Themes and Issues in User Stories of Mental Health Emergency Responses: Retrospective Qualitative Study

BACKGROUND Mental health crises generate millions of emergency calls in the United States each year, yet current 911 systems were largely designed for other emergency contexts. Recent investments such as the 988 crisis line, co-responder models, and digitally enabled crisis response systems aim to improve mental health emergency response, but little is known about the lived experiences of individuals who contact these services. User-centered and socio-technical design approaches suggest that effective crisis technologies and response systems should be grounded in a clear understanding of caller experiences, needs, and real-world crisis dynamics. However, existing research has focused primarily on providers, specialized response programs, or extreme outcomes, leaving a significant gap in understanding the perspectives of callers and those directly involved in mental health crisis events. OBJECTIVE This study investigated how individuals involved in mental health (MH) emergency crisis situations perceived the services provided when they or someone else contacted 911 or 988, the primary public emergency numbers in the United States. The objective was to identify recurring themes in user experiences during and following the calls to enable better human-centered systems designs in the future. METHODS A retrospective qualitative study was conducted using Critical Incident Methodology for thematic analysis. Eight adult interviewees above 18 years of age residing in the metro Atlanta area participated in the study. They reported fifteen (15) distinct mental health crisis incidents where they were involved in 911/988 calls, with fourteen (14) between 2020 and 2025 and one from 2005. Participants were recruited through purposive sampling in partnership with the Georgia chapter of the National Alliance on Mental Illness (NAMI). We conducted anonymized in-depth interviews with individuals who experienced mental health crises involving 911 or 988 services using phone, video, or in-person formats. Interviews lasted 30–120 minutes and were conducted under Institutional Review Board (IRB)-approved procedures with written consent. Data were analyzed using critical incident technique and thematic analysis, and preliminary findings were reviewed with NAMI leaders to support accurate representation and assess applicability of identified themes. RESULTS We conducted eight interviews covering 15 mental health crisis incidents involving 911 or 988 calls. Findings revealed variability in caller knowledge, unmet requests for help, escalated responder actions, misinterpretation of crisis situations, and limited follow-up support contributing to recurring crises. CONCLUSIONS The resulting caller journey maps and user stories identify critical breakdowns and opportunities for improving mental health crisis response systems and provide a replicable framework for analyzing user experiences across crisis contexts.