Averting Crisis
Policy Center Playing Key Role in How State Manages Behavioral Health Dilemmas
llinois’s emergency behavioral crisis system was fragmented and insufficient to meet the needs of the public. Individuals experiencing a mental or behavioral emergency were at risk of being unnecessarily harmed because an “alternative” behavioral health emergency response was not readily available to individuals and families in crisis. The emergency response system needed overhauling, and state agencies sought to partner with the Behavioral Health Crisis Hub at the Jane Addams Center for Social Policy and Research to assist them in improving the system.
The Behavioral Health Crisis Hub (BHCH) is collaborating with the Illinois Department of Human Services Division of Behavioral Health and Recovery (IDHS/DBHR) to alter how 911 emergency response telecommunicators refer calls seeking mental and behavioral health support. Traditionally, police have been dispatched on calls involving individuals in mental health crisis, but officials at the National Police Accountability project said officers are not qualified as mental health professionals. Their unwarranted presence during such crises may increase the risk of adverse incidents.
A 2023 report from the National Alliance on Mental Illness (NAMI) said 25% of all fatal police shootings between 2015 and 2020 involved someone with serious mental illness. Those individuals, the report went on to say, are 10 times more likely to experience use of force in interactions with law enforcement than those without serious mental illness.
Led by Creasie Finney Hairston, PhD, dean of the University of Illinois Chicago’s Jane Addams College of Social Work and director of the Policy Center and Lorrie Rickman Jones, PhD, program director and co-investigator, the Crisis Hub was named the state’s academic partner to provide support in implementing the Illinois Community Emergency Services and Support Act (CESSA). The legislation, also known as the Stephon Edward Watts Act, was signed into law by Illinois Gov. JB Pritzker on Aug. 25, 2021.
“CESSA is an alternative response to law enforcement,” said Jones, who previously served as the commissioner of mental health and senior policy advisor for behavioral health in the Office of the Governor. “When a person is undergoing a behavioral health crisis and 911 is called, how does an operator know that the caller or the public is in danger? And how do you provide for, yet protect, the individual who is calling?”
Stephon Watts was a 15-year-old male with autism when he was shot and killed in his Calumet City, Ill., home by police after they had responded to a call about a domestic disturbance in February 2012. The youth reportedly became violent after his father told him he had lost his computer privileges. When the two officers confronted the youth in the home’s basement, Watts reportedly lunged at them with a knife, slashing the arm of one of them. Watts was shot twice, once by each officer.
In addition to limiting the number of calls law enforcement, fire and emergency medical services (EMS) respond to behavioral health issues, CESSA’s goals are to link community members with available and appropriate behavioral health care; promote crisis resolution while maintaining dignity and respect to the individual in crisis; and reduce unnecessary hospitalization and incarceration when possible and appropriate. Illinois is one of only two states (Virginia is the other) undertaking this level of changes to the systems, in compliance with similar legislative mandates.
The Crisis Hub provides a plethora of services to the IDHS/DBHR, including project management, research, evaluation and analysis, meeting design and convenings, report writing and communications, training, consultation on performance management and improvement, technical systems development, data and information management, technical assistance, and toolkit development.
Averting Crisis quote
When a person is undergoing a behavioral health crisis and 911 is called, how does an operator know that the caller or the public is in danger? And how do you provide for, yet protect, the individual who is calling?
Averting Crisis continued
Illinois has 168 911 emergency call centers spread throughout its 103 counties, and each uses a series of protocols for a myriad of situations. Operators are trained to ask specific questions to determine the necessary response to the crisis, and they provide instructions over the telephone until help arrives. The Crisis Hub is building the framework to modify the protocols to specifically reflect mental or behavioral emergencies, and they are currently negotiating those proprietary changes with vendors for implementation.
“The CESSA statute allows for changes in the 911 protocols, acceding different rules for law enforcement and behavioral health,” Jones said. “Numerous questions were developed for consideration by the vendors, such as does the person have symptoms of a mental illness? Is a weapon involved, or is the person violent?”
The questions are designed to assess the acuity of the situation and determine if it is appropriate to send a non-law enforcement emergency response or, should a law enforcement response be necessary to assure the safety of everyone on the scene if a crime is in progress, Jones said. All the protocol changes have been updated, and 35 new training modules have been developed.
Training and technical assistance will be provided to all 911 and 988 call centers, as well as the 69 mobile crisis response teams (also referred to as 590 programs) that are staffed by mental health clinicians and individuals with lived expertise. These “alternative response” teams, as they are known, are dispatched in situations involving behavioral health emergencies instead of law enforcement whenever appropriate.
“The coverage areas for these teams are currently too expansive, and response times need to be improved related to situations requiring an immediate response,” Jones said.
With the massiveness of the system’s expansion, the Crisis Hub and the IDHS/DBHR hosts learning collaboratives with 988 Lifeline Call Centers, Program 590 mobile crisis response teams (MCRT) and regional advisory committee liaisons to ensure there is continuity in developing the needed services throughout the state. IDHS/DBHR provides funding to Illinois’s seven Lifeline centers that provide compassionate, accessible care and support for anyone experiencing mental health-related distress. Regular monthly meetings between the Crisis Hub and IDHS/DBHR are held with each center to focus on service response improvements and to share operational perspectives, concerns, and opportunities.
Since its national launch on July 16, 2022, the 988 Suicide and Crisis Lifeline has responded to nearly 13 million calls. More than 100,000 calls have been answered in Illinois. Jones’s team was instrumental in the state’s Lifeline implementation.
The monthly meetings held with Program 590 mobile crisis response teams provide project directors an opportunity to obtain information on operational processes, state policies, guidance and protocols, and national best practices on developing optimal response times. The Crisis Hub and the IDHS/DBHR are also developing key performance measures that reflect 911 systems’ handling of behavioral health crisis calls, 988 response standards, and mobile crisis response team performance. The entirety of the work must be completed by June 2027.
“These three major policy initiatives – CESSA, 988 and Mobile Crisis Response Teams – are clearly interdependent and provide the impetus, the foundation, and the guideposts for the considerable work being done to reform Illinois’s behavioral crisis system,” Jones said. “Much of CESSA’s work depends on the successful implementation of these and other reforms.
“Once all the tools are in place, we must trust the mobile response teams and the 911 call center staff to send the right folks to help. This has been a major task but one that is beneficial to everyone in Illinois.”