THE ESSENCE OF THE AMERICAN EMERGENCY RESPONSE SYSTEM IS, like so much else in our society, encapsulated in a line from The Simpsons. “Hello! Operator!” Homer Simpson shouts into his phone in an early episode. “Give me the number for 911!”
Behind the joke is this bit of truth: 911 is so ingrained in our consciousness that it has become synonymous with “emergency” and “rescue.”
The theory is that by calling that number anywhere in the United States, one is immediately connected with an expert who will quickly determine the nature of the problem and dispatch the closest firefighters, paramedics or police officers wearing Batman-like utility belts full of tools they will use to render aid and defuse tense situations. 911 is meant to be the taxpayer’s key to a concierge-level government response. It’s the front end of a system in which police are seen as neighborhood problem solvers, sort of like 19th Century English bobbies, but dispatched by phone call rather than walking a beat, and amped up with cutting-edge technology, high-grade weapons and rigorous training.
Too often things work out differently than expected, though, especially for someone experiencing a behavioral crisis triggered by emotional trauma, mental illness or substance use. Consider, for example, the tragic case of Miles Hall, a 23-year-old man with a history of mental health problems, shot to death a block from his Walnut Creek home in 2019 by police responding to his family’s call for help when he was in crisis. Or Isaias Cervantes, a 25-year- old autistic and deaf man, shot and paralyzed in his own home in 2021 by Los Angeles County sheriff’s deputies whom his family had called when his mother had some trouble managing him. Or countless others killed or injured by police who had been called in order to get bobby-like assistance to defuse, calm and help, but who instead responded with guns blazing.
The 911 system and the often misplaced public expectations it represents lie at the heart of the urgent policy debate over excessive police force, mental health and equity. Along with policing, the nation’s program for emergency response is undergoing a long-overdue examination, especially in how it fails the poor, the sick, people of color and others most marginalized in U.S. society and most likely to be in harm’s way. Few subjects have attracted as much examination by policymakers and researchers in the past decade.
The proportion of Americans killed by police who had a mental illness is generally estimated at about 25%, but that’s conservative. Include people living with any type of intellectual disability or cognitive difference, or any emotional trauma or substance-use disorder that is expressed in behavior that police see as uncooperative, dangerous or simply unexpected, and the percentage is likely at least twice that.
These are multiple tragedies: for parents at their wits’ end whose desperate calls for help lead instead to needless police escalation ending in injury or death; for a public losing faith in the competence of its law enforcement agencies; for officers who want to help but whose training focuses on responding to armed criminals; and for Americans of color who perceive, correctly, that their kids with disabilities or behavioral challenges have a greater chance of dying at the hands of police than do their white counterparts.
Reformers intent on fixing the problem once focused exclusively on improving the quality of the “concierge”: Give police better tools, better funding and, above all, better training. Or include a mental health team when officers respond to calls.
But the tragedies continued, and the discussion shifted. Maybe 911 was the wrong number to call, the police the wrong people to send, and the backseat of a patrol car or a jail cell the wrong place to address a behavioral breakdown or treat a mental illness. Perhaps there could be an alternative system of crisis response, one without guns or badges, or even people whose training focused on confrontation and crime.
By 2019, a movement had coalesced and thinkers had landed on a plan: Get a new number, with new responders and new systems to support them on the phone, at home or if necessary in clinics. Almost unnoticed, municipalities, federal agencies and nonprofit service providers joined to create 988, not just a parallel phone number but an entire planned complex of unarmed crisis response. In California, a key piece of authorizing legislation now pending before lawmakers is appropriately designated Assembly Bill 988.
It’s also known as the Miles Hall Lifeline Act, in recognition of the young man shot dead, rather than aided, by Walnut Creek police. It was introduced by Rebecca Bauer-Kahan, whose Assembly district includes that Bay Area city.
In Los Angeles County, Supervisor Janice Hahn launched several programs that put county agencies at the forefront of 988 planning. There, the system is known as alternative crisis response — meaning an alternative to police. L.A. city officials prefer the term unarmed crisis response for their various pilot programs, but the point is the same.
Change inspired by police murder
The new system was already on the drawing boards of hundreds of cities and counties across the nation in May 2020, when George Floyd was murdered by a Minneapolis police officer and angry and often violent protests called for defunding not just police but jails, prisons, juvenile probation and, in fact, most parts of a criminal legal system often seen as unjust and grounded in white supremacy.
The events of that tumultuous year increased the interest in alternative crisis response programs and lent efforts an anti-police tinge that, depending on one’s view, was either a distraction or the entire point of the exercise.
Special attention was given a program begun in 1989 in Eugene, Oregon, known as CAHOOTS: Crisis Assistance Helping Out On The Streets. The program diverts 911 calls for assistance with mental health and cognitive problems to clinicians and other staff at the nonprofit White Bird clinic. They respond without guns, and with training of an entirely different nature. In- stead of jail or the ER, patients are taken to sobering centers, mental health clinics or just a place to chat with peers, as the situation requires.
The nationwide 988 system is envisioned as a means to direct similar calls in every part of the United States, meaning of course there would have to be clinics and properly trained staffs in each community to back up the new phone number. It could be the single biggest development in the way that government responds to emergencies since the first 911 call in 1969. And it’s due to come online on July 16.
Are all the components ready? Not even close.
Completing the system won’t come cheap, and there has been considerable pushback. There are labor issues, for example. Public mental health clinicians aren’t available 24/7, and their unions aren’t always pleased with private sector contractors filling in. There has been some tension over whether the best person to respond at the scene of a crisis might be a mental health clinician, or a peer counselor with no professional training but valuable lived experience. Funding is needed for training, hiring and evaluation.
Divergent goals for 988
Ideology plays a role as well. Some see the 988 project as a way to reduce or eliminate police presence in American life, and current police budgets as the obvious source of the needed funding. Others see an essential complement to police that allows officers to focus on crime-fighting by designating someone else to deal with the cognitively atypical, whose needs were never met by a promised but undelivered network of community clinics after the “deinstitutionalization” of the mentally ill dating back to the 1950s. The differing points of view lead to differing strategies for building, funding and operating the system.
And there is a small but growing core of people who care for mentally ill or simply atypical family members who dismiss even 988 as too much government and too much bureaucracy to secure a positive outcome in the event of a crisis. The solution, they suggest, is a program of mutual aid among affected families and stronger ties to neighbors, to educate them on who to call (in other words, not the police, not 911, not 988) when they witness unexpected behavior. Interestingly, this mistrust-the-government, do-it-ourselves approach has been adopted by Americans of widely diverging political viewpoints, and is touted as much on the left as the right.
Still, it’s hard to get away from the seductive notion of a government concierge with a utility belt, ready to solve all problems. And isn’t that what we expect a police officer to be? In Eugene, it’s worth remembering, there’s a reason they chose the name CAHOOTS: The inside joke is that the non-profit clinic is in cahoots with the cops. And indeed, police and White Bird staffers work together closely. If CAHOOTS is called, for example, about an apparently mentally unstable person walking in the middle of traffic, they know that’s not something they’re equipped to deal with. That’s a safety hazard and, besides, a violation of law. The crisis workers’ agreed response would be to call the police.
But in any event, 988 is coming, and it holds a great deal of promise, if it garners the commitment, the funding and the public attention required to make it work. It could end up being as pointless as just another phone number. Or it could be the beginning of a transformed emergency system that finally gives people in crisis but non-criminal situations someone to call, someone to come, and somewhere to go.
