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988: A step towards transforming mental healthcare in California

988: A step towards transforming mental healthcare in California

Mara Cavallaro is El Tecolote’s Report for America Corps Member who reports on mental health & healthcare inequality in the Latinx community.

California has repeatedly failed people who struggle with mental health and whose families call for help. In 2020, when Angelo Quinto’s family dialed 911 from Antioch for emergency assistance, police arrived on the scene and killed him. The year before that, in 2019, police shot and killed 23-year-old Walnut Creek resident Miles Hall during a mental health crisis. Taun Hall, Miles’ mother and AB-988 advocate, told CalMatters that had she had another emergency number to call, “Miles would be alive today. With everything I have in my body, I believe that.” 

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Next month, the framework for an alternative number will be in place, and with it, an opportunity to rethink state responses to mental health emergencies and implement policies that reimagine public care. Beginning July 16, dialing “988” will connect callers with an expanded National Suicide Prevention Hotline, thanks to federal legislation from 2020.

Publicized by the California Department of Health Care Services as an “alternative to 911 for people seeking help during a mental health crisis,” the new number should eventually be interoperable with 911. In other words, if someone dials 911 with a mental health crisis, the call should be transferred to a 988 call center. 

It seems unlikely, though, that the interoperability goal will be met this month statewide. “We’re going to start with one 911 call center, work out the kinks, work out the protocols, and then slowly build out to the rest of the team,” said Binh Au, the Alameda crisis line program director. “A more formalized process is going to take some time to build.” 

Au’s call center, Crisis Support Services of Alameda County, is one of 13 centers that currently answer National Suicide Prevention Hotline calls and that will answer the state’s “988” calls. Of those 13, four others — San Francisco Suicide Prevention, Contra Costa Crisis Center, Starvista, and San Rafael’s Suicide Prevention and Community Counseling — serve the Bay Area. For the most part, California’s call centers are limited to remote (ie. over the phone) services. 

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To date, $20 million in state funding has been designated to support 988 implementation. Dr. Le Ondra Clark Harvey, CEO of the California Council of Community Behavioral Health Agencies (CBHA), which includes the 13 988 call centers, told El Tecolote that so far that funding has gone towards hiring and the technological infrastructure for an interoperable hotline.

However, as California’s call centers prepare for a predicted doubling of calls, texts, and chats with the easy-to-remember 988 number, it has become evident that $20 million in one-time funding will not be enough to support the expanded lifeline. On May 25, the CBHA requested additional funds from Governor Newsom. In their letter to the governor, they wrote, “California is not prepared to deliver on the promise of 988. We will not be ready to connect callers with lifesaving mobile crisis response or crisis receiving and stabilization centers. However, with a small $8 million investment, we can ensure that, at the very least, the California crisis centers are ready and able to answer the calls…” 

The mobile crisis response teams and crisis stabilization centers that the CBHA refers to as part of the “promise of 988” are central to legislation introduced by Assemblymember Rebecca Bauer-Kahan (D-Orinda) last year. AB-988, also known as the Miles Hall Lifeline Act, recognizes that the introduction of 988 is just a first step. “AB-988 is really a special, unique opportunity that California has. It’ll transform the way that behavioral health crisis response in California is conducted,” Jordan Curley, Bauer-Kahan’s Chief of Staff, told El Tecolote

The bill, which held two senate hearings this week, seeks to scale up 988’s services by establishing a phone line surcharge. The fee, of up to 30 cents per line, would serve as an ongoing source of funding for the hotline. Equally important, AB-988 outlines a five-year plan for the creation of mobile dispatch units that can respond in person to emergency calls, as well as crisis stabilization programs to provide short term patient observation and professional support. Californians have been able to call Suicide Prevention Hotlines and speak with someone over the phone for decades. AB-988 seeks to finally establish a consistent system for in-person responses to those calls. 

Washington, Colorado, and Nevada have already passed lifeline funding legislation similar to AB-988. And at the local level, a handful of counties have been practicing similar models of mental health care response, most famously in Eugene, Oregon. Eugene’s CAHOOTS (Crisis Assistance Helping Out on the Streets) program is transferred over 20 percent of calls to 911— the calls that are nonviolent and have a behavioral health component. Instead of police, CAHOOTS dispatches a medic and a crisis responder, who bring medical supplies and blankets with them. Program Coordinator Ebony Morgan told NPR that in thirty years of operation, “we’ve never had a serious injury or a death that our team was responsible for.” 

By contrast, as the cases of Miles Hall and Angelo Quinto demonstrate, involving law enforcement in mental health crises has caused preventable deaths. Binh Au told El Tecolote that “many of our community members…have trauma around the police.” And yet, in the East Bay, several existing mental health mobile crisis teams—such as CATT, the Alameda City CARE Team, and the Fremont MET team—involve law enforcement. Still, consensus among advocates and mental health professionals on the need to remove police from mental health responses is growing. Oakland’s MACRO program, which is in development, has made a commitment not to involve law enforcement in their mobile responses. 

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Looking beyond AB-988’s five-year plan, Kulwa Apara, Alameda CSS’ Spanish text line supervisor, expressed the need for more mental health housing programs. “One thing that I would say has been a major stressor…especially for Spanish speaking clients—is definitely the increasingly exorbitant cost of living in the Bay Area,” she said. “The housing crisis is really pushing people to the edge.” 

There is a lot of work left to do to ensure a comprehensive societal response to mental health crises—whether that be mobile response units, greater state funding for call centers, or housing programs. But the Bay Area is fortunate to count on dedicated professionals like Au and Apara who are prepared to respond to the community’s mental health needs. 

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“With COVID and discrimination and acts of violence within our schools, it makes sense that people live with suicidal thoughts,” Binh Au told El Tecolote. “It makes sense that people live with depression or anxiety. It’s not your fault that you have those feelings. And there’s help for folks. We do have capacity. We want people to reach out…It doesn’t have to be an emergency, it doesn’t have to be a big thing. You deserve to be heard, you deserve care and kindness. You deserve the help now.”

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*The National Suicide Prevention Lifeline has both English and Spanish lines. Other languages should be accommodated for by call interpreters. Anyone can call. 

To reach the National Suicide Prevention Lifeline before July 16, call 800-273-8255

To reach the National Suicide Prevention Lifeline on/after July 16, call 988 or 800-273-8255.

For Crisis Support Services of Alameda County’s text/chat line in text “Safe” to 20121 or “Seguro” to 20121. English text line hours: 4pm-11pm 7 days/week. Horario español: 5pm – 9pm martes-viernes.

To reach San Francisco Suicide Prevention text line, text 415-200-2920. 

To reach the Contra Costa Crisis Center text line, text ‘HOPE’ to 2012

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