Four months after Santa Clara County rolled out its 988 mental health crisis call center and intervention teams, the program remains short-handed, testing the confidence of mental health advocates who have eagerly awaited its arrival.
In several cases, 988 calls resulted in a police-only response, which runs counter to the program’s goal of lowering the risk of officer-involved shootings and limiting law enforcement’s interactions with people in crisis. In other instances, hotline callers say they were placed on lengthy holds or routed to the wrong call centers, a result of area code discrepancies.
Launched in mid-July, 988 is a national suicide prevention hotline intended to provide mental health resources to people in crisis as an alternative to 911. Santa Clara County is one of the few call centers in the state to pair in-person services with its 988 line, and has been heralded as a leader in suicide prevention in California. But some have grown wary of the service.
“Our protocol now is to not call 988,” said Sparky Harlan, CEO of the Bill Wilson Center, a nonprofit that serves unhoused people and runaway youth. “We don’t even expect a response.”
Despite growing concern about police responses to these calls, only three of the more than 1,700 calls to the county’s hotline have been diverted to 911 since 988 launched in July, Santa Clara County Health System spokesperson Maury Kendall told San José Spotlight—all of them involved a threat of violence or self harm.
“The majority of 911 responses (to local 988 calls) are due to the call rolling over to state 988 operators, who handle calls that are not picked up within a set number of rings,” Kendall said. “State 988 operators are not familiar with the additional services offered by Santa Clara County.”
The county is working to educate state operators on the local resources available in these cases, Kendall said.
Handcuffed to a stretcher
On Aug. 12, a 21-year-old woman arrived barefoot and talking to herself at The HUB, a San Jose drop-in center for youths who’ve aged out of foster care. HUB staff called 988 requesting a mobile crisis team.
“Nobody felt in danger or at risk,” said Harlan, whose staff runs The HUB. “We were just trying to get her help.”
One of the crisis teams was busy and asked the San Jose police to handle the call. Two officers arrived and told HUB workers they couldn’t do anything unless someone pressed charges against the woman, Harlan said. The staff refused, so the officers left.
Over the next several hours, HUB workers called 988 at least four more times, Harlan said. Meanwhile, the woman began shouting at HUB clients and workers, then broke a window and crawled through the shattered glass, slicing her legs.
When HUB staff finally called 911 to request an ambulance, Harlan said, an officer told them they would not respond unless staff agreed to press charges. Ultimately, HUB had no choice.
Thirteen officers arrived, followed by the 988 crisis team. Police forbade the team or HUB workers from approaching the young woman as officers handcuffed her to a stretcher, Harlan said. Officers took the woman to a hospital to be treated for her wounds, then to jail, where she was placed on a psychiatric hold.
“County 988 operators will not tell a caller that a crisis team is not available,” Kendall said, and should always forward callers to the appropriate mobile crisis resource. He declined to comment further on the incident, citing privacy concerns.
In another recent 988 call on behalf of a suicidal teenager, Harlan said, an operator referred her to the 911 non-emergency line. Other callers have reported police running warrant checks during 988 call responses, being hung up on by operators, placed on hold for several minutes during calls and non-local numbers being routed to call centers several states away.
Need for patience
Nonprofit leaders charged with running the crisis teams urged the need for patience during a monumental restructuring of the county’s mental health crisis response—one that may be years from reaching its full potential.
“We’re not going to flip a light switch and everything’s going to be different,” said Karen Meagher, clinical director of Pacific Clinics, a nonprofit contracted with the county to lead the newest mobile crisis team, TRUST. “But (988 is) grounded in the right perspective and the right philosophy.”
TRUST launched last Monday, one of the county’s two crisis teams that does not include police. Critics hope that if the county can resolve its staffing issues and call center hiccups, TRUST could become the model for mobile crisis response.
Kendall denied that 988 callers are placed on extended holds, saying that all local 988 calls are automatically routed to backup call centers after 30 seconds.
He acknowledged the “confusion and delay” experienced by callers with non-local phone numbers, but said it was a statewide limitation. The county plans to implement geo-location services that will direct non-local numbers to the closest 988 call centers next year.
A nationwide shortage of behavioral health workers has hit the county hard, leaving the county’s call centers and crisis teams short-staffed.
“It’s a bit of a struggle to recruit,” said Bruce Copley, director of the Department of Alcohol and Drug Services.
The issue is exacerbated by the county’s high cost of living. But the county is working on incentives to attract more clinicians to 988, Copley said, including a $5,000 sign-on bonus.
County Supervisor Susan Ellenberg said she’s heard many of these complaints, adding that the county needs a further review of its 988 response.
“That’s where I think we are struggling right now, to get the right groups out in the right circumstances,” Ellenberg said.
Kendall did not respond to claims that officers run warrant checks during 988 calls.
A new service brings hope
988 critics say they’re hopeful the addition of TRUST to the county’s repertoire will help streamline its response to these calls.
“As a mother, I would feel more comfortable calling if I knew TRUST would come out,” said Regina Cardinas, a Silicon Valley De-Bug organizer. “I (work with) many mothers and fathers who did call police in those situations and their children were killed.”
Local police agencies have begun referring 911 calls to the TRUST team, and 988 callers can now specifically request a TRUST response, Meagher said.
TRUST, which consists of a first aid responder, crisis intervention specialist and a peer specialist with lived mental illness experience, doesn’t have a police officer. But there are extreme circumstances when they may need to request police assistance—encounters with an imminent suicide attempt or an armed person.
“The most important thing when you’re responding to mental health crisis is safety: safety of the person who is in crisis and also the safety of the people who are responding to the crisis,” Meagher told San José Spotlight. “We don’t have the capabilities to intervene with someone who has a gun.”