Health Policy

988: A New Lifeline for Mental Health Emergencies

By BEN WHEATLEY

Miles Hall, a 23-year-old Black man experiencing a psychotic episode, was shot and killed by police after 911 received calls of a disturbance in his Walnut Creek, California neighborhood. His mother Taun Hall had taken steps to warn the local police that her son had been diagnosed with schizoaffective disorder and that he might be prone to mental health crises. She believed she had done enough to ensure that, in the event of a crisis, her son would be treated with care. But when the crisis came, authorities viewed Miles’ behavior through the lens of public safety, not through the lens of mental health, and it cost him his life. 

On June 2nd, 2019, the day of the shooting, Miles believed he was Jesus. He believed that a large iron gardening tool resembling a crowbar had been gifted to him by God. But according to police reports, Miles had used the crowbar to break a sliding glass door at his parent’s residence. 911 received calls from his grandmother, who said that Miles had threatened her, and from his mother, who said that he was acting violently. In the calls, they both reiterated that Miles had mental health issues.

In addition to the calls from his family, nearby residents also placed calls to 911. One resident said he could hear “an argument, and possibly a gunshot.” The other said that a man with a red bandanna over his head and face and a “giant crowbar in his hand” had been pounding on his front door. 

In response to the 911 calls, police arrived on the scene. The police report stated that “officers gave multiple commands to Mr. Hall to drop the pry bar. [However,] Mr. Hall ignored those commands and ran towards the officers with the pry bar in his hand.” They fired upon him first with bean bags, but when he didn’t stop, they shot him fatally with their handguns. 

The events of June 2nd, 2019 constituted both a mental health emergency for Miles Hall and a public safety emergency for those around him. However, the sequence of events involving 911 calls and police dispatch dictated that his case would be treated exclusively as a public safety issue. The deadly force employed by the police was seen as an appropriate countermeasure to the threat he posed. 

A lawyer for the Hall family said that an officer who had experience working with the mentally ill and who “knew Mr. Hall well” had been on her way to the scene. “But instead of waiting for her to arrive so she could help calm him down, officers approached him aggressively, weapons drawn.” 

The police chief said after the shooting, “My heart goes out to the family of Miles Hall as this was an outcome nobody wanted to have happen.” In September 2020, the city of Walnut Creek agreed to pay the Hall family a $4 million settlement as recompense for the loss of their son. None of the officers involved in the shooting were charged with crimes. 

The family has established the Miles Hall Foundation and is working to ensure that other families do not face similar situations in the future. “We really want to see a non-police response to mentally ill calls,” Taun Hall has said. For its part, the police have expanded its crisis intervention team, with the goal being to have someone available around the clock to respond to mental health emergencies. 

988 for Mental Health Emergencies

In October 2020, the federal government enacted legislation establishing 988 as the national number dedicated to mental health crises. The law instructs that calls to 988 will be patched through to the national suicide prevention hotline (800-273-TALK). Like 911, the new number will be implemented at the state and local levels. The federal government has said that each jurisdiction around the country will need to have its 988 lines open by July of 2022. 

The federal law allows states to raise funds by levying a surcharge on monthly bills for mobile and landline phone services. This money can be applied in several ways, including supporting the dedicated call centers, paying for trained mobile response teams, and providing more involved stabilization services for people in crisis. Telecommunications companies have argued that their portion of the funding should only support the call centers, not the other components of the response. 

California’s Department of Health Care Services has already announced that it will invest $20 million to support the launch of the new 988 hotlines in the state. Assemblymember Rebecca Bauer-Kahan, who sponsored supporting legislation, said “The Miles Hall Lifeline and Suicide Prevention Act will develop and designate a new three-digit phone number, 988, as the universal number to request an appropriate response to urgent mental health crises. With 988, callers will be connected to around-the-clock intervention, including mobile crisis teams staffed by qualified mental health professionals and trained peers instead of a traditional law enforcement response.” She said, “Mental illness is a health condition, not a crime, and health practitioners should respond to crisis calls, not law enforcement.”

A well-known and highly respected model for this type of response is known as CAHOOTS (Crisis Assistance Helping Out On The Streets), based in Eugene, Oregon. The program includes mobile crisis teams that work closely with the local police to assist in non-violent cases such as those involving homeless residents in need of help and people who are overdosing or intoxicated. These are cases that police are not well trained for and, in many cases, would prefer not to be involved in. But CAHOOTS does not immediately address violent situations or cases where there are potential weapons involved. In those instances, 911 dispatchers send police to the scene first, and police issue an “all-clear” before CAHOOTS members approach. 

The impetus for a non-police response gained momentum after the May 2020 murder of George Floyd and the “defund the police” movement that occurred nationwide. There are grave concerns that 25% of all officer-involved shootings involve people showing signs of mental illness. However, public safety obviously remains a central concern and most see the need for a continued police presence.

Making 988 Work

In order to work, 988 will need to address (and ultimately reconcile) two very different kinds of situations. In one scenario, a person in distress calls a phone line seeking help for themselves (the suicide helpline model). In another, people who are fearful about someone else’s erratic behavior call the police for help (the 911 model). 

The existence of 988 will not in itself mitigate public safety concerns. 911 operators and the police saw Miles Hall as a potentially violent person wielding a 5-foot-long weapon with a sharp edge, not as a suicide risk. And Miles wasn’t placing calls on his own behalf. Neighbors (and family members themselves) wanted some type of force to be utilized to restore calm to a chaotic situation. But the family expected that force would be wielded with compassion, with an emphasis on de-escalation. To quote the National Alliance on Mental Illness (NAMI), there are some cases that require “help, not handcuffs.” 

In responding to a mental health emergency, personal safety is the central concern. This applies to everyone involved, including family members, neighbors, strangers, the person in crisis, and the police themselves. Members of CAHOOTS have come to recognize that, when they arrive at a scene, their first step is to make sure the situation is as physically safe as possible. The Eugene police chief has said that CAHOOTS “has a tendency to almost immediately deescalate a situation,” and that is its “secret sauce.”

Addressing the needs of people in mental health crises involves both care and containment. This is illustrated by the close working relationship established over time by CAHOOTS and the Eugene police department. According to David Zeiss, CAHOOTS’ co-founder, “Partnership with police has always been essential to our model. A CAHOOTS-like program without a close relationship with the police would be very different from anything we’ve done. I don’t have a coherent vision of a society that has no police force.”

But we are left with the question: what should we do about situations called in to 911 involving potential weapons or violence? Miles Hall was not the first psychotic person to wield a potentially lethal weapon and he won’t be the last. To ensure that steps toward de-escalation are taken, 988 must be integrated with the 911 response. The calls placed to 988 will serve as a reminder to responders that the person posing the threat is someone in the middle of a mental health emergency, and that it is still possible to avoid a tragic mistake.

Ben Wheatley has 25 years of experience working in health policy with organizations including AcademyHealth, the Institute of Medicine, and Kaiser Permanente.

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