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By Julie Whittaker

For the Enterprise

In March of 2022, the nationwide implementation of 988 was coming.

NC Health News reported on the Crisis Hotline rollout. Congress passed the National Suicide Hotline Designation Act of 2020 which created the 9-8-8 hotline.

The 9-8-8 mental health crisis number is designed to give people a different option that isn’t routed through law enforcement. State lawmakers passed a budget in June that directs $1.3 million in annual funding for the 988 call center. Earlier this year, North Carolina received a $3.3 million federal grant from the Substance Abuse and Mental Health Administration to help with the launch of 988.

Amanda McGough, board president of the N.C. Chapter of the American Foundation for Suicide Prevention, is concerned that the crisis response network has not been fully funded throughout every area of the state and the country. There needs to be enough people to answer the phones and respond on the ground in every community, she said.

988 was launched on July 16.

What has been known as the Suicide Prevention Lifeline was updated to enable the use of a short number to call or text, 988; and renamed to be the Suicide & Crisis Lifeline. North Carolina contracted with Real Crisis Intervention headquartered in eastern NC,  to manage calls, refer them to trained counselors who begin listening and working with persons regarding their crisis, then work to de-escalate and guide them to mental health resources.

If the person needs more help, the counselor can redirect the call to a local mobile crisis team of mental health responders. For Davie that means Daymark Recovery Services’ Mobile Crisis Team will learn where to go, and report back their expected availability. The MCT covers several counties. So, they have a window of time to respond which depends on their location. If the mobile crisis responders don’t expect to be able to respond in person within two hours, then the call is routed to the 911 center for the location of the caller.

Davie County chose not to create a local mental health crisis response team a few years back, when issues with transporting mental health patients were considered by the NC Legislature. These considerations resulted in the 2019 passing of Senate Bill 630. It mandated that mental health crisis plans be developed, and this presented an opportunity to make improvements to the process. But few counties did that, many like Davie put the current plan into writing without making any changes regarding responses to mental health patients. Since we had access to the ‘regional’ MCT, it was decided if they could not get here fast enough, then Davie’s law enforcement would still need to respond.

The full intent of the 988 initiative is to establish mental health responses without the automatic use of law enforcement. A few NC counties developed local mental health crisis teams in a variety of ways and had them working before or by July 2022.

But not Davie.

Michelle Ivey, chief program officer with Daymark, is serving on a statewide group planning for the implementation of 988. She reports that the Mobile Crisis Team is fully staffed, and ready to respond, but over the past several years they have not received many calls from Davie. A consultant from the group revealed through her, that NC’s 988 counselors will call 911 in the caller’s area, and it will be up to that county’s 911 Center to direct the response.

Davie’s Director of 911 Communications, Rodney Pierce says, “From the 911 standpoint, if a person calls 988 directly, they will be speaking to a crisis counselor, based on that evaluation and if a response is deemed necessary, they would contact the 911 center and request the appropriate help if needed. If the person dials 911 directly the call would be processed through our emergency medical call taking protocol: Psychiatric /Abnormal Behavior/Suicide based on the particular case and the final coding the approved response would be dispatched.”

Sheriff JD Hartman said his department strives to have officers Crisis Intervention Trained soon after they are hired. But he cannot guarantee that a Crisis Intervention Team will be available when there is a call about a mental health crisis. Unfortunately, our sheriff’s department is not finding it possible to have every officer trained using the full 40-hour Crisis Intervention Team course. The newer officers are trained using an alternative 16-hour course, to save time and money. Further, the department’s turnover rate makes it difficult to have officers trained for mental health crisis before they are on the job.

This leaves Davie residents experiencing a crisis in the hands of law enforcement, who are not fully trained to address their needs. More about Crisis Intervention Teams can be learned from “A Best Practice Guide for Transforming Responses to Mental Health Crises,” published in 2019.

The sheriff and the director of Emergency Services were asked if there are any plans to develop a dedicated trained team for mental health crisis calls, perhaps through the new community paramedics program. Hartman said he could not speak to what another department is planning, “…other than to say that I have always been an advocate for a mobile crisis response team. The issue is and always has been that only law enforcement will respond in a timely manner.” Unfortunately, the Director of Emergency Services, which includes the community paramedics program, did not respond.

Furthermore, Ms. Ivey reports; “The state is in the process of doing an assessment for the MCM teams across the state. It is my understanding that the assessment outcome will determine the next action steps from the state [regarding] rates or flat funding.”

Now, with a national initiative, that describes the best crisis response scenario; people can call or text 988 and speak to a trained counselor,

Great.

The state is working on how to support funding for Mental Health Mobile Crisis Teams to be dispatched to people with urgent need. Davie could be served by a team that may not be able to respond within two hours, and defaults to law enforcement with inadequate training for this need.

While there is a national and state effort to improve mental health crises responses, Davie officials do not appear to be thinking about or working together on how to develop and fund a local Mental Health Crisis Response Team.

If you were having a heart attack or stroke, would you consider response by minimally trained law enforcement acceptable?

Not likely, and it is not acceptable regarding a mental crisis because this too can be life threatening.

Developing local crisis response teams is not a state responsibility, it is a local responsibility. The CIT manual mentioned above is a free community how-to guide that we can use to help get us started. We must advocate for community mental health services and supports; the best crisis response should be a top priority. Please join me in advocating for the funding and development of the best and most timely response for mental health crises.

Julie Whittaker is with the DC Mental Health Advocates and NAMI NW Piedmont.