When to Call 911 in an Urgent Mental Health Situation

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University of Wisconsin–Madison

It is commonly known that police are first responders to 911 calls made about urgent mental health situations, but little is known about when it is appropriate to call 911. Some sources indicate that these time-consuming and resource-intensive calls are increasing. Mental health advocacy organizations are a leading source of information about these situations and as such have outsized influence on whether individuals decide to call 911 or not.

Police respond to mental health crises when a family member or friend calls 911, when officers encounter a person in an urgent mental health situation while on patrol, or when an individual unknown to the person with mental illness calls 911 because of unusual or threatening behavior. Sadly, many of these calls end in fatality and of the people with mental illness killed by police during 2015 and 2016, over forty percent began with a family member or friend calling 911.

When to Call 911 in an Urgent Mental Health Situation?

In my research, I found 38 examples of advice published online from 36 mental health advocacy organizations about the decision to call 911 in an urgent mental health situation. To be included, advice had to involve a discussion about calling 911 beyond brief statements such as “if you or a loved one is experiencing a mental health crisis, call 911.” I find that these resources had distinct definitions for “emergencies” and “crises.” Though both included instances of immediate threat, resources discussing “mental health emergencies” placed greater emphasis on immediate emergencies. The phrase “mental health crisis” was used to describe a wider range of situations and was used twice as often as the latter.

Emergencies
  • Individual has harmed themselves or others

  • Individual is likely to harm themselves or others

  • Serious property damage

  • Individual is unable to care for self

  • The caller feels scared or unsafe

Crises
  • Need for immediate action or intervention – if the individual has disappeared, is likely to harm themselves or others, or is threatening, talking about, or making specific plans for suicide

  • Excessive substance use

  • Individual cannot resolve the situation with skills and resources available

  • Individual is unable to care for self

  • Individual is participating in unlawful behavior

Neither “mental health crisis” nor  “mental health emergency” are clinical phrases included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, which is the most widely referenced classification system of mental health disorders in the United States. Therefore, it is not surprising that both definitions vary. In over a third of the sources, readers were advised to call 911 in a “mental health crisis” or “mental health emergency,” without providing an explanation of the precise characteristics of each situation. This could be confusing and mental health advocacy organizations must ensure that their advice is clear about the types of situations that warrant police intervention.

Weighing the Benefits and Risks of Calling 911

In addition to giving advice on when to call 911, the resources I examined also described what police may or will do when they arrive. The online advice was generally more emphatic about what police are more likely to do.

Police Are Likely To:
  • Ask about firearms

  • Assess the level of danger present

  • Make the scene safe

  • Take control of the situation

  • Use the minimum amount of force necessary

Police May:
  • Detain and handcuff the individual

  • Arrest or take the individual to jail

  • Take the individual to a medical facility for mental health evaluation

  • Use lethal force on the individual

Overall, the advice presented a broad view of potential outcomes. Police can resolve the situation and connecting the individual in crisis with the services they need and they at times, can use lethal use of force to gain control of the situation. Depending on how a “mental health emergency” or “mental health crisis” is described, there are a range of situations that warrant police intervention, but there is no single answer for when individuals should call 911.

Friends and family of those experiencing mental health crises or emergencies will make better decisions if they are informed about the range of situations that may warrant police intervention and have a better understanding of the potential benefits and risks of doing so.

To reduce uncertainty, mental health advocacy organizations should be clearer about the differences between a “mental health crisis” and a “mental health emergency” and make sure that these phrases are clearly explained to readers.

Read more in Emma Frankham, “Mental Illness Affects Police Shootings,” Contexts 17, no.2 (2018): 70-72.