In 1966, a landmark paper lamented the sorry state of emergency response to accidents within the United States.
“Although it is possible to converse with the astronauts in outer space, communication is seldom possible between an ambulance and the emergency department that it is approaching,” wrote a joint committee of the National Academy of Sciences and the National Research Council.
The committee proposed an elegant solution: “It would seem feasible to designate a universal, easily remembered number for all dial telephones throughout the nation.”
Two years later, the first call to 911 was placed.
The service has evolved many times since then, and it’s also become a go-to for any kind of perceived emergency, not just calls for an ambulance.
LAist reader Ed Costello wanted to know: What happens when you call 911, especially for a mental health issue? Does it vary based on where you’re calling from?
We unraveled the vast network of emergency services — all under one number, but not all operating the same way.
When someone calls 911, where does that call go? Well, that first depends on the caller’s location.
The Warren-911-Emergency Assistance Act, signed in 1973, requires every local public agency in California to make “911” the primary emergency phone number.
In other words: 911 calls are routed to the nearest 911 call center, which are operated by law enforcement agencies. Los Angeles County has 78 centers, according to Ella Sotelo, Los Angeles County’s 911 Coordinator.
Orange County has 25 law enforcement agencies each operating their own 911 call center, according to Leslie Gallant, Orange County’s 911 Coordinator. The Orange County Sheriff’s Department is one of those 25 agencies, and they cover 13 cities and unincorporated areas within Orange County.
“The [911] call taker is trained to know what to title the call, what information to get, they route it over to our dispatchers and then we have designated beat areas for our deputies who work specific areas in whatever city they’re in. And then we dispatch it on the radio to whatever unit’s the closest,” said Gallant.
For medical-aid-related incidents, 911 calls are transferred to the Orange County Fire Authority. Orange County law enforcement deputies will go out to assist the fire department in medical emergencies.
If you call 911 with a mental health issue, what happens next may vary by county, and by circumstance. More on that in a little bit.
988 is a crisis support lifeline that those experiencing a mental health crisis can call, text, or online chat 24 hours a day, seven days a week from anywhere across the country. 988 was established as the national number for a behavioral health crisis when the National Suicide Hotline Designation Act of 2020 was signed into federal law. The 988 crisis line went live last July.
California’s 988 call centers are not led by local law enforcement, but by Didi Hirsch, a Los Angeles-based mental health organization. Didi Hirsch has over 500 trained staff and volunteers answering the 988 hotline across L.A. County and Orange County. It works with the state of California to coordinate the centers and ensure they follow best practices for 988 services.
What should someone calling 988 expect?
“A caring empathic person who wants to understand what’s going on, what has got you to this point,” said Shari Sinwelski, vice president of Crisis Care at Didi Hirsch. An important point 988 counselors distinguish is whether the caller is thinking about suicide.
“Oftentimes we find that allowing a person to just speak what’s in their minds and in their hearts can decrease the crisis level of a situation,” said Sinwelski. 988 counselors can provide resources and next-step resources to the caller, including when the caller is calling on behalf of someone else in crisis.
Sinwelski has been in the mental health care field for over 30 years and says society has come a long way when it comes to how people talk about mental health, including their own. “It used to be that these topics weren’t even spoken about in day-to-day life,” said Sinwelski. She also said, however, there’s work to be done. “But I’m not sure that everybody on the other end knows how to listen yet, I think they’re still learning.”
The counselors on the other end of 988 are trained to be good listeners. “They know how to say things like, ‘it sounds like you’re having a really rough day, what’s going on, tell me about your pain, tell me what’s going on today that’s got you thinking about taking your own life,’” Sinwelski said.
On average, 988 calls are answered within 13 seconds and each lasts about 13 minutes, according to a report filed with the Los Angeles County Board of Supervisors.
What’s the difference between these two memorable numbers?
Dialing 911 connects the caller to the closest law enforcement agency, where a police officer, ambulance, or fire department can be dispatched to respond to emergencies. “Sometimes when people are having a mental health crisis or mental health emergency, they might call 911,” says Didi Hirsch's Sinwelski.
When someone calls 988, they aren’t calling a law enforcement agency. The person on the other end of a 988 call is specifically trained to answer calls of mental health related crises.
One of the biggest differences is that 911 is dispatcher-focused. “The difference is we have counselors that are trained to talk to somebody who is in distress,” Sinwelski said. The role of 988 call takers is to determine what is going on, assess the safety in a situation and try to make the caller feel less distressed.
Calling 911 with a mental health issue does not mean you will be automatically routed to 988.
In Orange County, someone who calls 911 with a mental health-related problem, but is not in immediate danger, will be transferred to OC Links, Orange County’s behavioral health agency.
“Anytime somebody is thinking about [death by] suicide though, or it’s in progress, of course, we’re going to respond to something like that,” said Gallant.
In Los Angeles County, Didi Hirsch collaborated with the Los Angeles Police Department to create a 911 diversion program, which has been operating for over a year. People often call 911 when they don’t know where else to call.
“In this collaboration, the 911 operators have been trained to make that distinction as to whether or not this is an emergency situation or if this is someone who really maybe needs someone to listen. And most of the time it’s somebody who needs to listen, so they can actually then transfer the person right into one of our counselors in 988,” said Sinwelski.
Calls don't often get transferred in the reverse direction.
According to a report filed with the L.A. County Board of Supervisors, 95% of 988 calls (calls include texts and chats) made in the county in October and November of 2022 were resolved — meaning that after speaking to the counselor on the other end of the line, the caller feels better and plans to stay safe, according to Sinwelski.
“It’s very rare for us to actually involve anybody else,” Sinwelski said. In about 2% of those 988 calls, the call was transferred to 911 or the L.A. County Department of Mental Health’s Psychiatric Mobile Response Teams.
Sometimes there are instances where people might need more than talking to a counselor, and 988 counselors are limited by the resources available in the community a person is calling from.
“The vision for 988 across the nation and in local communities across the country is that 988 is sort of, will be the front door, so to speak, into the crisis system,” Sinwelski said.
She said 988 is the first piece of a developing three-part continuum: someone to call, someone to come, and somewhere to go. “So, ultimately there are places in every community that, instead of an emergency room, kind of a crisis stabilization facility. Somewhere where there’s counselors available 24/7,” said Sinwelski.
The expansion of mental health care services is progressing. Recent federal government funding to the 988 lifeline has enabled quality of care improvements, allowing many 988 call centers to increase their workforce. And early data show that a few months after being launched, 988 is seeing a boost in use.
Orange County's Gallant says their motto at the Sheriff’s Department is, “if they want a deputy, they get a deputy.” Gallant says those kinds of calls are frequent. OCSD will send out patrol deputies or Behavioral Health Team deputies.
Susana Parras from Community Alternatives to 911 (CAT-911) told LAist in 2021 that “a lot of us actually fear calling the police because we know that situations are lethal at many times.”
Calling 911 for serious mental health incidents can result in deadly consequences, such as when LAPD officers killed Takar Smith in early January 2023. People with an untreated serious mental health illness are 16 more likely than average to be killed during encounters with law enforcement, according to the Treatment Advocacy Center.
Grassroot community groups, such as CAT-911, have taken matters into their own hands by offering trainings and resources that suggest alternatives to calling the police.
If you or someone you know is in crisis and needs immediate help, call or text the Suicide and Crisis Lifeline at 988, or visit the 988 website for online chat.
For more help:
Crisis Text Line: Text HOME to 741741 for 24/7 crisis counseling
