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Calling 911 for a mental health crisis can be fatal, especially for Black and disabled children.

Black children are disproportionately restrained and sedated in psychiatric emergency rooms.

For autistic children, the ER's chaos and sensory overwhelm can escalate a crisis rather than calm it.

Alternatives to 911 and the ER exist—and every family deserves to know about them before a crisis happens.

In March 2024, a San Bernardino County sheriff's deputy shot and killed Ryan Gainer in his own backyard. Ryan was 15 years old, autistic, and in crisis—and his family had called 911 for help. Officers said he approached them holding a garden tool. Within moments, he was dead.

Ryan Gainer is not an anomaly. Approximately one in five fatal police shootings in the United States involves someone with a mental illness. Ryan was also Black, and Black children are six times more likely to be shot to death by police than white children. Disabled children—especially those who are autistic, neurodivergent, or in psychiatric crisis—are disproportionately at risk.

This piece is for every family navigating a child's mental health crisis. It is especially for Black, Brown, Indigenous, immigrant, and disabled families, who face the greatest danger from a system that was not built to protect them.

The Standard Approach for Mental Health Crisis Care

"If you or your child is having a psychiatric emergency, please hang up and call 911 or go to your closest emergency room." Virtually all mental health providers feature this statement in their voicemail recordings. Prominent organizations like the National Alliance for Mental Illness and the American Academy of Child and Adolescent Psychiatrists also recommend these options as the surest way to promote safety.

But this unanimous messaging betrays the inequitably distributed dangers and harms embedded within the mental health crisis continuum of care. In many cases, calling 911 means involving police—and the tragic deaths of people like Ryan Gainer, Daniel Prude, Ma'Khia Bryant, and others demonstrate how police involvement during crises can be fatal. The risk is heightened for people of color and other vulnerable groups.

The 988 crisis line is an improvement over 911—but it can still result in police being dispatched. In the case of Yong Yang, a California man experiencing paranoia, a mobile crisis team spent less than two minutes with him before calling the police, who shot him within 10 seconds of arriving.

The Risks of Being in an Emergency Room

The risk of coercion and violence does not end when children arrive in the emergency room. When I previously worked in these settings, I observed that children of color were far more likely to be brought in by paramedics restrained.

In my experience, paramedics often treated children of color like they were adults, calling them "male" and "female," rather than "child," "boy," or "girl." White children, by contrast, were more likely to be brought in covered in a warm blanket, engaged in playful banter, or described to emergency room staff as "a good kid"—presented as deserving of care rather than punishment.

Recent papers indicate that Black children and adults are more likely to be secluded or restrained during ER visits. Though intended to be an option of last resort, seclusion and restraint are often invoked as an option of convenience. Injuries and broken bones are not unheard of, and the emotional toll of being tied down or subdued is immeasurable.

For autistic and neurodivergent children, the emergency room can be its own form of trauma enacted through sensory overwhelm. I once worked with a Black middle school-aged boy on the autism spectrum experiencing an acute psychiatric crisis. I made daily calls to his family, doing everything I could to keep him home.

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Other providers on his team insisted the standard recommendation was the ER. I disagreed—because I knew what awaited him there: a high risk of being perceived as dangerous and restrained.

He stabilized at home, and I remain confident that the ER would have only caused further harm. But my colleagues could not acknowledge that risk.

What Should Families Who Need Crisis Care Do?

As a child psychiatrist, I don't default to 911 or the ER. My approach centers on keeping children at home, where their families—not police or hospital staff—can care for and monitor them, with my medical support.

When families do need to go to an ER, I write a doctor's letter stating clearly my recommendation to avoid the use of force, to provide quality trauma-informed care, and to contact me directly.

I tell families directly: "If you or your child is having a mental health emergency, the standard recommendation is to call 911 or go to the closest emergency room. But getting the police involved carries significant risks, including the possibility of being shot and killed. Let's look at all the options together so you can make an informed decision."

When commencing a child's mental healthcare journey, I recommend asking your provider these questions:

Can you tell me what to do during a psychiatric emergency for my child?

How do you determine whether the benefit of calling 911 and going to the emergency room outweighs the risk of further violence and trauma?

What is my child's risk of being restrained or forcefully injected in the emergency room?

Can we make a crisis plan together now, before an emergency happens?

If there is any chance police may come to a home during a crisis, I also advise clearing out gardening tools, kitchen knives, scissors, and any other household items that could be perceived as weapons. Ryan Gainer was holding a garden tool. Many people in mental health crises hold objects—not necessarily to harm anyone, but often because they are terrified. Police may not see terror, however; they might see a threat, and the consequences can be fatal when they do.

All of the above isn't fair, and it shouldn't be necessary. But that doesn't change the reality.

Protecting Against Healthcare Trauma

Families can protect themselves by understanding the risks of calling 911 and going to the emergency room up front, and by seeking providers who have the expertise to weigh those risks carefully with them. Accessing liberating mental health care treatment from affirming, antiracist providers can prevent emergencies from happening in the first place.

Certain kinds of trauma often cannot be avoided. In healthcare situations, however, there is usually some freedom to choose—meaning that at least some traumatic healthcare incidents are avoidable.

No family should have to navigate mental health crises alone—and no child should die because their family called for help.

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