911 Call-Takers Are Demoralized, Overwhelmed and Dealing With Their Own Mental Health Woes

By ROB REID and FELICITY HUANG

MindSite News

Published: 09-19-2023 6:11 PM

In her 21 years as a 911 dispatcher, Lynette McManus Williams has served as the first person callers speak with on one of the worst days of their lives. She’s coached desperate callers on how to provide CPR and the Heimlich maneuver to loved ones, dispatched emergency medical personnel and police, and convinced people that life is worth living when they’ve given up hope. 

“I’m the person who listens to you cry as you’re begging your mother to take another breath,” she wrote in a 2018 Facebook post contrasting her high-stress, lifesaving work with the public view of her as a low-level call-taker.

Nearly five years after Williams’ “Just a Dispatcher” post went viral, under her pre-marriage name of Lynette McManus Jeter, she continues to hear from other dispatchers who share their experiences and police officers who thank her for what she does. But while she sees appreciation of dispatchers slowly growing, she says they’re not getting enough support to deal with the high rates of post-traumatic stress disorder, depression and suicide that are a byproduct of the job. 

Indeed, a recent survey of 911 call-takers, dispatchers and managers confirmed what other studies and experts have said: 911 professionals are overstressed, understaffed and underpaid – and few feel they have the training, managerial support or technology necessary to adequately perform their jobs, especially in response to mental health calls. A high turnover rate also helps fuel the serious shortage of call-takers reported across the country.

“For some people, it just becomes mentally draining and they just decide they don’t want to do it any longer,” Williams said.

Dealing with mental health crises – not to mention fires, car accidents, violent crimes and other traumas – becomes exhausting during a typical 10-to-12-hour shift, when call-takers get so busy they’re often reluctant even to run out and grab a sandwich. 

Across the country, operators like Williams handle more than 650,000 calls to 911 every day, and they bear an outsized responsibility: They’re expected to respond to a wide range of crises, provide expert guidance and support, navigate conflicts and calmly gather and interpret information from distressed callers.

Especially for calls that relate to mental health crises, those decisions initiate a chain of events with potentially life-changing consequences for the call’s subject: whether they receive the help they need or are harmed, sometimes fatally, by police.

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Call-takers must evaluate, sometimes in a matter of seconds, the nature of an emergency, and convey that information to first responders. And they’re expected to possess the rare ability to sustain a positive worldview while experiencing significant exposure to trauma – it’s virtually a job requirement at some centers.

“We’re very much like the Wizard of Oz” – unseen and yet ever-present – said Anthony Landry, a former 911 dispatcher in Boston who now works as a union representative for call-takers.

In some places, the volume of calls is also on the rise, dispatchers say. And more of those calls are reporting mental health problems, Williams says, adding to the stress and burnout of call-takers.

“We’re getting more mental health callers, which sometimes ties up the line for 10 minutes, 15 minutes, 20 minutes,” she said, even though she and her colleagues haven’t received any specific training on how to handle such calls.

Estimates about the percentage of 911 calls that relate to mental health vary widely. When researchers from the Vera Institute compiled data from nine cities, they found that an average of 2.1% of calls were coded by the cities as mental health-related. That number rose to 19% when they applied a broader definition of behavioral health needs. Even that figure might be low, the Vera researchers suggest, since many call-takers haven’t been trained to identify mental health-related calls.

An analysis by the Medill School of Journalism at Northwestern University and MindSite News found that cities use a dizzying array of codes to categorize mental health calls, ranging from “EDP” – “emotionally disturbed person” – to “demented person.” Some had no mental health classifications at all, while others had more than 10. This lack of uniformity can lead to inaccurate characterization of incidents, misguide first responders and create real risks for people in crisis, the MindSite-Medill analysis suggests.

A 911 call-taker’s read of a situation can set in motion a variety of events, from summoning emergency medical services to sending out armed police officers. They must also assess who may be at greatest risk – the responding police officers or the person experiencing a mental health crisis. That calculus has become increasingly fraught in recent years as the count of people in crisis shot or killed by jittery officers continues to mount.

Most Americans stillunfamiliar with 988 hotline

While the 988 Suicide & Crisis Lifeline launched one year ago is intended to route mental health calls to trained staff and resource centers, a recent Pew survey found only 13% of Americans even know the line exists. In its first year, the 988 line handled the same number of calls – 5 million – that 911 handles in eight days.

To better handle mental health crises, a growing number of cities are deploying alternative response teams of trained mental health workers to respond alongside or instead of police. While financial and public support for these programs is growing, they add another layer of complexity for dispatchers, who are often the ones deciding whether a call should be handled by police or alternative responders.

Amid these challenges, 911 call-takers are suffering a collective mental health crisis of their own, according to researchers, employees and a recent “state of the industry” report by the National Emergency Number Association (NENA), a leading professional association.

The July 25 report, based on a survey of call-takers, dispatchers and managers at 911 centers across North America, found that 82% of respondents reported their facility was understaffed, 75% reported staff burnout, and, within the past six months, 56% reported work-related anxiety and 35% reported depression. Coping mechanisms used by the call-takers ranged from prayer to alcohol consumption.

Respondents to NENA’s survey also called for increasing the diversity of what is now an overwhelmingly white and female profession. In the NENA survey, only 8% of respondents identified as Black and 9% as Hispanic, while just 11% speak a language other than English – all well below these groups’ representation in the U.S. population.

These demographic mismatches may act as an impediment that limits the ability of call-takers to understand the true needs of callers, while also making immigrants and people of color more fearful of law enforcement and less likely to call 911, according to the University of Chicago’s Health Lab.

The survey also found that a quarter of the 841 respondents felt unprepared to deal with mental health calls and pinpointed mental health issues as the second-largest category of misidentified calls. These findings echo a 27-state survey by Pew Charitable Trusts conducted in 2021, which found most responding 911 call centers did not offer behavioral health crisis training to their staffers. In addition, the survey noted, fewer than half documented the outcomes of crisis calls in their data systems.

Stress, poor workingconditions fuel shortage

The staffing shortage is severe: NENA estimates that 911 call centers are operating with an average 30% shortage of staff. And 911.gov, a federal program that coordinates efforts to support 911, found the staffing problem to be worsening, with most centers reporting vacancies and one in five operating with a vacancy rate of 41% or more.

“When people realize that they can go somewhere else that’s less stress and a normal work schedule and get paid just as much, you know, they will, of course, welcome the opportunity,” said Lynette Williams.

Anthony Landry agrees. Overwork and stress drive the shortages, and in his experience as a dispatcher, call centers used people “like energizer batteries” engaged in a “constant cycle of rifling through people,” he said. “By the time somebody fills a vacancy, somebody else quits.”

High turnover and staff shortages mean calls are less likely to be answered by an experienced call-taker – and may not be answered at all. Boston’s call center abandoned about 5.5% of the 600,000 or so calls it received in 2019 and again in 2020, according to a recent audit.

Calls were “stacking like a bunch of dirty plates for a call-taker or dispatcher,” Landry said. “If you hang up one bad call, you go to the next call with someone dealing with a mental crisis.” That’s a big problem, he said, because “when you call 911, you very much expect the call to get answered.”

The Boston audit also found that dispatchers faced excessive mandatory overtime, a heightened risk for PTSD due to “duty-related trauma,” disruptive work schedules and job demands that can lead to conflicts at home. A 2022 assessment led by The University of Chicago’s Health Lab found that call-takers’ daily exposure to trauma and forced overtime contributed to physical and emotional health issues that can lead to burnout and undermine the effectiveness of staff.

Despite the challenges and critical importance of the job, the national median pay rate in 2021 was $22.44 per hour according to the U.S. Bureau of Labor Statistics. In Boston, some call-takers lived with roommates or their parents in order to afford housing.

The wrong code can boost the risk of police shooting

The information that dispatchers convey to police officers and other responders plays a significant role in determining how they will respond. Yet dispatchers are often given little training and guidance in how to collect and pass on that information. Criteria for classifying mental health calls is particularly vague, according to a study by Jessica Gillooly, a former dispatcher who’s now a 911 subject matter expert for the Department of Justice. This lack of clarity leads to subjective interpretation, which can be dangerous in calls involving the risk of suicide or mental health concerns.

Some efforts have been made to provide guidance for handling mental health calls, including a Department of Justice initiative known as the Police-Mental Health Collaboration. It offered a set of guidelines, which recommend that 911 call-takers ask callers about their mental health history and access to weapons to determine if they present a threat to themselves or others. Still, problems remain.

Call-takers typically use a computer-aided dispatch system to assign each call with a code indicating the type of emergency, crime or crisis at hand. But the codes vary widely, as shown in the Medill-MindSite News analysis of codes from 50 U.S. cities, based on data obtained through public records requests and open data portals.

For example, Dekalb County in Atlanta has four codes – Behavioral Health Crisis, Behavioral Health Crisis: EMS needed, Suicide Attempt/Threats, and Suicide Attempt/ Unconscious. Cambridge, Mass. provided a list of 21 codes related to mental health. Many police departments including those in Aurora, Ill., and Jacksonville, Fla., provided only one classification.

Los Angeles uses different codes for mentally ill men and women, adding a “V” to each to signal potential violence. Some cities use language that is stigmatizing; at least three departments, including Fort Worth, Texas, use codes that contain the word “demented.” Glendale, Ariz., offers “insane person.”

The Association of Public-Safety Communications Officials (APCO), representing 35,000 public safety workers, published standards in 2019 listing five recommended mental-health related incident codes: EDP (emotional disturbance, abnormal behavior), MNTL (mental person non-violent), MTLV (mental person violent), SUICIDE, and SUICTHRT (attempting or threatening suicide). Use of these standards by call centers, however, is voluntary. (Click here to visit our interactive map of mental health call classifications by city police department, pictured in non-interactive form on the left).

Call-takers and dispatchers must make these determinations – including the potential for violence – quickly, and often with little information. This can have serious ramifications: Their assessment may or may not reflect reality, but a code referring to violence can prime police to respond more aggressively.

Boston uses codes that distinguish between two subtypes of Emotionally Disturbed Person: EDP2 – “potential for violence” – and EDP3 – “no indication of violence.” An EDP3 classification calls for emergency medical (EMS) response, while EDP2 typically requires police to secure the scene before EMS arrives.

Use of the EDP2 code signaling potential for violence contributed to the fatal shooting of Terrence Coleman, a 31-year-old Black man, by Boston police in 2016, according to a 2018 lawsuit against the city of Boston by his mother, Hope Coleman.

Her son, who “was not a violent person” and had no criminal record, was having an episode in which he was withdrawn, uncommunicative and did not want to come inside from the apartment’s stoop even though it was cold, according to the suit. She contends that although Terrence was not acting in a violent way on the night of his death and that she had told the dispatcher he needed medical help but that she did not need or want any police involvement, the 911 call-taker filed the call as EDP2, which triggered the deployment of police alongside EMS workers.

Terrence was shot and killed by the responding officers allegedly after he “calmly refused” to leave with the EMS workers, according to his mother. The EMS workers insisted he come with them. The suit charges that the officers heard raised voices inside the house, broke through the door, knocked over his mother, and tackled Terrence. One officer shot him twice in the abdomen.

Police later contended that Terrence had brandished a kitchen knife, but his mother, who was present, says that was false, according to the suit.

Hope Coleman has said that calling 911 is the greatest regret of her life.

A data brief by Boston officials showed that in 2020, four out of five of the 10,079 mental health-related calls were categorized as potentially violent (EDP2), requiring police dispatch.

Similar patterns show up in other cities. Detroit flags as potentially violent nearly 70% of all calls coded as “mental” (not including those related to suicide or wellness checks) and Cincinnati does the same with 40% of calls coded as “mentally impaired,” according to the Medill-MindSite News analysis of 2017 to 2021 data acquired from open data portals.

Cities classifying such a high proportion of 911 calls as potentially violent could reflect a perception of people with mental illness as inherently dangerous, even though a wide body of evidence suggests that mentally ill people are no more likely to be violent than anyone else, but are 10 times more likely than the general public to be victims of violent crime.

People experiencing a mental health crisis may also face violence from police. The Washington Post reported that from 2019 to 2021, calls to 911 or other crisis lines seeking help for a mental health crisis led to at least 178 fatal shootings by officers – despite there being no reported threat to other people’s safety. Police use of non-fatal force including tasers when responding to mental health calls is even more common, as Northwestern University and MindSite News are documenting in an ongoing investigation.

Promising changes in store for operators?

While most 911 systems offer mental health resources, only a third of call-takers responding to the NENA survey have utilized them, suggesting a lack of awareness or trust. Industry leaders and advocates are calling on police departments and jurisdictions to expand and improve mental health offerings and to treat 911 call-takers as professionals providing a vital service.

“We have things going on in our own lives,” said Lynette Williams. “We have to set that aside, to be there and answer the next call. And if we have a bad call, we have to move on to answer the next call.”

Though she has persevered in the work, “it would just be nice to be recognized,” Williams said, “and for people to realize that what we do is also equally as important” as the work of other first responders such as police and EMS.

The Department of Labor currently classifies “telecommunicators” who take 911 calls as a clerical occupation – “alongside secretaries and commercial dispatchers such as those for trash collection services,” according to NENA.

Last spring, U.S. Rep. Norma Torres (CA-35), the only former 911 dispatcher serving in Congress, co-sponsored a bill, the 911 SAVES Act, that would reclassify 911 operators as first responders. The change would help make the same training, overtime regulations, and retirement benefits enjoyed by firefighters and police available to 911 operators.

Boston Mayor Michelle Wu recently took such action, reclassifying 911 operators as public safety workers alongside police, firefighters, and EMS. Advocates also want 911 call-takers to be made eligible for mental health services, and for spouses to be allowed to collect life insurance if a call-taker commits suicide due to work-related distress.

Anthony Landry was initially drawn to the dispatch profession following a positive interaction with a 911 call-taker. His uncle, a police officer 14 days from retirement, had a heart attack in front of him and he called 911. The dispatcher and Landry worked together to try to save his uncle, with Landry following directions and providing CPR. Sadly, they failed – but Landry was captivated by the work and became a call-taker.

He enjoyed the opportunity to help people in need, but soon enough, his “rose-colored glasses were broken” as he saw first-hand the lack of support provided to call-takers by the department he worked for and society at large.

He became active in his union, SEIU Local 888, and two years ago, joined its professional staff, working to improve the conditions of his colleagues. In his spare time, he also helps run Commonwealth 911 Peer Support, a 24/7 helpline, staffed by volunteers, that provides support to 911 operators across Massachusetts who may be struggling with mental health or other issues.

Decades after his uncle’s death, Landry continues to feel the same motivations that got him to sign up in the first place – inspired by a beloved uncle and the dispatcher who tried to save him: “Maybe the best way to honor him is to help others, to pay it forward.”

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