooms.” For KTOO, Juneau’s local PBS affiliate, Katie Anastas reports on the city’s new mental health stabilization center for local teens in crisis at the Bartlett Regional Hospital.
Dr. Marie Roy Babbitt, a child and adolescent psychiatrist who leads the center’s crisis services, explained to the news station that the center is “staffed with psychiatrists, nurses, counselors and community navigators to help teens get the treatment they need” with “the goal to provide well-rounded services all in one place…‘offering medications, a medical check-up, one-on-one counseling, family counseling and link[s] to services outside of the crisis unit.’”
Here’s more from KTOO on the facility, which “aims to reduce reliance on law enforcement and emergency rooms when people are in crisis”:
“Patients’ rooms have built-in nightstands and desks, and the windows overlook the Gastineau Channel. Most teens will be there for less than a week. Before they leave, staff will work with families to explain the treatment plan, which may involve medication or working with the teen’s school on an Individualized Educational Plan. The unit’s navigators will keep working with teens and their families to make sure they’re getting the outpatient services they need…”
New Crisis Stabilization Center In Scranton, Pennsylvania Adds Long-Term Focus To Acute Care. WBRE News in Scranton has a segment on a new 24/7 crisis stabilization center that aims to help patients “beyond the immediate crisis intervention,” including helping patients “connect to ongoing support which can include follow-ups with their mobile team [that] supports that individual with transitioning back to living at home, or wherever they’re living… [as well as] do phone check-ins [and] in-person check-ins… we do a lot of planning around discharge and successful discharge in ways to divert crises in the future and connect them with resources in the community.”
