Mara Cavallaro is El Tecolote’s Report for America Corps Member who reports on mental health & healthcare inequality in the Latinx community.
On a Wednesday afternoon in August, five in-person phone operators wait for a call to Alameda Crisis Support Services in Oakland. It’s one volunteer’s second day, and another’s 24th year. They sit at lime green desk chairs, except for Linsey Parecadan, this shift’s supervisor, who sits on the couch she used to sleep on when she worked the “overnight”—a 4AM to noon stretch.
Now, due to the pandemic, most crisis line responders work from home. The bright room is quiet, apart from soft conversation and the periodic BART train. And then, the phone rings.
In the two weeks following implementation of 988 as the National Suicide Prevention Hotline number, average weekly calls to Alameda CSS, one of six 988 call centers in the Bay Area, have increased by about 30 percent. Average daily talk time has also gone up, and hovers around 8 hours and 45 minutes. Simultaneously, however, social media has been flooded with concerns about the mental health hotline’s involvement of police and questions about how it operates.
If you read nothing else in this article, let it be this: In cases of mental health crisis, 988 is a safer phone number to call than 911. You will be connected with trained mental health responders. However, for about 0.67 percent of all calls to Alameda CSS, or 30 percent of “high-risk” calls, know that law enforcement will likely get involved. This happens with or without consent in cases of “imminent risk,” or when someone is likely to die soon, according to the call center. Nationally, that number is a bit higher: the lifeline reported that around two percent of calls to 988 involve emergency services.
Moving Away from Carceral Care
As it currently exists, the American healthcare system is designed to address mental health crises with carceral ‘care,’ or psychiatric responses that surveil and police. Stories about law enforcement intimidating, harming, or killing folks during a crisis—or about people being involuntarily hospitalized or institutionalized—demonstrate the inherent violence of this approach. They also reveal the flaws of health policy that prioritizes force and control over peer-led, caring intervention. And, as is often the case, marginalized groups are at greater risk of harm. A recent study found Black people were nearly three times as likely as their white peers to be forcibly admitted to psychiatric hospitals.
Callers, mental health professionals, and suicidologists all emphasize that police should not be responding to mental health crises. But in most areas, including Alameda County, there are no 24/7 dispatch alternatives yet. In Oakland, only two mobile crisis response teams, Community Assessment and Transport (CATT) and Mobile Assistance Community Responders of Oakland (MACRO) operate seven days a week. Both work from 7am to 11pm. “It’s not enough,” Parecadan said.
When CATT responds to crises, officers join clinicians on-scene. MACRO, according to its impact report from April 9 to July 15, “completed” 99 percent of its calls. Three calls—or .001 percent of total calls—were transferred to police.
Suicidologist Dr. Emily Krebs, who tweeted concerns about 988, told El Tecolote that to truly prioritize safety, there should be “programming that’s totally separate from law enforcement.” As of now, two major 24/7 lifelines, BlackLine and the Trans Lifeline do not involve police, ever. The Trans Lifeline website reads, “while intended as a last resort on many hotlines, in practice [nonconsensual emergency responder interventions] are too readily used…”
At Alameda CSS, phone operators are aware of the dangers of police intervention and many of them do envision a system where mental health professionals and peers respond in person to crises instead. But until that system is established—and it should be, urgently—the most they can do is avoid police, and train new operators to avoid them too. The danger of involving police, especially when callers are people of color, is introduced in training, but “discussing police intervention from that perspective isn’t enough,” said Parecadan. “We do talk about it a lot [especially] post the BLM movement…[but] this is all new. We have a long way to go.”
“Our teammates are very sensitive to the power police hold. And so we work really hard to not involve the police in our crisis line calls,” Binh Au, Alameda CSS’ Operations Officer, told El Tecolote. “A person could hold pills in their hand and shake them in my ear and I could hear it—that does not warrant a police call yet…We’re going to explore every single option to help this person stay safe before we even think about calling the police.” According to Au, Alameda CSS only calls police when someone is likely to die—when responders can hear an attempt happening, or the caller becomes unresponsive after speaking about attempting.
When Yolanda Carcamo, a shift supervisor at Alameda CSS, calls the police because a caller is at imminent risk of death, she holds her breath. “I’m scared too,” she said. “It’s a moment of holding your breath until you know that that person is safe from this attempt but also that this person that you sent to respond is going to treat them in a manner where they are safe.”
CSS operators stay on the phone with the person in crisis, make sure the police know that mental health responders are on the line, that the person is in a mental health crisis, that they are not dangerous, and that they do not have a weapon. Even so, they are aware that the act of sending officers puts people in danger. We have to be “as loud of a voice” as possible, Carcamo said.
Consent and Emergency Care
Consent, or lack thereof, also plays a role in carceral care, though lines of consent can be blurred when someone doesn’t feel like they have options. People request law enforcement wellness checks, but what does it mean to consent to police presence in your home during a crisis when there is no 24/7 alternative? And how can life-saving non-consensual emergency responses be less carceral?
For Krebs and other critical suicidologists, “any hotline or resource that engages in nonconsensual active rescue is a carceral system that cannot be trusted.” And while Au asserts that CSS is “going to do everything we can…to collaborate with that person and to make a safety plan that we both can agree on,” ultimately, preventing death is the center’s priority. Kulwa Apara, CSS’ Spanish text line supervisor, said that “when a person reaches out, they are inherently saying that there is a little bit of them that wants to make it through this episode…We do want to keep the person alive because they may feel hopeful tomorrow.”
Although posts on social media stated that 988 had location tracing capabilities, Au said that Alameda CSS, at least, doesn’t use geolocation. “We would not be able to find you unless you gave us your address….Practically speaking, geolocation is not a thing at this time, and if it does become a thing then we will tell the community, because we believe that’s part of the consent piece,” he told El Tecolote. In fact, when callers dial 988, they are routed not to the nearest call center to their location, but to the call center closest to the region of their area code. If someone has recently moved to the Bay Area from Texas, for example, their call would be answered by someone in Texas. Connections based on area code mean that for many, response will not be localized: operators won’t know of resources nearby.
Michelle Alas Molina, policy director for Generation Up, a student-led advocacy group in California, saw graphics about geolocation and 988’s police involvement on Instagram. “Social media…can leave out bits and pieces of information that are important,” she said. “I recognize that 988 is not a perfect solution—it’s still potentially associated with police and the carceral system—but people know 911 and when people have a crisis, they call 911. What I am hoping is going to come out of 988 is a renewed vigor for non-police, non-carceral responses to mental health crises.”
A Systemic Approach to Suicide Prevention
Lack of access to healthcare, lack of affordable housing, and a minimum wage that does not reflect inflation all define access to care. And when we think about mental health, we need to be thinking about all of these things. “Suicide prevention [is]… giving places for folks to live, having access to food, having proper insurance,” Carcamo said. “You can’t avoid these thoughts if people don’t have access to health insurance, and access to fresh meals, and are worried about where they’re going to sleep from one night to the next.”
Nearly a fifth of all calls to Alameda CSS last year explicitly named basic needs (housing, employment, homelessness, food, etc…) or health (insurance coverage, illness) as a reason for calling. “At the end of the day, a lot of our mental health distress is really triggered because poverty is hella traumatizing,” Apara told El Tecolote. “And there’s a lot of poverty in Alameda county.”
As advocates work toward safer, more comprehensive systems of mental health care, 988 is a valuable resource to know about. “If a person needs someone to talk to, 988 is still a better option than 911,” Krebs said. And “as 988 shifts to what it was initially promised to do, which involves increased funding to local crisis centers and the mobilization of more non-police mental healthcare units, I think (or hope) it will become safer.”
Lifelines that do not involve police:
BlackLine: 1 (800) 604-5841(according to the BlackLine website, they’re a hotline “geared towards the Black, Black LGBTQI, Brown, Native and Muslim community. However, no one will be turned away from the Hotline.”)
For more information about Alameda’s 988 call center, visit https://988alamedacounty.org/.
To apply to work at Alameda CSS, which is actively recruiting people of color and Spanish speakers, visit https://www.crisissupport.org/get-involved/.
Read more about 988 here: https://eltecolote.org/content/en/988-a-step-towards-transforming-mental-healthcare-in-california/