The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team.

An unmarked gray van pulled into a South King County apartment complex on a drizzly June afternoon. A 911 caller had reported a family member was hearing voices and seemed disconnected from reality.

A mental health professional and a case manager, not police or emergency medics, knocked on the door. A few hours later, this emergency crisis response team drove the resident to a crisis stabilization program, where she could get inpatient treatment and support.

The first response system has long relied on 911 calls, police officers and firefighters to get people urgent help. Experts agree this hasn’t served people with mental health or substance use needs, who have often ended up in hospital emergency rooms or in jail, or haven’t gotten help at all.

King County is building an alternative. As part of a massive mental health care expansion, largely funded by a $1.25 billion property tax levy, the county is creating a mental health-focused response system driven by the 988 suicide and crisis lifeline, mobile crisis teams that respond to emergencies in person and low-barrier centers dedicated to providing walk-in care.

Each of these new teams is part of a complicated, fragmented mental health system that must work together smoothly to get people the help they need. The expansion has come with growing pains.

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Introducing new dispatchers, new responders and new health care centers takes time and trust. First responders must have confidence in new services to refer people in need, and the public needs to be aware they can use 988, which launched nationally three years ago, to access mental health services.

“We’ve had a system that’s been so underfunded and hasn’t had the resources, so you get this learned helplessness, where people say, ‘I tried and called for help, and it didn’t work, so I’m not going to call again,’” King County Behavioral Health and Recovery Division Director Susan McLaughlin said. “We have to undo that across the whole system, for our first responders, our providers, the hospitals and the community members, to understand that there actually is capacity. It’s available now and you can use it.”

Despite the challenges, county leaders say they feel good about how the expansion of care has rolled out. They get “a lot of calls” from other cities and counties seeking to understand what King County is doing, McLaughlin said.

911: Where calls often start

Since the 1960s, people have been told to call 911 for any type of emergency, and dispatchers are trained to dispatch police and fire departments. But people with serious mental illnesses are disproportionately killed by police, and police and fire departments lack specialized training on mental health conditions.

Last March, King County began diverting mental health calls that don’t pose a safety risk to 988, the suicide and crisis lifeline. Staff and volunteers are trained to talk people through crises and de-escalate them, and they’re able to spend more time on the phone with callers.

Valley Communications, which takes South King County 911 calls, started working closer with Crisis Connections, the nonprofit that handles 988 in King County. Early in the partnership, Valley Communications averaged 20 transfers per month to 988 staff. In June they sent 251 calls, Valley Communications Deputy Director Angee Bunk said.

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In Valley Communications’ 911 dispatch center in Kent, rows of call receivers (who talk with callers seeking assistance) and dispatchers (who work with police and fire departments to send responders to scenes) sit at desks with computer monitors. Lights above desks show who’s actively on a call.

Staff listen for calls with a mental health connection — someone might be suicidal, or experiencing psychosis. If the caller doesn’t have a weapon, and isn’t actively threatening to harm themselves or others, the call receiver can do a “warm transfer” to 988, introducing the caller to the 988 call taker and handing them off.

Call receiver Dustin Freeman sees the partnership with 988 as a positive change. “We weren’t using them enough” when they were in the same building, he said.

“When someone is in a mental health crisis, there’s no crime happening, and 988 has more resources to help people,” Freeman said. “Sometimes people in that situation don’t want to talk with the police.”

How transfers to 988 have changed over time Since March 2024, Valley Communications, which handles 911 calls for South King County, has diverted mental health calls that don’t pose a safety risk to 988, the suicide and crisis lifeline.

Call receivers also transfer callers to 211, a line to help callers access resources to help with housing, transportation and other basic needs.

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The partnership with Crisis Connections has gotten stronger, Bunk said, and the organizations regularly meet and share data about call outcomes. But it’s taken time to help staff feel comfortable transferring calls to 988 — they’d been used to handling everything themselves.

Bridging cultural divides is a common challenge when 911 and 988 programs integrate, said Stephanie Brooks Holliday, a professor of policy analysis at the RAND School of Public Policy who has studied 988 and 911 coordination.

“Call takers take the safety of the caller very seriously, and it takes time to build trust that when you transfer a call over, the person is going to get an appropriate response,” Brooks Holliday said.

988: Where calls are transferred

From a cluster of desks in Crisis Connections’ Belltown office, dispatchers use an interactive map to track mobile crisis teams spread throughout the county. On a recent Tuesday afternoon, the map showed one team en route to a call near Northgate and all others were available.

Crisis Connections has run the local suicide lifeline for decades, but it’s only been dispatching mobile crisis teams throughout the county since December. The dispatch hub is a key part of the county’s efforts to send mental health professionals to help community members connect to health care, shelter or other resources.

Most calls to 988 don’t lead to a mobile crisis dispatch; many callers just need someone to talk to. In cases where there isn’t an active safety risk, staff focus on connecting with them and coming up with a plan for what they’ll do after the call, crisis services clinician Brady Mathieson said.

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But around 1% of calls warrant emergency help and a dispatch from a mobile crisis team. Fire departments, hospitals and social service providers are also able to call directly and request a dispatch.

Dispatchers gather a physical description and location to help the team know where to go. Then they ask callers: Are you able to stay safe before a team gets to you? Are there weapons present? Are there any physical or accessibility needs?

In rare cases, 988 will transfer a caller to 911, potentially leading to a police response, but only if there’s an imminent threat of harm to the caller or others. This was the case for less than 2% of 988 calls in 2024, Crisis Connections CEO Michelle McDaniel said.

Even within the crisis response system, information on any one person — like background on their mental health diagnoses or medications — is fragmented between different electronic health records, 911 dispatch and mobile crisis team records, clinical manager of dispatch hub services Wynonna Susilo said. Having one comprehensive online record would “solve a lot of problems,” she said.

For example, Sound Behavioral Health, a nonprofit that operates some of King County’s mobile crisis teams, uses one kind of health record but can’t access records from police and hospitals — which makes it a challenge for mobile teams to get a full picture of the person they’re working to help.

“Everything stays where it is, which is helpful for confidentiality, but for care coordination, it is not,” Sound program manager Michelle Bollinger said.

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King County is working on building out its data infrastructure for care coordination, McLaughlin said. A bill passed in 2021 directed the state to find a centralized technology platform to help behavioral health providers coordinate beds and services, but lawmakers have asked the state to slow down while they focus on funding 988 call centers, state Sen. Tina Orwall said.

“I’m protective of those dollars and want as many to go toward clinical dollars as possible,” Orwall said. “I think we need to move carefully and strategically. We want to make sure we’re keeping it simple and not creating a huge IT system that’s more complex than the needs of 988 itself.”

Mobile crisis teams: Responding to calls

Crisis Connections dispatchers send information to teams run by one of two organizations. The Downtown Emergency Service Center, a housing and homeless services nonprofit, responds to calls in Seattle and Vashon Island. Sound Behavioral Health, a nonprofit health care organization, covers the rest of King County.

On a June afternoon, seven crisis responders awaited calls in Sound’s Auburn office, decorated with Pride and Juneteenth posters and superhero figurines. By the door, the keys to specially equipped vans were stored in a lockbox and red backpacks serving as “go bags” were stocked with the overdose-reversing drug naloxone.

King County has contracted with DESC for mobile crisis services for adults since 2009, but added 10 new teams starting in December for a total of 27. The two organizations operate teams 24/7.

Sound leaders say it’s taken time to build relationships with law enforcement and make it clear how these teams are distinct from others, like Seattle’s CARE Department (which responds to select calls alongside Seattle police) and North King County’s Regional Crisis Response Agency (which responds alongside, not instead of, first responders). The mobile crisis teams are being used more and more, but “we have not tapped its full potential yet,” McLaughlin said.

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At 4:04 p.m., a dispatch came in: A community member with mental health and substance use disorders needed help getting food and shelter. A team of emergency medics had called 911, who diverted the call to 988, where it was dispatched to the mobile crisis team.

Ten minutes later, a case manager and certified peer counselor were out the door, taking a van to the gas station where the man was waiting. They talked with him to see how they could help him and offered housing resources, but he declined services unless he could go to DESC’s Crisis Solutions Center, where a friend had recently gone.

His mental health needs weren’t serious enough to meet the criteria for DESC’s center, Sound crisis services director Joe Vela said, so there wasn’t much the team could do besides offering him other resources.

“We might end up getting another call for him,” Vela said. “That’s the way it is.”

People don’t always want services right away, and a key part of the team’s work is following up. The day before, a team had met with a man with suicidal ideations, but he didn’t want to go anywhere for fear of being “locked up,” case manager Sara Pearson said.

The next morning, Pearson called him to follow up, and he said his bags were packed and he was ready to get help. The team took him to Connections Kirkland, King County’s first walk-in crisis care center. He was able to talk with a staff member, who explained he wouldn’t be forced to stay there, and he felt much more relaxed, Pearson said.

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Mobile crisis services are voluntary, but starting a few months ago, the teams also respond to community calls to King County’s designated crisis responders, who are responsible for evaluating people for involuntary mental health treatment. DCRs have long been overtaxed, and these teams are a quicker, less restrictive response, McLaughlin said. The mobile crisis teams still call DCRs if someone meets the threshold for an evaluation.

The mobile crisis teams, 988 and 911 all have to work together to get people the right response at the right time.

Preston Looper, a mental health provider and consultant who conducted a national survey of mobile crisis teams for the federal Substance Abuse and Mental Health Services Administration, praised King County’s approach to the teams as part of a broader behavioral health buildout.

“They’re really looking at this as a system of care as opposed to component parts,” Looper said. “Mobile crisis in isolation is cool, but a component in a coordinated and integrated system is super powerful and can create some significant return on investment.”

This story was published with the assistance of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, supported by The Commonwealth Fund.