I take mental health calls no one sees. Missouri’s system is already breaking | Opinion

We called it a win.

In a small Missouri apartment, a mother stood in her hallway while her adult son, gripped by psychosis, yelled at voices she couldn’t hear. The hallway smelled faintly of cigarette smoke and old carpet. He hadn’t slept in days. She didn’t want to call the police, but she didn’t know who else to call. I showed up with an officer and talked him down. He trusted me. He agreed to go to the hospital.

But I already knew how this story ends.

I’m a mental health first responder embedded in a small police department in eastern Missouri. I get dispatched to the same 911 calls officers do, not as an outside clinician, but as part of the team. I respond to overdoses, delusions and family implosions. My job is to deescalate the crisis before it turns into an arrest or worse, and then help families figure out what comes next.

Even when things go well, they often don’t hold. That young man was discharged within hours. No medication. No follow-up. No support. His mother was left carrying the weight again.

We tell ourselves there’s a system. But what’s left of it is coming apart.

Since July, major federal rollbacks have accelerated the collapse of our mental health infrastructure. You’re already seeing the cracks here in Missouri.

Missouri now ranks 47th or lower in the nation for access to mental health care. That’s not a crisis waiting to happen. That’s a system that has already failed too many people, too many times.

And this is only going to accelerate. We are heading into a fall and winter with fewer coverage options, fewer crisis teams and fewer ways to intervene before tragedy hits. The safety net isn’t fraying. It’s vanishing. One program. One family. One call at a time.

LBGTQ+ youth hotline shut off

The 988 lifeline for LGBTQ+ youth has gone silent. Until recently, young people could press 3 and talk to someone who understood. That option is gone. In two years, it had taken more than 650,000 calls and texts. Now, one awkward question or wrong name from a crisis line worker who doesn’t understand their identity can shut the whole thing down.

Kids are losing Medicaid. In Missouri alone, thousands of families have been told their children no longer qualify. Across the country, 17 million people are at risk of losing coverage. One father I know now splits his seizure medication so his son can take his.

Police mental health training has stalled. Federal pressure has faded. Families calling 911 have even fewer guarantees the response will be safe.

Mobile crisis teams are disappearing. Even though they work. In 2022 and 2023, 24 states added more than 250 mobile units. These teams prevented hospitalizations, saved lives and saved money. And now, many of them are under threat.

We’re not behind. We’re already in the collapse. We just haven’t called it that yet.

You can feel it everywhere.

Teachers are absorbing more behavioral spirals. Emergency rooms are packed with people who don’t belong there. But they can’t go to urgent care without coverage. They no longer have a primary care provider. And there’s nothing else left. Families are making quiet choices about rent, utilities, medication and treatment.

We don’t have a system. We have a patchwork of waiting lists, bad fits and missed chances.

Some say the system is too broken to save. I don’t disagree. It didn’t work for everyone. And yes, some people took advantage of it. But tearing it away without putting anything better in its place doesn’t fix the problem. It spreads it. And families are the ones left to carry the weight.

And the cost isn’t just emotional. It’s borne by every responder, teacher, dispatcher, ER nurse, pastor and nonprofit worker trying to hold the line. It’s paid by the communities where these families live. Through burnout. Through strained budgets. Through lives lost too soon.

Denver STAR reduced repeat crisis calls

But I’ve seen what helps.

It’s showing up after the crisis, not just during it. It’s case managers who don’t vanish. It’s providers who know your name, not just your chart. It’s recovery centers that focus on remission. Not just crisis control.

In Missouri, my team stays. We call back. We go with families to appointments, or we connect them to the people who can. We vet providers who get results. In Denver, a program called STAR paired clinicians with first responders and saw a 30% drop in repeat crisis calls. Because someone followed through.

Still, even the best teams hit walls.

I recently sat with a father trying to gain guardianship of his adult daughter. She was cycling in and out of short-term psychiatric units. Each one kept her two to five days — just long enough to stabilize her symptoms. Not long enough to help her reconnect with reality. I had to tell him the truth: There is no long-term care program in our region equipped to meet her needs. This might be the most stable she gets.

That kind of truth wears people down. It wears us down, too.

So we meet people earlier. We hosted a resource fair inside a Salvation Army gym. Families didn’t just leave with flyers. They got connected directly to utility help, birth certificate applications, haircuts, people who helped complete Medicaid paperwork, and providers who could see them now. They also learned where to go for free groceries and food support in their community.

That’s what access looks like. Not a hotline. Not a form. A person.

Long-term community outreach

We’re also building long-term community bridges. The police department’s Faithful Steps program equips religious and secular partners to recognize risk and connect people to trusted support. The TransFamily Support Network offers safer access points for LGBTQ+ families.

It’s not just about more services. It’s about better ones. Ones that show up. Ones we trust.

This isn’t a warning. It’s what’s already happening.

And no one is coming to fix it from above.

If we want to hold the line, Missouri communities will have to move first. But we can’t keep handing this work to the same agencies, the same departments and the same voices that are still lobbying for their own piece. We need new partnerships. Smarter investments. Care that shows up where people already are.

When the system breaks, someone is still standing in the hallway holding the phone.

Let’s make sure they don’t have to wait alone.

Dr. Shannon Cubria Farris holds a doctorate in clinical psychology and serves as a mental health first responder in eastern Missouri. The views expressed here are his own.

This story was originally published August 24, 2025 at 5:03 AM.