The first few seconds of a 911 call often determine everything that follows, and information can be just as important as speed.
In Memphis, city leaders hope a new method of response during those initial seconds will improve the way mental health emergencies are handled.
“Not every emergency is the same,” Mayor Paul Young said. “A person that’s experiencing a mental health crisis may need a different kind of response.”
Callers to 911 in Memphis can now identify a mental health crisis alongside requests for police, fire or EMS. Officials say the added option allows dispatchers to recognize behavioral health emergencies sooner and begin coordinating the most appropriate response.
The so-called “fourth option” is designed for situations that can quickly become overwhelming for families — someone threatening suicide, experiencing a psychotic episode, suffering an overdose or facing another behavioral health emergency.
‘Police, fire, EMS … or mental health?’
The added category, announced Wednesday, Aug. 26, at the Memphis EMS command center, adds mental health to the choices callers hear when dialing 911.
For families, Young said, the change provides a way to communicate the nature of a crisis from the outset.
“This is a mental health crisis. This is the kind of help that we need,” he said, describing the message callers can now convey at the beginning of an emergency call.
Once callers identify a mental health crisis, they are not locked into a particular response. Instead, dispatchers begin asking another series of questions to determine exactly what is happening and what resources should be sent.
Angie Sullivan, deputy chief of EMS for the Memphis Fire Department, said the call is then transferred to the fire department, where emergency medical dispatchers continue gathering information before deciding how best to respond.
In some cases, that means dispatching the city’s CARE Team, a partnership between the Memphis Fire Department and Alliance Healthcare Services that pairs a paramedic with a licensed clinical social worker. The team operates 12 hours a day and responds to behavioral health calls when available, providing both medical and mental health expertise on scene.
If the CARE Team is unavailable, Sullivan said, an ambulance is dispatched.
Dispatching the right kind of help
The biggest change isn’t necessarily who responds to a mental health emergency. It’s when dispatchers know that’s what they’re responding to.
Those first moments on the phone can shape everything that happens afterward.
“So many times officers are dispatched to various types of calls without knowing whether or not the individuals … experience mental health challenges,” Memphis Police Chief Cerelyn “CJ” Davis said. “With the fourth option, our supervisors and communications dispatchers can appropriately send quickly the appropriate help.”
Davis said the change should also reduce delays by allowing police officers, firefighters, EMS personnel and behavioral health responders to be coordinated earlier rather than requiring officers already on scene to request additional resources after discovering a mental health component to an emergency.
Preparing for that response required more than simply adding another option to the opening 911 greeting.
Deputy Chief Lauren Farr, who oversees information technology, said emergency medical dispatchers received about six hours of additional training before the rollout, including instruction on “Protocol 41,” a caller-in-crisis protocol designed specifically for behavioral health emergencies.
The protocol provides dispatchers with additional questions and tools to help identify the nature of a crisis while building trust and rapport with callers and keeping them engaged until responders arrive.
By the numbers
The fourth option comes as Memphis continues handling a substantial number of behavioral health emergencies.
Sean Lovejoy, deputy commander of the Emergency Communications Bureau, said Memphis police respond to roughly 25,000 calls each year involving mental illness, suicide-related incidents, overdoses and other behavioral health emergencies requiring Crisis Intervention Team officers.
City data displayed during Wednesday’s announcement showed Memphis’ 911 center had already processed more than 421,000 emergency calls through Aug. 25 this year, underscoring the scale of the city’s emergency communications system.
Even so, officials do not expect the fourth option to increase the number of mental health-related 911 calls. Lovejoy said that volume has declined in recent years, a trend he attributed in part to the national rollout of the 988 Suicide & Crisis Lifeline.
Rather than requiring an emergency response, 988 allows people experiencing emotional distress or other behavioral health challenges to speak with trained crisis counselors, who can provide immediate support and connect callers with community resources.
911 or 988?
One of the city’s goals is making sure residents understand the distinction between the two systems without discouraging anyone from seeking help.
Educational materials released Wednesday explain that 988 is intended for people experiencing emotional distress, suicidal thoughts or other behavioral health crises who need counseling, support or referrals. Situations involving immediate danger, serious injuries, overdoses requiring emergency medical care or threats to life and safety should still be directed to 911.
Officials stressed, however, that callers should not feel they must diagnose a crisis before asking for help.
Lovejoy said dispatchers are trained to ask follow-up questions, determine what resources are needed and send the appropriate response — even if callers are unsure which option best fits their situation.
Months in the making
Young said the initiative has been in development for six to seven months after community members raised the idea and city leaders began looking at similar efforts in other communities.
Police, fire, emergency communications, Alliance Healthcare Services and the Memphis Crisis Center spent months working through operational details before quietly introducing the fourth option in July to test and refine the process.
Wednesday’s announcement marked the public rollout.
“It was something that the community has asked for,” Young said. “We saw a need for it, and we were able to execute.”
