Is 911 Outdated and In Need of a Behavioral Health Change?

Along with emergency triage, treatment, and transportation, the US Centers for Medicare and Medicaid Services covers emergency medical response providers who transport patients to an alternative facility such as a primary care office or community mental health center. ET3 also covers emergency responders to initiate treatment at the scene or via telehealth, along with a qualified healthcare partner.

According to Vice President Justin Miller, the ET3 model also encourages local governments and other entities that have a vision to promote and establish medical triage lines for low-intensity 911 calls and reduce avoidable transportation to emergency departments and hospitals. or has authority over 911 dispatch. Customer success at eVisit, a telemedicine technology and services company.

“Navigators help triage people who have called 911 and previously entered the emergency response pipeline by ascertaining whether they are eligible for a telehealth call or an actual emergency visit,” he explained. Healthcare IT News Last year.

“The dispatcher connects the caller with a nurse who will try to understand the patient’s concerns and connect them to the correct provider before dispatching an ambulance crew. The focus is on providing the right level of care at the right time,” he said as he traveled to the country to observe telehealth during the pandemic.

As a federally funded five-year pilot project, ET3 aims to make emergency medical care more accessible. However, CMS has already announced the abolition of ET3 two years in advance – effective December 31.

CMS recently announced on its ET3 website, “The decision was made due to lower-than-expected participation and fewer interventions than anticipated.”

“Emergency medical services remains an area of ​​focus for CMS, and we believe the lessons learned from the ET3 model can aid in the development of potential future initiatives.”

Meanwhile, according to the following article from Molly Castle Work, a California campaign is lobbying to shift responsibility for some 911 calls to the healthcare sector based on the success of public safety dispatchers initiating clinical triage by nurses in mobile crisis units. Is. KFF Health News,

A wealth of evidence shows that police often fail to respond appropriately to people experiencing a mental health crisis. This can lead to avoidable deaths and criminalize mental illness, especially among people of color.

A poll conducted by Public Health Advocates, a Davis-based health policy nonprofit, found that more than two-thirds of California voters want behavioral health professionals to be part of the emergency response to non-life-threatening situations. Of the seven types of situations potentially requiring an emergency response, voters think law enforcement agencies are the least equipped to respond to calls about mental health crises and homelessness, according to a May 24 poll. Are.

Ryan McLinton, who manages Public Health Advocates’ First Response Transformation Campaign, said, “The police response has become a huge band-aid for something that a band-aid was never created to cover or fix. “

Her group and like-minded advocates in California are waging a campaign to overhaul the state’s 911 system so that instead of police, more mental health professionals and others with specialized training can handle many emergencies.

Law enforcement officials agree that 911 response requires a more nuanced approach. But powerful police unions are against proposals that could reduce their control over 911 operations and the budgets and staff that go with them. Police representatives contacted said they support alternatives that would complement rather than replace the current system, and that overall responsibility for 911 would remain with police departments.

“Our 911 dispatchers do amazing work and are the perfect people to handle people in crisis,” said Tim Davis, president of the Sacramento Police Officers Association, a union. “It is essential that 911 remains under the direction of the police department, as most of the calls they receive are for police services.”

However, McClinton said that the emergency response systems were out of date and in need of change. In several California counties, the change is already underway. According to a survey conducted by the County Behavioral Health Directors Association of California, forty-one of the state’s 58 counties have some form of mobile crisis services, in which mental health workers go out and respond to crisis needs in the community. .

CBHDA executive director Michele Cabrera said mobile crisis services will be operational in all California counties by next year.

Established in 1968, 911 was designed to report fires. However, it soon became an all-purpose system for dispatching a wider set of calls to the police.

Californians now make more than 25 million 911 calls annually. Nationally, about 15% are for behavioral health emergencies, according to a 2021 study in the Journal of Psychiatric Services.

Andrea Rivera, a legislative health advocate, said today 911 centers are inundated with calls that aren’t necessarily emergencies — an influx that the system was not built to handle.

“911 has become a challenge,” said Rivera, who works for the California Pan-Ethnic Health Network. “While this may be unfair to law enforcement who do not have the capability or training, it is especially unfair to members of the community who do not feel like they have someone to help.”

Alternative approaches varied widely across the state. For example, Santa Clara County has five mobile response teams that can respond to 911 calls, and can also be deployed by dispatchers at the National Suicide and Crisis Lifeline 988.

Some teams are made up of physicians and other trained professionals who can provide peer support. Some respond with police, while others arrive in plain clothes in a non-police vehicle.

Sandra Hernandez, a division director of behavioral health services in Santa Clara County, said the program is in its infancy but has been effective so far. One surprising thing she noted was how much community members appreciated being able to call for help without emergency vehicles arriving at their doorstep and alert nosy neighbors in a moment of crisis.

Hernandez recalled a letter his team received from a grateful resident: “My neighbors didn’t even know. They thought I had company.

Cities in Oregon, New Mexico and Colorado have similar programs.

Advocates point to cases such as Jaime Naranjo, a Sacramento County resident who was shot and killed by police at his home last year. Naranjo’s wife, Alyssa Naranjo, said her husband was suicidal and when she called 911 for help he was delusional and had a knife.

There is a mobile crisis support team in Sacramento, but it’s not 24/7 and Alyssa calls 911 outside its hours of operation. The Sacramento County Sheriff’s Office said when police arrived, the deputy asked Naranjo to drop the weapon, but he did not comply. That’s when Naranjo lunged at the deputy, who shot and killed him, the sheriff’s office said.

In California, proposed legislation would make alternate response a statewide requirement. State Senator Ayesha Wahab’s SB 402, which is supported by public health advocates, would require 911 service centers to dispatch professionals other than armed police officers for calls related to mental health or homelessness.

The approach, Wahab said, is similar to the role that 988 was meant to fill, but low awareness of the number 988 has been a hindrance to effectiveness.

Wahab introduced an alternative response program three years ago while on the city council in Hayward, and said its success inspired him to draft the legislation. He said the bill, whose fate will not be decided until next year, is his priority but acknowledged that implementing the statewide change would be complex.

Police union representatives said they support the idea of ​​an alternative response in principle.

“Our members are not mental health professionals,” said Alexa Pratt, communications director for the Orange County Deputy Sheriff’s Association. “We agree that law enforcement should not only be leading in addressing mental health calls, but should be there to assist with these programs.”

Tom Saggau, a spokesman for the San Jose Police Officers’ Association, referenced a pilot program in San Jose that police were initially skeptical about, until they saw that sharing the burden of emergency call response could benefit their work. How did the burden get reduced? The program has grown sixfold in eight years.

Saggau, who also represents the Los Angeles Police Protective League, a union, said Los Angeles has compiled a list of 28 types of calls that can be forwarded to other first responders and do not require police presence. .

Still, police departments are protective of their control over 911 and related personnel and funding.

Saggau criticized the 911 restructuring proposals as the result of the “defund the police” movement and expressed dismay that some advocates feel the redistribution of police budgets is needed to support an alternative response.

The effort to reduce police funding, which gained momentum internationally after the killing of George Floyd in 2020, is meant to reallocate funding from police departments to other government agencies that support social services.

Saggau said, “It’s either-or not.” “You can have a fully staffed, strong police department and you can have a strong alternative response model.”

Wahab believes it is important to ensure that physicians and other unarmed emergency responders are available in all cities and counties.

Wahab said, “It is very easy.” “You save lives by responding appropriately to a crisis.”

This article was written and produced by Molly Castle Work of KFF Health News KFF Health Newsthat publishes California Healthlinean editorial independent service of California Health Care Foundation,