An unmarked gray van pulled into a South King County apartment complex on a drizzly June afternoon. A 911 caller had reported a family member was hearing voices and seemed disconnected from reality.
A mental health professional and a case manager, not police or emergency medics, knocked on the door. A few hours later, this emergency crisis response team drove the resident to a crisis stabilization program, where she could get inpatient treatment and support.
Case manager April Coberly, left, and certified peer counselor Jennifer Spofford, both with Sound Behavioral Health, respond to a crisis situation last month in Auburn. The team is part of King County’s expanding mental health crisis response system, which responds to behavioral health emergencies without police when there is no immediate safety risk. (Akash Pamarthy / The Seattle Times)
The first response system has long relied on 911 calls, police officers and firefighters to get people urgent help. Experts agree this hasn’t served people with mental health or substance use needs, who have often ended up in hospital emergency rooms or in jail, or haven’t gotten help at all.
King County is building an alternative. As part of a massive mental health care expansion, largely funded by a $1.25 billion property tax levy, the county is creating a mental health-focused response system driven by the 988 suicide and crisis lifeline, mobile crisis teams that respond to emergencies in person and low-barrier centers dedicated to providing walk-in care.
Each of these new teams is part of a complicated, fragmented mental health system that must work together smoothly to get people the help they need. The expansion has come with growing pains.
Introducing new dispatchers, new responders and new health care centers takes time and trust. First responders must have confidence in new services to refer people in need, and the public needs to be aware they can use 988, which launched nationally three years ago, to access mental health services.
“We’ve had a system that’s been so underfunded and hasn’t had the resources, so you get this learned helplessness, where people say, ‘I tried and called for help, and it didn’t work, so I’m not going to call again,’” King County Behavioral Health and Recovery Division Director Susan McLaughlin said. “We have to undo that across the whole system, for our first responders, our providers, the hospitals and the community members, to understand that there actually is capacity. It’s available now and you can use it.”
Despite the challenges, county leaders say they feel good about how the expansion of care has rolled out. They get “a lot of calls” from other cities and counties seeking to understand what King County is doing, McLaughlin said.
911: Where calls often start
Since the 1960s, people have been told to call 911 for any type of emergency, and dispatchers are trained to dispatch police and fire departments. But people with serious mental illnesses are disproportionately killed by police, and police and fire departments lack specialized training on mental health conditions.
Last March, King County began diverting mental health calls that don’t pose a safety risk to 988, the suicide and crisis lifeline. Staff and volunteers are trained to talk people through crises and de-escalate them, and they’re able to spend more time on the phone with callers.
Valley Communications, which takes South King County 911 calls, started working closer with Crisis Connections, the nonprofit that handles 988 in King County. Early in the partnership, Valley Communications averaged 20 transfers per month to 988 staff. In June they sent 251 calls, Valley Communications Deputy Director Angee Bunk said.
In Valley Communications’ 911 dispatch center in Kent, rows of call receivers (who talk with callers seeking assistance) and dispatchers (who work with police and fire departments to send responders to scenes) sit at desks with computer monitors. Lights above desks show who’s actively on a call.
Staff listen for calls with a mental health connection — someone might be suicidal, or experiencing psychosis. If the caller doesn’t have a weapon, and isn’t actively threatening to harm themselves or others, the call receiver can do a “warm transfer” to 988, introducing the caller to the 988 call taker and handing them off.
Call receiver Dustin Freeman sees the partnership with 988 as a positive change. “We weren’t using them enough” when they were in the same building, he said.
“When someone is in a mental health crisis, there’s no crime happening, and 988 has more resources to help people,” Freeman said. “Sometimes people in that situation don’t want to talk with the police.”
Call receivers also transfer callers to 211, a line to help callers access resources to help with housing, transportation and other basic needs.
The partnership with Crisis Connections has gotten stronger, Bunk said, and the organizations regularly meet and share data about call outcomes. But it’s taken time to help staff feel comfortable transferring calls to 988 — they’d been used to handling everything themselves.
Bridging cultural divides is a common challenge when 911 and 988 programs integrate, said Stephanie Brooks Holliday, a professor of policy analysis at the RAND School of Public Policy who has studied 988 and 911 coordination.
“Call takers take the safety of the caller very seriously, and it takes time to build trust that when you transfer a call over, the person is going to get an appropriate response,” Brooks Holliday said.
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