Most people in the United States cannot remember a time before 911 when it was necessary to call or run to the nearest police or fire station for help or contact a general phone operator. As a result, behavioral health advocates have pushed for years for a well-funded, interconnected emergency system for mental health crisis response.
The country took a vital step toward that goal in July 2020 when the Federal Communications Commission (FCC) announced a new three-digit number that would “effectively establish 988 as the 911 for mental health emergencies.” The hope is that the implementation of 988 as the unique crisis line number for mental health, substance use, and suicide crises will be as effective as 911 is for medical emergencies.
Too often, people experiencing a mental health crisis do not receive a mental health response. Instead, the situation is handled by law enforcement alone. Between 2015 and 2020, one in four fatal police shootings involved someone with a mental health condition, and more than 2 million people with mental illness are booked into our nation’s jails every year.
People in crisis deserve better, and the country is listening. In October of 2020, President Donald J. Trump signed the National Suicide Hotline Designation Act into law, which created 988 as a universal phone number for mental health and substance use crises and suicide prevention. It will be fully activated by July 16, 2022, across the United States.
The implementation of 988 and its importance to mental health crisis response will be significant. 988 is not just about answering calls – it’s about creating a system of mobile crisis teams, making appropriate referrals, and offering crisis stabilization programs that connect individuals to appropriate care at critical moments.
It will reduce avoidable emergency or hospital admissions, make better use of law enforcement resources, and avoid traumatic engagements with the criminal justice system. As a result, 988 is being called the future of mental health crisis response for many reasons, a few of which will be discussed in this article.
988 Means Reimagining Mental Health Crisis Response
What exactly does reimagining the mental health crisis response mean? The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed National Guidelines for Behavioral Health Crisis Care which describe three core components of a mental health crisis system:
- Crisis Call Centers
- Mobile Response Teams
- Crisis Stabilization Services
Crisis Call Centers
Typically, in the U.S. today, law enforcement handles crisis calls. Still, under 988, calls will be directed to call center hubs with well-trained, experienced staff who can respond quickly to mental health, substance use, and suicidal crises. In addition, calls can be handled promptly, including by text or chat, through which experienced clinicians can provide crisis counseling and conduct mental health assessments.
Mobile crisis teams can be dispatched if needed, appointments can be scheduled with providers, and follow-up calls can be conducted. Approximately 80 percent of the time, calls can be de-escalated over the phone without calling upon law enforcement.
Mobile Response Teams
When a person requires more support than can be provided over the phone, mobile response teams staffed by trained professionals can be deployed to a person’s location. Teams can de-escalate situations on-site, arrange transportation to crisis stabilization, or connect people to services.
Mobile response teams work closely with law enforcement but include them as co-responders only in high-risk situations. Typically, less than 5% of dispatches require law enforcement backup in communities with mobile response teams.
In the ideal system, a secure physical location is established that provides a place for people in crisis to be brought by law enforcement or other first responders as an alternative to an ER or jail.
Crisis Stabilization Services
Individuals in crisis can receive short-term (23 hours) stabilization services and assessments at Centralized Facilities. Once stabilized, they can be linked to services from within the community, including long-term treatment needs.
Ideally, effective crisis stabilization programs include peer support, detox facilities, and dedicated areas for first responders to drop off an individual with a 5 – 10-minute turnaround. In addition, crisis stabilization can keep someone from needing more intensive care and ensures a warm hand-off to follow-up care.
Only 20 – 30% of people in these programs need more intensive services such as hospitalization or connection to short-term facilities or residential crisis care.
988 is America’s Mental Health Safety Net
In October 2021, the National Alliance on Mental Illness (NAMI) conducted a poll that showed that 75% of Americans are not content with mental health treatment in this country. As a result, 988 will be America’s new mental health safety net by providing emotional support and immediate connections to care for individuals in mental health and substance use crises.
It represents the first step in a fundamental shift in the way people in crisis are engaged, mainly shifting from a law enforcement response to a mental health response.
The 988 hotline provides an opportunity to weave this national mental health safety net into the fabric of local crisis care in communities. The promise of improved resources such as mobile crisis teams and crisis stabilization means that people will receive appropriate care faster from trained professionals.
Increased call/chat/text capabilities mean that a higher percentage of calls will be de-escalated more quickly in an empowering and culturally responsive manner. In addition, the help provided will be more impactful as it will include not only professional assistance but also help from individuals with diverse backgrounds, including lived experience.
Though people should be connected at the local level, John Palmieri, acting lead for 988 at SAMHSA, has stated: One of its goals “is making sure that there is that safety-net infrastructure that exists at the national level, so that when individuals call, if…those calls aren’t able to be received at the local level, that there’s a national safety net to support those individuals in crisis.”
988 Will Redefine the Role of Law Enforcement in Crisis Situations
The activation of 988 will be the first step toward a transformed crisis care system that will redefine the role of law enforcement in crisis situations. When a person in crisis dials 988, they will be routed directly to trained mental health professionals instead of police officers.
Collaboration with local law enforcement will continue to be essential, however. Though a response from law enforcement and/or Emergency Medical Services may be needed in extreme cases, the coordinated response through 988 is intended to promote stabilization and care in the least restrictive manner.
Because 911 will likely continue to be the default for people to call for a period, law enforcement will still require basic training in de-escalation and identification of people experiencing a behavioral health crisis. In addition, clear communication protocols with 988 planning committees should be established to state when police officers will be deployed or called a backup.
Such collaboration can reduce the costly use of law enforcement and hospital emergency departments.
988 Will Help to Reduce Stigma Surrounding Mental Health
An easy-to-remember 988 number will make it easier for Americans to access the crisis help they need while helping to reduce the stigma surrounding mental health. Kimberley Williams, CEO and President of Vibrant Emotional Health (administrator of 988), has said: “The implementation of 988 is really a game-changer for our society.
By designation a three-digit number, we tell Americans that they now have an easy-to-remember, easy-to-access way to connect to immediate crisis support and care directly. It also helps destigmatize access to mental health resources by encouraging help-seeking behavior.”
The Role of Technology in 988
The role of technology in 988 cannot be understated. The success of a mental health crisis response system will largely depend on how easily information can be accessed regarding individuals in crisis. The technology selected should be able to address the following issues:
- Interoperability across emergency and crisis response systems
- Accurate data collection
- Secure, HIPAA compliant platform
Julota’s flexible cloud-based platform is an excellent choice for an effective crisis response system. It can transform the disconnected patchwork of providers such as EMS, behavioral health professionals, and law enforcement into a well-coordinated network.
To achieve true interoperability across emergency and crisis response systems requires sophisticated and robust data application interfaces such as Julota’s TouchPhrase Interface. This interoperability will empower organizations to collect accurate, secure information in a single location compliant with HIPAA guidelines.
A mental health crisis can happen to anyone, but no one should have to live in fear of the response they will receive when they call for assistance. 988’s importance to mental health crisis response is vital as the focus of care switches to diversion away from law enforcement and the criminal justice system to appropriate treatment and services.
In November 2021, NAMI and 16 other organizations came together to create the Consensus Approach and Recommendations for the Creation of a Comprehensive Crisis Response System. The report stated: “Law enforcement should take a secondary role in crisis response.” This, they said, would be “a paradigm shift” that recognizes mental health conditions as “matters of health care, not criminal justice.”