Opinion: As a psychiatrist, I have seen how the current emergency response system fails my patients

The San Diego Union-Tribune

By Eric Rafla-Yuan

April 19, 2021

Rafla-Yuan, M.D., is a psychiatrist and legislative director of the San Diego Psychiatric Society. He lives in Point Loma.

Fifty years ago, if you fell and broke your leg or had a heart attack, there likely weren’t ambulances around. Instead, someone called 911 and the police came to take you to the hospital. It wasn’t until the 1970s when national policy changes and grassroots advocacy led to the emergency medical services (EMS) model we rely on today. Assembly Bill 988 gives us the opportunity to similarly update our mental health emergency response with the same important premise: Mental health emergencies need trained professionals, not police.

Last year, the federal government established a 988 calling code, requiring it to be available nationwide by July 2022. There are many goals for this new 988 number, foremost to serve as an alternative to 911 for mental health emergencies. To support this effort, the U.S. Substance Abuse and Mental Health Services Administration has created recommendations for implementing best practice crisis services. Congress has also appropriated millions of dollars for states to enact these life-saving measures.

Here in California, Assemblymember Rebecca Bauer-Kahan, D-Orinda, and 20 other legislative sponsors have taken up the charge with Assembly Bill 988, named the Miles Hall Lifeline Act. This bill not only incorporates best practices in crisis services research but has involved stakeholders at every level, evidenced by the bill’s wide range of supporters. Among them are patient advocacy and research groups such as the National Alliance on Mental Illness, American Foundation for Suicide Prevention, Mental Health America, The Trevor Project and Miles Hall Foundation; cities and counties including Walnut Creek and Los Angeles County; social service agencies like Jewish Family and Child Services; policy think tanks such as the Steinberg Institute and the Kennedy Forum; and health professionals like the San Diego Psychiatric Society, the California State Association of Psychiatrists and the California Association of Local Behavioral Health Boards & Commissions.

As a psychiatrist, I have seen countless times how the current setup fails my patients and our community. When someone has a fall, a broken leg or a heart attack, I know that an ambulance with trained professionals will be swiftly available to provide on-site resuscitation and clinical interventions. I wish I could have the same confidence when my patients have a mental health emergency, but the second-class treatment of mental illness is clearly on display when the best we can offer someone with a life-threatening psychiatric diagnosis is a pair of handcuffs and the back of a police car. Assembly Bill 988 will help change the paradigm to assistance and treatment over threat control and transportation.

Assembly Bill 988 will also allow California to effectively implement the required 988 system. Anyone experiencing or witnessing a mental health crisis will be able to call 988 to access 24/7 support provided by trained counselors. If more intervention is needed, mobile crisis teams will be dispatched, rather than law enforcement, linked to stabilization and further services in the community. Some cities and counties across the country have already established this model, finding both better outcomes and cost savings. One such program in Oregon is named Crisis Assistance Helping Out On The Streets (CAHOOTS). Its result has been approximately 24,000 calls annually and requesting police back up in less than 1 percent of cases. CAHOOTS saves Oregon taxpayers an average of $8.5 million per year in police and emergency room expenditures by effectively triaging emergency care to clinical teams.

Importantly, Assembly Bill 988 will save lives by promoting equity and access to care. Communities of color and individuals with mental illness are both overexposed to violence from law enforcement. Relying on these same police officers to provide professional clinical services during psychiatric emergencies is not a viable system. Miles Hall, the bill’s namesake, was a young Black Californian living with mental illness. When he was in crisis, his family called 911 to take him to the hospital. Instead, the police shot him six times, killing him. Miles had no history of violence or criminal record. This story is not new here in San Diego County. In 2016, Alfred Olango, a refugee from Uganda, was shot and killed by El Cajon police after his family called 911 for help during a mental health crisis.

As the national deadline for the 988 rollout approaches, we have been given an incredible opportunity to develop an integrated crisis system. Assembly Bill 988 will also help decriminalize psychiatric treatment and improve access to care by decoupling mental health services from policing. The federal government has provided guidance and funding, but it is now up to us to act and tell our state representatives — California needs Assembly Bill 988.