The 9-8-8 Helpline Exists In An America Full Of Broken Systems — Of Course It’s Flawed

On Saturday, July 16, 9-8-8, the 9-1-1 alternative designed specifically for mental health crises, was launched across the country. Ahead of the rollout, many predicted there’d be kinks and flaws with the hotline, which is a reboot of the National Suicide Prevention Lifeline (NSPL), designed to be much easier to remember in a crisis than the original 1-800 number. And those so-called “kinks” with 9-8-8 seemed to get a lot more attention than the good the line can do after the number launched. Perhaps the most concerning issue with 9-8-8 was that, in some cases, police will be called to respond to 9-8-8 calls — for example, if the person answering thinks you’re at risk of harming yourself and others (which was also true when you called the previous NSPL 1-800 line). This police or Emergency Medical Services (EMS) involvement may be consensual or not. This news was surprising to many, as 9-8-8 has been touted as a way to help reduce harmful police interventions in mental health emergencies. And while it very well might do that, many said the fact that police or other emergency responders can be called at all was under-advertised. 

When police or emergency medical teams are called without a person’s consent, it’s called “nonconsensual active rescue,” which “is dangerous because people with actual or assumed mental illnesses die at the hands of police at high rates, especially when they’re also people of color, trans people, immigrants, and/or members of other marginalized groups,” says Emily Krebs, PhD, who tweeted about the issues with 9-8-8 and who’s been studying suicide since 2014. “Beyond this, involving police can lead to long-term issues such as people losing custody of their children, losing housing, and being fired from their jobs. There are also major concerns about PTSD from being treated like a criminal — and coming face-to-face with firearms, in many cases — during a mental health crisis.” 

Fewer than 2% of calls to the line required connection to emergency services like 911, according to the 9-8-8 FAQ website from the Substance Abuse and Mental Health Services Administration. 

But 9-8-8 is now a much better option than simply calling 9-1-1 for a mental health crisis, according to JaNaè Taylor, PhD, psychotherapist and founder of Minding My Black Business. This is because people trained in mental health crisis response should be responding to the calls, versus a garden variety 9-1-1 operator. The folks on the other end of your 9-8-8 call are ostensibly less likely to call police or EMS, she says, and in some states and cities (but not all), they’ll have the resources to send a “mobile crisis response team” trained in mental health instead. And that could save lives (if it operates as designed) because people ideally will get better care in response to their crises with less interaction with cops — imperative, because one in four fatal police shootings between 2015 to 2020 involved a person with a mental illness (and the folks who survive are more likely to face jail time). But, again, the fact that police may be called at all after dialing 9-8-8 is concerning to many.

Already, people are hesitant to call 9-1-1 — a survey by the National Alliance on Mental Illness (NAMI) found that 46% don’t feel safe calling 9-1-1 if their loved one is having a mental health or suicide event. 9-8-8 gives them a different option. Still, it certainly isn't a perfect solution and a similar kind of distrust of the number could form, because there are still gaps in the system. 

Although the crisis helpline may be incredibly helpful to some people who need to just talk something through or be pointed to resources, if in-person help is needed immediately, there will be a group of people who are at risk of police interaction, especially if their community hasn’t set up enough or any “mobile crisis teams” trained to respond, Dr. Taylor says.

While 9-8-8 is well-intentioned (it’s designed to be a place where you can call and get help for a variety of mental health issues from trained counselors) and may very well do a lot of good, it’s far from perfect. In part, this is because it exists in an America already full of broken systems — systems of criminal justice and healthcare, and, yes, mental healthcare, says Fanny Tristan, LCSW-R, a therapist and founder of Restority Space, which offers group and individual therapy. “It’s wonderful that we have a number like this now, but it’s not the answer to everything,” says Tristan. She echoes Dr. Krebs’ concerns about marginalized communities being most at risk with police intervention and agrees that a line isn’t enough, it also needs even more infrastructure around it — mobile crisis teams everywhere designed to respond to emergencies instead of police, and support for after the initial crisis has passed. “If you’re going to fill in the gaps, fill in the gaps,” she says.

Some states are doing a better job with infrastructure around the line than others, adds Dr. Taylor. Where Dr. Taylor lives, for example, in Virginia Beach, VA, there is only one mobile team she knows of equipped to respond in crisis situations, which is not enough. “I think 9-8-8 is a wonderful tool, but there are some gaps and we need more infrastructure around it," she says. "There need to be other tools." A goal baked into 9-8-8 is to eventually have more mobile crisis teams and crisis stabilization programs where people could go during or after a crisis everywhere, but, due to funding and logistics, these programs aren’t in place in all areas.

Wendy Burch, executive director of NAMI-NYC, agrees that there needs to be more infrastructure and connection to local resources and mobile mental health crisis units. Burch also believes law enforcement should be getting more training as well on how to respond in extremely high risk situations with those dealing with a mental health crisis or mental illness, which is something NAMI has helped facilitate with different departments, including in New York.

All this goes to show why more localized training and responding techniques, and even more federal, state- and local-level funding is crucial (meanwhile, some are worried knowing that the millions in federal funding dedicated to staffing at call centers is set to expire in a few years, and that several states such as Ohio haven't approved long-term funding plans for the hotline, which is federally mandated). All concerning, especially since the line has gotten so much bad press already around police interaction, which may lead to fewer people feeling comfortable calling in at all. “I believe that any crisis hotline that engages nonconsensual active rescue will scare people away from calling,” Dr. Krebs says.

Another potential issue with 9-8-8 is call volume. The NSPL line, which was established in 2001 and can still be reached at 1-800-273-8255, already reportedly had long hold times. A New York Times data analysis found that of the approximately two million calls to the Lifeline last year, more than 17% were abandoned before callers could get help. The numbers were even worse for Lifeline texting and online chats (you can both text and chat via the website) — with 41% of texts and 73% of chats not attended to. Although people abandon calls for lots of reasons, a long hold time is problematic, and can potentially lead to even more police intervention if someone hangs up and calls 9-1-1 instead. In a written response to a request for comment, a spokesperson for 9-8-8 and Vibrant Emotional Health, the nonprofit administrator of the NSPL, told Refinery29: “It is worth noting that 80% of callers that abandon do so after waiting two minutes or less after the greeting. Of all calls that were marked as ‘Abandoned By Caller’ during 2021, 28% called back within 24 hours and were connected to a counselor.”

With 9-8-8, the counselor you speak with is will ideally be in your state, but may be rerouted elsewhere if someone local can't answer. “​​9-8-8 has been initiated without much of the background labor and funding that needs to be in place,” Dr. Krebs says. “That means that, right now, many calls to 9-8-8 aren’t answerable by those local centers and instead are routed to the [national call center], which openly engages nonconsensual active rescue and describes its procedures for doing so publicly online.” 

“Through 9-8-8, and the larger crisis care continuum, we have the chance to reimagine how we respond to people in mental health crisis,” the spokesperson for Vibrant Health said in response to a request for comment. “Our hope is that with a fully resourced crisis care continuum, all mental health crises will be responded to with effective and supportive mental health care.”

Dr. Taylor notes that fear of having the police called is absolutely a fair concern, but time will tell how frequently police are involved in these situations, and 9-8-8 is still a much better alternative to calling 9-1-1 in the first place. “I am leaning towards being hopeful, particularly because the people who answer the calls are mental health professionals, and they’re people who are well-trained and skilled in de-escalation,” she says. “But we need more supports around it and we’re going to have to continue doing a big push to advertise around it because I can see there being skeptics and misinformation.” 

Tristan herself is a bit of a skeptic because of the police intervention aspect and because it’s so new, and says she’d send her clients in New York to NYC Well, a more established mental health crisis support program, before 9-8-8 because she knows more about how people will be cared for with that option. Dr. Krebs recommends Project LETS and the Fireweed Collective as alternatives, as well as Trans Lifeline. But Dr. Taylor notes that a lot of the country doesn’t have local alternatives like NYC Well and they won’t always have time in a crisis to research other options, so she’ll be updating her answering machine message to tell people to call 9-8-8 in an emergency if she’s unavailable after hours. She hopes that as the line gets going, even more infrastructure and supports around it will come to be so that fewer and fewer police and other emergency responders need to be called. 

“9-8-8 is a solid step one,” Dr. Taylor says. “But there need to be other steps.”