Dramatic Rise in Police Interventions on 988 Callers

Editor’s Note: This story is the first part of a two-part series on 988. This piece addresses the increase in unwanted or coercive police interventions after 988’s implementation. The second part addresses issues around privacy and the sharing of the contents of conversations for AI development.

Two years and a billion dollars in, the 988 Suicide and Crisis Lifeline continues evolving rapidly. Vibrant Emotional Health (Vibrant), administrators of 988Lifeline under contract from the Substance Abuse and Mental Health Services Administration (SAMHSA), has spawned a political lobbying division that’s helping usher state infrastructure investments and legislative initiatives. The developments are aimed at gradually reshaping a loose network of call centers into a coordinated access hub for America’s “crisis care continuum” and mental health service system.

However, none of this is stemming the stream of 988 callers who receive unasked for, unwanted, or unexpected visits from police and emergency medical services (EMS)—and then get taken, with or without consent, to hospitals or crisis centers for mental health evaluations. Some report having been further subjected to forced stripping, solitary confinement, prolonged detentions, and even involuntary treatments.

Callers to 988 targeted by these practices describe feeling misled, betrayed, and ultimately battered by their experiences. And, contrary to 988 promoters’ promises of “getting police out of crisis care” and previous public assurances from SAMHSA and Vibrant about the low frequency of these police/EMS interventions, stunning new data show that the intervention rates have in fact skyrocketed—quadrupling in 988’s first year. And rates of police/EMS interventions on callers who discuss suicidal feelings appear to be even higher.

Openness is risky

A California-based mental health advocate and speaker, last summer Emily Wu Truong was distraught near the anniversary of her father’s death. She was out walking late at night, and didn’t want to bother relatives or friends, so she called 988.

Truong said she was not actively suicidal, but called so she could confidentially open up about her sadness and suicidal feelings—what 988Lifeline ads say the service is for. “I wanted to be anonymous while processing my emotions,” she said.

Truong did not know, and her local call center’s website did not disclose, that 988Lifeline’s “imminent risk” policy requires call-attendants to potentially contact 911 to trace calls and send out police/EMS if a caller expresses “a desire and intent to die and has the capability of carrying through.” NextGen911 allows tracking mobile devices to within three yards and, typically, police/EMS then take these callers—with or without consent—to a hospital or crisis center for psychiatric evaluation. Some call centers have started disclosing this practice, but often still mislead users; for example, SAMHSA’s 988 website says that call-attendants contact 911 only when there is “an immediate risk to life”—yet the actual policy explicitly states that it should be applied far more broadly.

The goal is to stop callers from killing themselves. But studies show that, for every person who’ll actually kill themselves, hundreds of others have desires and plans. Even experts barely beat random chance in predicting suicides.

People like Truong can get ensnared. In conversation, her emotions are close to the surface, and frequently flow out as expressively as the colorful outfits she often dons. It’s easy to laugh along with her exuberance—and tear up or fret about her sorrow. “I’m very public about my emotions and expressions,” Truong acknowledged. “So [the 988 call-attendant and first responders] were probably overwhelmed and at a loss. They didn’t know how to handle my over-expression. I was crying a lot, too.”

While pouring her feelings out to the 988 call-attendant—including without filter mentioning exactly where she was—paramedics arrived. Truong was taken to a noisy emergency room, forced into scrubs, monitored in the bathroom, put in solitary confinement, restrained in a gurney for transfer, and then detained in a psychiatric hospital. The experience, she said, felt like she wasn’t in a helping setting but “in a jail.” She was offered drugs but no therapy, and after two days of stress wondering why she couldn’t leave, she was sent home with $4,500 in medical bills.

“How does this promote healing?” Truong said, furious that a few people “overreacting” to her open emotions led to her psychiatric incarceration. “It’s traumatizing. It’s a living nightmare.”

When she asked for the recording of her call to buttress her complaints to 988Lifeline, Vibrant told her she’d have to get a court order—a policy Vibrant has implemented.

“If you want people to trust you, you need to show transparency,” said Truong. “Where’s the accountability?”

Elle has the same question—she felt threatened by the call-attendant and also got detained, and Vibrant refused to release the recording of her call as well.

Go to a hospital—or else

Elle (not her real name), a law student in her early 20s, often experiences traumatic flashbacks from a history of sexual assaults. A therapist recommended 988.

Last autumn, Elle called. “I just wanted somebody to walk me through those flashbacks and do things like grounding techniques or breathing exercises,” she said. “It’s just really nice to have another person as an anchor.”

Elle found the 988 call-attendant helpful. After ten minutes, though, the call-attendant asked her what city she was in, then abruptly transferred her call to that city.

The new call-attendant immediately pressured Elle for her full name and address—repeatedly. “Given the nature of my history, which involves stalking and assault, I was very, very uncomfortable giving her this information,” said Elle.

The call-attendant also asked Elle if she was suicidal—repeatedly. “I wasn’t suicidal. But I might have said something like, ‘I want all of this to stop.’ Meaning, my flashbacks. I was having severe flashbacks throughout this.”

The call-attendant asked if she was going to kill herself how would she do it. “She just kept pressing this issue of suicidality,” said Elle, who was not told she was being put through 988Lifeline’s risk-assessment. “I felt like I needed to answer. I felt like I couldn’t hang up. In the situations that I have been in with predators, I often found that the path of least resistance was the path that led to the least pain; so, you do what they want.”

Elle suggested she might jump from a nearby high-rise or obtain pills. The call-attendant then insisted that Elle drive to a psychiatric facility. Elle declined. “She told me that if I did not come in, she would have to send the police to my house.”

Elle drove herself. “I very much did not want the police to come and drag me out of my apartment.”

At the psychiatric facility, staff took away Elle’s belongings, including her smartphone and, over Elle’s pleas, a bracelet she’d worn every day since her late-grandmother gifted it.

Elle had never experienced psychiatric incarceration. “I didn’t know what was happening,” she said. “I was very terrified… Every access I had to the world was taken away from me. I could not keep the small things that might have brought me comfort.” She was confined in a room about six feet by nine with three chairs and a blacked-out window. She knew from her law studies that seclusion is extremely dangerous for prisoners—but never imagined she’d experience it herself. She pulled two stiff chairs together and curled up across them, hugging herself for warmth.

Hours later, two men strapped her to a gurney and drove her to a psychiatric hospital. After hours more waiting alone, Elle was ordered to sign intake forms.

“One of the forms was whether I was allowing myself to be admitted voluntarily or whether it was an involuntary admission.” Elle asked, if this was a voluntary admission, then could she leave? The admissions coordinator told Elle that if she didn’t sign in voluntarily, the detention would last much longer. By this point, Elle said her flashbacks had retreated and her “lawyer mind” was “kicking in.” She stifled an impulse to reply, “Fuck you, you goddamn bitch.” Later, Elle would study her state’s commitment law and submit complaints about the institution’s processes.

Over the next four days, Elle and others were corralled into a common room by day, where male patients frequently sexually harassed the younger women. One man talked about clothing he wanted to see Elle wearing, put objects she touched in his pants pockets, and described wanting to track her down outside hospital. By night, with no lock on her room’s door, Elle didn’t sleep.

“I wasn’t suicidal going in, but I sure was coming out,” said Elle.

In its April 2024 Report to Congress, SAMHSA admits “no research” validates 988Lifeline’s emergency intervention policy—while some research suggests psychiatric hospitalization may well heighten suicidality. Elle has frequent nightmares about the hospital, and scans streets for the threatening male patient to “make good on his promises.”

For Elle, involuntary psychiatric detention “was like being assaulted again, but in your entire brain, and also your soul.” With disturbing, visceral imagery, Elle described her experiences of sexual assault as being treated like an animal “valued” only for its “meat.” But in the psychiatric hospital, she said, “It’s like I was a rat, or a gnat… I don’t think it mattered to them whether I lived or died, beyond their own legal liability.”

After learning more about 988Lifeline’s intervention practices, Elle said, “It’s really frightening and inappropriate that somebody can ruin your life based on a ten-minute phone call.”

Vibrant and SAMHSA have long publicly said less than 2% of 988 calls lead to such police/EMS interventions and hospital detentions—but haven’t released actual data. Through a freedom of information request, Mad in America confirmed this rate from a 2017-18 national survey of crisis call centers.

Vibrant has also claimed that many emergency interventions occur “with consent” of callers, but former call-center staff challenge such characterizations. Notably, since Elle drove herself to hospital and Truong disclosed her location, both interventions would apparently be listed as “with consent.”

Recent data from one major 988 call center shed light on exactly how, and how often such interventions truly occur.

Types of intervention, levels of coercion

The New Mexico Crisis and Access Line (NMCAL) is operated by Protocall, a company that also runs hotlines for schools, communities, and corporations.

Wendy Linebrink-Allison, Protocall’s New Mexico Program Manager, said that their 988 contract with the state mandates aggregated public reports. Protocall supports the practice for providing insights about who’s calling and why. “It has really benefited our community partners,” said Linebrink-Allison. “They’ve always expressed appreciation.”

Linebrink-Allison understands criticisms of unwanted interventions by people like Elle and Truong. “I want to encourage people to continue to share their voices to facilitate change,” she said. But she worries negative stories can make people wary of calling. “I don’t want, at any point, people to feel like there’s no place for them to call.”

The data alone might make some feel that way.

Many 988 call centers, including NMCAL, still also take calls through a local 800-number crisis line, and combine data. Overall, police/EMS interventions occurred on 3.5% of all calls to NMCAL. (In most of the data discussed in this story, “contacts” or “calls” to 988 through text, chat, and phone are combined.)

However, the majority of calls to NMCAL don’t involve people discussing troubles. Protocall defines “clinical calls” as those involving someone discussing a serious concern instead of, say, just seeking information. According to their year-end report, clinical calls composed about 40% of their crisis line contacts in 2023.

For these clinical calls, NMCAL’s data describes interventions such as getting callers to contact 911 themselves, making a conference-call connection involving caller, call-attendant, and 911 dispatcher, and contacting 911 without caller consent.

Linebrink-Allison said these reflect the steps their call-attendants take. “We want to make sure that we’re involving people in their decisions, and we’re allowing people choice and a voice… We don’t threaten people… We encourage people to engage in what is best for them.”

Still, on average in 2023, at least 6.3% of clinical calls led to interventions apparently involving pressure or coercion, with 911 or police contacted by call-attendants rather than by callers.

Furthermore, only 27% of clinical calls involved people talking primarily about suicidal feelings, as opposed to work stresses, anxiety, substance abuse, or other concerns. People with suicidal feelings were targeted for coercive interventions much more frequently—in 15.1% of cases.

In other words, people primarily discussing suicidal feelings had odds of nearly one in six of getting an unwanted visit from police/EMS.

These rates seem high compared to SAMHSA and Vibrant’s claims—however, stunning new national data shows NMCAL implements such interventions less frequently than average.

Skyrocketing rates of interventions

A recently-released national survey conducted by NRI, the research arm of the National Association of State Mental Health Program Directors, gathered data on 3.5 million calls in 2022—about half to 988 call centers and half to non-988 centers (including centers that answer both 988 and local 800-lines). The survey found that, of all contacts, 3.6% resulted in law enforcement being dispatched, 1.9% resulted in EMS dispatch, and a further 2.3% of calls were transferred to 911 “which may have then dispatched law enforcement or EMS.”

In total, then, 7.8% of all contacts of all types received police/EMS interventions—nearly four times the rate previously claimed by Vibrant and SAMHSA.

What’s also striking are the wide variabilities; in one state, over 17% of all callers got police visits, and in many others, below 2%.

How many people does this represent? During that first year following the launch of 988 in 2022, the 988Lifeline handled about 5.2 million contacts. So, more than 400,000 callers that year received visits from police/EMS, and were likely taken to psychiatric institutions.

Mobile crisis teams (MCTs) are touted as a less-coercive alternative. But according to the same survey, 16.9% of calls resulted in MCTs being dispatched—and MCTs got hundreds of thousands more people taken to hospital emergency rooms or crisis centers.

When I presented the striking NRI findings to Vibrant and SAMHSA, they declined to comment, and did not provide other data.

Since many non-988 crisis lines implement interventions as well, the total numbers of people around the country affected each year are still higher.

Told of the 988 numbers, Truong cried, “People are just trying to find a helpful listener to validate and hold space! It’s fucking unacceptable.”

“I feel appalled,” said Elle. “Horrified. Angry. It makes you wonder how many of those people will never recover.”

Liz Latty helped research a forthcoming Trans Lifeline report on crisis hotlines, focusing on experiences of users from marginalized communities—including BIPOC, LGBTQ+, and self-identified disabled and mad people. Latty said many described damaging long-term impacts from these unwanted interventions on their privacy, safety, sense of identity, finances, and more. “It devastates people’s lives,” said Latty.

What’s driving it?

Since Vibrant and SAMHSA have for years refused to publicly release data on these interventions, it’s unclear if the rates have risen steadily across the country since 2018, or if the launch of 988 precipitated a sudden, massive increase.

The latter is certainly plausible: Early on, even proponents of 988 worried what might happen with a huge upsurge in calls coupled with no significant increases in mental health supports in communities to direct people to.

There could also be other factors at work.

It would obviously be simple to change the policy to implement interventions only with expressed consent of callers. And indeed, partly due to criticisms of the imminent-risk intervention practices from inside and outside 988Lifeline, during the original drafting of 988 legislation, the federal government declined Vibrant’s requests for direct access to 911’s call-tracing technology. Congress instead ordered a stakeholder consultation. However, the software company RapidDeploy has developed a technical workaround. Already installed by Mental Health America of Greenville County (MHAGC), 988 call-attendants in South Carolina can connect directly to 911’s call-tracing system. RapidDeploy said in 2022 that South Carolina was “the first of many states.” These and other tightening relationships between 988 and 911 could be part of what’s driving the rising rates.

Neither MHAGC nor RapidDeploy responded to requests for interviews. SAMHSA and Vibrant declined to respond to questions about 988Lifeline uses of RapidDeploy.

SAMHSA also hinted to Congress that Vibrant could be using “new technologies” to “enhance the precision of identifying imminent risk situations”—in other words, AI bots may be monitoring calls and flagging people for police/EMS interventions, as occurs in Canada’s 988 system. Such alerts could generate bias or even put pressure on call-attendants.

Even as these questions hang in the air, though, SAMHSA’s obscure remarks to Congress about new technologies and 988 serve as a cryptic warning about a vast new frontier opening up for entirely different kinds of breaches of confidentiality and privacy. There appears to be a goldrush on among researchers, AI developers, and corporations as Vibrant and 988 call centers have started sharing recordings and transcripts of the intimate voice, chat, and text conversations of people contacting 988.

In the second part of this series, Rob Wipond takes a deeper look into these issues around privacy and the sharing of the contents of conversations for AI development.