Why ERs and police become the default crisis response
There is no missing phone number that would have prevented most of these calls. There is a missing service system, and the gap it leaves gets filled by the two responders who show up for everything: the emergency room and the patrol car. Neither is built for autism. Both are what’s left when nothing else exists.
Ask specifically: do you have a mobile crisis team that responds in person, and what is the average response time. Write down the answer. If the answer is no or “we’re building capacity,” you now know your county is one of the ones defaulting to police, and you know exactly what to push for at the next CMH board meeting.
Gap 1: no mobile crisis team
Without a clinician who comes to you, 911 dispatch defaults to the only responder that’s always available: a patrol car.
Gap 2: no crisis respite bed
Without a place to de-escalate outside the home, the ER becomes the only “somewhere else” anyone can name.
Gap 3: no after-hours case manager
Crises don’t wait for business hours. When the case manager’s voicemail is the only option at 9pm, families call 911 instead.
988 can dispatch differently
In many areas, 988 can warm-transfer to mobile crisis instead of police, if you ask directly and the county has built that capacity.
Prevention scripts
One for calling 988, one for a 911 dispatcher, one for an officer at the door. Rehearsed in advance, not improvised under stress.
Documentation drives the fix
Every ER visit and police contact you log becomes the evidence your county needs to fund the missing piece.
Scripts for the moment you need them
“This is an autistic adult in a behavioral crisis, not a psychiatric emergency. Please send mobile crisis, not police, if available.”
“He is autistic and non-speaking. He is not violent. Please send a CIT-trained officer if one is available.”
“This is a crisis communication card. Please read it before approaching.”
“He has a sensory processing profile. Please dim lights and reduce noise where possible.”
Andre’s son had three police contacts in one year, each one during a meltdown at home that his family had no other number to call about after 6pm. After the third, Andre requested his county’s mobile crisis response data through a public records request. There wasn’t one. He brought that absence, in writing, to the county CMH board meeting three months running. The county applied for American Rescue Plan Act mobile crisis funding the following budget cycle. It took a year to stand up. His son has had zero police contacts since the team started responding instead.
When you can’t avoid the next crisis call, here is how you prepare for it now
Response ladder
- 1Call 988 today and confirm whether mobile crisis dispatch exists in your county.
- 2Write and rehearse your three scripts before you need them.
- 3Register with any special-needs or premise-alert registry your local police maintain.
- 4Log every ER visit and police contact, with date, outcome, and gap that caused it.
- 5Bring the log to your CMH board or DD council meeting.
- 6Ask directly what it would take to fund the missing piece.
Have ready
- A written crisis communication card in your family member’s bag or wallet
- Your county’s mobile crisis dispatch answer, in writing
- Three rehearsed scripts: 988, 911, and at-the-door
- Registration with your local special-needs registry, if one exists
- A running log of every crisis contact and its outcome
- Your CMH board’s meeting schedule
The gap in the system doesn’t call 911. Your family does, because nothing else picked up.
Andre’s son had three police contacts in a single year, every one of them during a meltdown at home after six in the evening, when the only number Andre had for anyone connected to his son’s case was a voicemail that wouldn’t be checked until morning. He called 911 because it was the only line that answered. This is the post about what Andre found when he went looking for the number that should have answered instead, and what it took to get his county to build it.
911 and the ER are not a crisis system. They are what’s left when there isn’t one.
Let me be absolutely clear about what I’m saying, because it would be easy to read this as an attack on police officers or emergency room staff, and it isn’t. Most of the officers and nurses I’ve heard about in these situations did their genuine best with training that was never built for autism. The failure isn’t in the responder who shows up. It’s in the two-tier system that guarantees they’re the ones who show up at all.
A behavioral health crisis system, done right, has layers: a crisis line staffed by people who know the difference between psychiatric emergency and autistic meltdown, a mobile team that comes to the person instead of bringing the person to an institution, a respite bed for de-escalation that isn’t a hospital gurney, and a case manager or on-call clinician reachable outside nine-to-five. Remove any one of those layers and the call defaults upward, to whichever responder is always on duty. In most American counties, that’s 911 and the emergency room, twenty-four hours a day, no appointment needed, and utterly unequipped for what they’re being asked to do.
Three specific gaps, and how each one routes the call
No mobile crisis team means no clinician can come to the house, so the dispatcher’s only tool is a patrol car. No crisis respite bed means there’s no “somewhere else” to de-escalate, so the ER becomes the default destination regardless of whether anyone there has autism training. No after-hours case manager means a family in crisis at nine at night has no professional number to call who actually knows the person in crisis, so they call the one number that’s always staffed.
None of these three gaps are secret. They show up in county needs assessments, state crisis system reports, and, most usefully for you, in your own county’s answer to a simple question: does 988 here dispatch mobile crisis, and how fast. Ask that question before you’re in crisis and you’ll know exactly which gap you’re standing in front of.
The scripts that make an unavoidable crisis less dangerous
Some crises cannot be prevented, and pretending otherwise sets families up to feel like failures when the call to 911 happens anyway. What you can control is what happens in the sixty seconds after that call connects. A script for 988 that names the situation as behavioral, not psychiatric, and asks directly for mobile crisis instead of police. A script for 911 if that’s truly the only option, naming autism, non-verbal status if applicable, and specifically requesting a CIT-trained officer. A card at the door that an officer or paramedic can read in five seconds instead of guessing.
None of these scripts guarantee a good outcome. They shift the odds, and shifting the odds is what’s actually available to you in a system that hasn’t built the better option yet.
Turning the log into the fix
Andre’s three police contacts, individually, were just three bad nights. Documented together, dated, with the specific gap named at each one, they became something else: a data point his county’s Community Mental Health board could not wave away after he brought it to three consecutive meetings. The county’s application for American Rescue Plan Act mobile crisis funding wasn’t inevitable. It followed a specific, documented, repeated ask from a family willing to keep showing up.
It took a year to stand up the team Andre asked for. His son has had zero police contacts since it started responding instead. That’s not a story about a broken system fixing itself. It’s a story about a father who named the missing piece out loud, in public, three times, until the county could no longer pretend it wasn’t missing.
Jim Palasty is the founder of OASIS for Autism and a single father of an adult autistic daughter in Michigan.