Many people in mental health crisis fear that if they dial 988Law enforcement might intervene or they might be forced to go to the hospital.
But receiving this kind of “involuntary emergency assistance” happens to about 1% of callers, suggests new data from Vibrant Emotional Health, the administrator of the 988 Lifeline for Suicide and Mental Health Crises.
“Involuntary intervention is the last resort. We want to make sure that we are collaborating and engaging with people in crisis “and empower them to act, so that we don’t have to go in that direction,” said Christopher Drapeau, Vibrant’s director of research and evaluation.
A survey conducted last year by the Pew Charitable Trusts, cited in Vibrant’s white paper, found that about 1 in 5 adults fear that law enforcement will be sent after them for using 988 or that they will be forced to go to hospital.
Under 988 policies, counselors are encouraged to use the “least invasive intervention” possible to respond to suicide attempts. But if other de-escalation attempts fail, counselors can then call on other crisis intervention services, such as involuntary rescue.
988 counselors don’t have the ability to pinpoint the exact location of callers. But the Substance Abuse and Mental Health Services Administration (SAMHSA), which oversees Vibrant and the hotline, says that in “rare situations,” counselors can ask a 911 dispatcher to use “geolocation services” to try to find out where a call is coming from.
The data do not make it clear what percentage of “unintentional” rescues required police intervention, as opposed to ambulances or some other type of emergency response.
“We haven’t been this transparent in the past. So we want to acknowledge that and show people that’s what we’ve done,” Drapeau told CBS News of the white paper he authored.
Drapeau said the white paper is his team’s first assessment of the 988’s performance and is the most comprehensive analysis of the topic to date. The idea for the report came from discussions with SAMHSA officials.
Law enforcement is often the first person 911 emergency services call to respond to suicide attempts. Victims’ rights groups have called on more jurisdictions to fund “mobile crisis teams” that can respond to suicide attempts with doctors and behavioral health professionals, rather than police.
“If someone attempted suicide during the call and suffered medical injuries as a result, you have to respond to that. So I don’t know if we could completely abolish all involuntary interventions,” Drapeau said.
“These numbers may not be perfect”
Vibrant’s white paper focuses on two snapshots of data that come largely from when the line was a 1-800 number, before the nationwide rollout of the easier-to-remember 988 shortcut to reach a counselor during a mental health crisis.
The largest snapshot presented in the document still covers only about 2 million calls made between 2019 and 2023, counted from a fraction of the more than 200 locally run crisis centers that underpin the network.
For context, more than 400,000 calls were routed through the 988 network in July alone.
“We recognize the limitations of this data. These numbers may not be perfect. They could be different if every center reported data, if we had a more precise definition, maybe that would change. But it seems today that the vast majority of calls to 988 do not involve the intervention of emergency services,” Drapeau said.
Of those nearly 2 million calls, the white paper estimates that about 2 percent resulted in emergency services being dispatched – both “voluntary” and “involuntary” – in response to the calls.
Callers classified by counselors as being at “imminent risk” of suicide, a much smaller group, were sent to emergency services at a higher rate.
Of these, a quarter benefited from “voluntary interventions” – with the consent of the callers – while another quarter benefited from “involuntary” rescues.
More precise data is being developed. While current numbers are based on a mix of requirements and voluntary reporting, a Vibrant spokesperson said it is working with SAMHSA to develop a national standard for what metrics all centers will be required to report going forward.
A plan developed by SAMHSA in April requires states to submit data to the agency on the number of contacts that result in law enforcement being dispatched.
Another evaluation planned by Vibrant will try to refine the definition of when a caller is considered to be at “imminent risk” and how to handle those cases. The evaluation will likely take a few years to complete, Drapeau said, and will help him determine how to move from involuntary to more collaborative interventions.
