Mental health crisis hotline is a resource for Philly’s marginalized communities

In light of the need for increased awareness of mental health resources, the Philadelphia Department of Behavioral Health and Intellectual Disability Services (DBHIDS) rolled out their version of the national 988 Suicide and Crisis Lifeline support system in the summer of 2022. For people experiencing a mental health crisis, including suicidal ideation or an emergency related to substance use, the lifeline is a quick way to connect to highly trained individuals who carry out assessments and interventions over the phone and at times in person, 24/7.  

“The vast majority of crises are resolved through that process, but they are also the people who will dispatch the community mobile crisis response team,” said DBHIDS Commissioner Dr. Jill Bowen. “It’s the one number to come in, to have the assessment, to have an intervention and if necessary, to have dispatched the community mobile crisis response team.” 

The community mobile crisis response team comes to the person in crisis, engages the people in the person’s support system, and works to alleviate the problem “with as little coercion as possible,” Bowen said. Coercion could translate to police presence or involuntary commitment. 

“Anything that can be done in the community with a focus on the social determinants of health — things like housing insecurity, food insecurity, the kinds of challenges that people have that contribute to behavioral health crises,” are important to address, Bowen added.   

For LGBTQ+ and other minority communities, having an easily accessible mental health crisis resource like 988 can be especially vital. 

“I think for people in general, having 988 is wonderful because it’s just a direct connection to resources that’s 24/7,” said J. O’Neill, peer counselor at William Way LGBT Community Center. “Of course, a lot of times when people are feeling at their lowest, it’s the middle of the night when things aren’t open, there are no choices.” 

Members of the LGBTQ community typically experience the same mental health problems as the cishet population, including depression, anxiety and addiction, said Brennan Jordan, assistant director of Behavioral Health at Mazzoni Center. The key difference is that queer and trans folks don’t have as many behavioral health resources that provide LGBTQ-affirming care, or even culturally competent care. As such, LGBTQ people are often reluctant to seek out help when they need it. 

“Some common themes we hear are that folks have had horrible experiences with previous providers, have been forced into unethical/illegal forms of treatment in the past (conversion therapy), and/or are afraid that receiving services may lead to them to either being outed without their consent to friends/family members,” Jordan said in an email. 

The DBHIDS 988 team receive extensive training in cultural competence, and have an awareness of the unique vulnerabilities and trauma that LGBTQ individuals often face. 

“Cultural competence is only the beginning point,” Jordan said. “Folks who work at crisis lifelines should be competent at providing LGBTQ+-affirming care. Workers taking calls at crisis lifelines are often the first point of contact for folks looking to receive mental health services. If they are not LGBTQ+-affirming, individuals calling may feel like they won’t be able to receive the help they need and give up before getting connected.” 

According to a 2023 mental health survey by the Trevor Project, 41% of LGBTQ youth respondents seriously considered attempting suicide in the past year, and 56% of LGBTQ youth who wanted mental healthcare in the past year were unable to access it.  

“If someone’s going to be doing that kind of work on a crisis lifeline, I would hope they’re well trained in LGBTQ+ issues, because not everyone who is working there is going to necessarily understand what it’s like to come out as a queer person, as a trans person, to be kicked out of your home because of that,” O’Neill said. “It certainly is true that for many teenagers across the country that suicidality and depression are way up, but if they’re queer it’s up even more. Having that knowledge is essential.”

The fact that 988 falls under the category of a non-police mental health unit also proves crucial for LGBTQ, Black and Brown, and other marginalized communities who often have discriminatory or violent encounters when it comes to police intervention. According to a 2019 report by the American Bar Association, not only are LGBTQ people more frequently stopped by the police than cishet people, they often experience discrimination and get profiled and criminalized by the police. According to the Journal of Epidemiology and Community Health, when it comes to fatal police shootings, Black and Indigenous People of Color have significantly higher death rates than white people.  

As the DBHIDS team was in the process of examining its former behavioral health crisis system and determining how to ameliorate it, Walter Wallace, a young Black man, was shot and killed by Philadelphia police in 2020. 

“With his death, it was a catalyst to fully implement, quickly and urgently what we call crisis 2.0, but it’s a behavioral health crisis system transformation,” Bowen said. “Philadelphia was lauded as the model city because we were ready.”

As part of her mayoral campaign, Helen Gym promoted non-police mental health units as an important component of mitigating Philadelphia’s crisis of violence that stems from issues such as addiction and homelessness. 

“I think that non-police mental health units are not only an extremely important resource for folks who are in crisis but a necessary one,” Jordan said. “Crisis workers having a solid foundation in mental health de-escalation skills, along with experience working with individuals who are in crisis, is needed in order to ensure the best chances to prevent them from causing harm to themselves or others,” Jordan said. “This is especially important for LGBTQ+ individuals, BIPOC individuals, and anyone with marginalized and intersectional identities that may have past traumatic experiences triggered by the sight of uniformed police officers.”

Philadelphia’s 988 crisis lines are embedded into the 911 radio room, Bowen said, so in the event that someone calls 911 and does not require a police response, the call can be immediately shifted to the 988 line. Over the year and a half that DBHIDS has been doing this kind of crisis work, they have shifted over 1200 calls from 911 to 988. 

“We’re also looking at a [crisis response center] capacity and adding a fifth CRC that opens up this summer,” Bowen added. “We’re developing an urgent care model for adults, so people will have another option. We’re trying to remove throughout the entire system the question, ‘I don’t know what to do.’”

Governor Shapiro recently announced a proposal that includes $500 million over the next five years so that schools can fund mental health counselors and services on site, prioritizing students’ mental health in addition to their physical health, and $20 million in 2023-24 — growing to $60 million annually by 2027-28 — to restore mental health funding to Pennsylvania counties, who provide critical community-based mental health services for residents.