The New National Mental Health Crisis Line Wants to Track Your Location

The New National Mental Health Crisis Line Wants to Track Your Location

 

L. Harris 

 

Content warnings: Police violence against mad and disabled people; involuntary mental health interventions

 

Calling 911 is all too often a death sentence for mad, neurodivergent, mentally ill, and disabled people. While there is no consistent national data collected on police killings of those experiencing a mental health or suicidal crisis, it is estimated that they comprise as much as one third to one half of people killed by cops each year, with disabled Black, Brown, Indigenous, People of Color in particular danger. With each new tragedy, calls to defund and abolish the police grow and gain in momentum.

There is no question that an alternative to 911 is desperately needed for people in crisis. Mainstream mental health and suicide prevention groups claim that a new, national mental health crisis line is the answer. In October 2020, Trump signed into law the National Suicide Hotline Designation Act of 2020, which designates 988 as the official number for suicidal crisis and other mental health emergencies. The three-digit number will replace 1-800-273-TALK, the current federally-funded National Suicide Prevention Lifeline (NSPL) number. 988 is slated to go live nationwide in July 2022. 

The 988 bill received significant media coverage when it became law last fall. But there has been little to no critical coverage of a controversial aspect of the national crisis line number: the proposal to include geolocation technology, identical to that of 911. 

Mad and disabled advocates who have experienced mental health crisis intervention, and even some crisis service providers, worry that geolocation would serve to further entrench coercion in mental health and crisis response systems, replicating problematic aspects of 911.

Jess Stohlmann-Rainey, abolitionist and disability justice activist who is also director of program development at Rocky Mountain Crisis Partners (RMCP) in Denver, summarized these concerns in a Twitter thread: “Autonomy and choice outweigh any benefits of geolocation services,” adding, “We marginalize and put communities who need us at risk by doing any kind of coercion.” 

 

988, Geolocation, and Mental Health’s Culture of Coercion

Paternalism and coercion are deeply woven into all aspects of mainstream suicide prevention and crisis response. For example, calls to the NSPL are advertised as confidential; however, in practice, breaches to confidentiality are allowed when anyone is assessed to be at imminent risk of suicide. Such an assessment can trigger “active rescue,” a euphemistic term for calling emergency services on people, with or without their consent. 

The NSPL also has a history of encouraging its affiliated call centers to collaborate with law enforcement, as detailed in their 2010 imminent risk policy, which is currently under revision. While the policy acknowledges that involving cops can lead to arrest or “other undesirable outcomes for the caller in need of care,” it also states that “fears of how the police may respond should not be a determinant in decision-making related to active rescue.” Disclosure: I currently serve on the NSPL’s Lived Experience Subcommittee, where myself and others have been advocating for major changes to the imminent risk policy.

The NSPL claims that its affiliated call centers dispatch emergency services only 2% of the time. Presumably this includes both non-consensual active rescue, as well as people who consent under duress. The 2% figure is used by suicide prevention authorities to excuse or deflect concerns about non-consensual practices. But given that NSPL projects as many as 40 million 988 users by its fifth year of operation in 2027, that’s potentially 800,000 individuals annually who may have non-consensual services dispatched to their location.

988 advocates’ justification for geolocation is that it is necessary to save lives. While coercive measures such as involuntary transport and involuntary inpatient hospitalization may prevent a person from killing themselves in the short term, research indicates that such practices can result in a “significant increase” in suicidality over the long term. These long-term risks of forced intervention are rarely discussed among the mental health and suicide prevention mainstream.

Kelechi Ubozoh, Nigerian-American mental health consultant, advocate, and writer, told me that these risks need to be discussed openly, and addressed in any crisis response. “As we consider the research in the field that people coerced during admission of psychiatric hospitalizations have an increased risk of a suicide attempt after discharge, we have to strongly question and reevaluate any new system that would replicate these results–even if it is ‘better packaged.’”

Ultimately, paternalism and coercion are choices, not necessities, in crisis response. For example, Trans Lifeline, a peer support line run by and for trans people, has since its inception had a policy against non-consensual active rescue, based on the recognition that Queer, Trans, Black, Indigenous People of Color are at great risk of harm from such interventions. 

“We need to examine the long-term impacts of coercion for people’s lives- especially those who are marginalized and have historically experienced trauma from systems that claim to help,” Ubozoh added. “If we are collectively responding to the outcry for an alternative to 911, are we also collectively decolonizing our crisis response services?”

In theory, 988 calls would be diverted away from police to social workers and mobile crisis. But the field of social work is also conditioned by a long history of white supremacy and carceral logic. The majority of social workers are white, and research indicates that they don’t display as much empathy towards communities of color as they think they do. Black, Indigenous, People of Color are more likely than white people to be subjected to coercive mental health treatment, including forced inpatient and outpatient commitment, and human rights abuses such as restraint and seclusion.

While a growing number of social workers are organizing and fighting for abolition, the ongoing carceral nature of mental healthcare was chillingly described in a TikTok video by Derrick Hoard @thesituationaltherapist: “As a therapist I hear a lot of people saying we should defund the police and transfer it to mental health. We are the police. We are the police. The quickest way to lose access to your rights is for me to diagnose you with a serious mental illness and get you locked in a mental facility. We are the police.”

 

Public Comments to FCC Emphasize Challenges to Consent

Last December, the Federal Communications Commission (FCC) put out a call for public comment on the “cost and feasibility” of 988 geolocation, including “non-monetary costs” such as “potential risks to consumer privacy,” that would be considered in its report to Congress in April. 

Comments to the FCC reveal that all national mental health and suicide prevention organizations unanimously support geolocation, with varying degrees of recognition of concerns around privacy, confidentiality, and consent. 

The American Association for Suicidology (AAS), while still commenting in support of geolocation, was one of the few national suicide prevention groups to acknowledge issues around involuntary treatment, geolocation, and consent: “The use of involuntary interventions paired with technologies like geolocation could prevent people in crisis from initiating contact if they are worried about their privacy or safety.”

The telecommunications industry had a more honest take on privacy than many of the suicide prevention and mental health groups. CTIA, a group that represents the U.S. wireless communications industry, noted in its public comment: “When a mobile wireless caller dials 9-1-1, it is with the expectation that the caller’s location information will be delivered to a PSAP [public-safety answering point] so that emergency services can be rendered at the location of the caller’s emergency. When a mobile wireless caller dials 9-8-8, however, the expectation of privacy may be different.”

Telecommunications company Mitel expressed similar concerns: “Would the knowledge that the caller’s location – even including apartment or room number – is available to the [National Suicide Prevention] Lifeline, and could be shared by the Lifeline with local authorities, potentially discourage callers?”

Jennifer Mathis, director of policy and legal advocacy at the Bazelon Center for Mental Health Law, shares concerns about privacy and consent. “This [hotline] is targeted at folks who may not want the police to come,” she told me in a phone interview. It’s even more important for 988 than 911 to let people know that they are being tracked.”

 “Creating a mental health service that is always already coercive (tracking your location without consent with the assumption it may want to send emergency services without your consent) puts us on the wrong side of history here,” Jess-Stohlman Rainey tweeted. “We can do better than this.” 

Alternatives to Coercive Crisis Care

From an abolitionist and disability justice perspective, simply replacing the police with social workers should not be the end goal. According to Stella Akua Mensah, a Black, neurodivergent peer support specialist, transformative justice advocate, and artist, speaking as part of “Decarcerating Care: Taking Police Out of Mental Health Crisis Response,” a panel held last September by the Institute for the Development of Human Arts:

I think there is an argument to be made for social workers being crisis responders as a brief evolution or stage of the movement toward abolition of state control. But for that to be pulled off, it would need to be thought of as a stage, not the end goal. Not like our salvation. And I worry that won’t happen because the nature of psychiatry and social work is it involves that state control element. So I’d rather bypass that altogether and go straight to the stage where peers are crisis responders.

Panelist Stefanie Lyn Kaufman-Mthimkhulu, director of Project LETS, agreed with Mensah. “I believe that if we don’t center peers in what we are trying to build now, we are just shifting one system of policing for another.” 

One example of community-based, peer-to-peer crisis response is Mental Health First, a project of the Anti-Police Terror Project in Oakland and Sacramento, which offers crisis response training and a community crisis response hotline on weekends, when many mental health service providers are closed. 

As a result of the advocacy of MH First and other local organizers, in March the Oakland City Council unanimously voted to fund a pilot program called Mobile Assistance Community Responders of Oakland, or MACRO. 

According to a March 15 memorandum about the pilot, the MACRO program aims to provide voluntary help, with the aim of immediate connection to care and a range of options beyond “5150s” (the California code for involuntary psychiatric holds), including “a safe place determined by the person in crisis, such as their own home or that of a loved one.” Utilizing a collaborative approach, “transportation and follow-up would be voluntary and next steps will be determined in consultation with the individual in crisis,” the memorandum said.

MACRO will engage civilian responders, trained in de-escalation and harm reduction approaches, “recruited from the neighborhoods they serve,” said a statement from the Coalition for Police Accountability. 

Contrast this localized, grassroots-led approach to crisis response with the top-down 988 rollout, which fails to meaningfully engage those most impacted by carceral crisis response. 

While statewide 988 planning coalitions are in theory supposed to involve “people with lived experience” and peer specialists, in practice such inclusion is being left up to the discretion of state authorities. No funding was budgeted in the 988 Planning Grant RFA for the leadership of peers and directly impacted people. Kathy Flaherty, director of the Connecticut Legal Rights Project, told me: “They keep going to the people whose current system is failing people, instead of going directly to communities that are going to be affected by any policy change.”

“Liberation HAS to be a component of our work,” Stohlman-Rainey said. “We have to listen to people who have been harmed by our institutions. We need care, not cops. If we proceed like this, communities we serve will be asking for alternatives to crisis care along with alternatives to policing.”

Lack of meaningful inclusion of impacted communities, combined with a wholesale push for geolocation surveillance tech, is a deeply concerning combination that does not appear to bode well for the rights and privacy of mad, disabled, and neurodivergent folks. It’s not yet entirely clear as to how geolocation will be implemented as part of 988, but we’ll soon know more. The National Suicide Hotline Designation Act directs the FCC to submit a report to Congress on the cost and feasibility of geolocation by April 17, which should be available to the public by the end of this month.

If you’d like to be involved in the planning for 988 rollout where you live, consider reaching out to your state’s mental health authority. Here is a list of states who have received 988 planning grants. You can provide feedback on the composition of the planning coalition, or ask to join yourself. These coalitions will meet officially from April – November 2021, but it is hoped that they will continue to operate past the funded time period. 

Thread: New FCC report on 988 & geolocation tech echoes advocates' concerns on privacy/consent!
"Although we recognize that the use of geolocation information with 988 calls likely would result in some benefits, the record is not sufficiently developed…" https://t.co/9WEDJVhOPa

— (((L. Harris))) #BlackLivesMatter #FreePalestine (@leahida) April 24, 2021

ABOUT

L. Harris (they/them) is a mad, disabled, non-binary writer and facilitator living on unceded Manahoac lands, in so-called Northern Virginia. Twitter: @leahida 

 

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