As of July 16, 2022, a new resource for mental health across the country is looking to help the 911 system relieve the pressure placed on it by mental health crisis calls. The unique number, 988, aims to make it easier for people to call for help anytime. Previously known as the suicide hotline, the ten-digit number was difficult for most to remember in a crisis and historically underfunded and under-utilized, leaving many individuals in crisis to rely on 911. Lawmakers and mental health advocates see this as an opportunity to radically change the mental health care system and make care accessible everywhere in the United States.
1. Faster response time for co-responder teams
988 and emergency services working together allows for further specialization of mental health services. In areas where co-responder teams have been handling all mental health crisis calls, 988 provides for these teams to focus on the calls with the highest level of need. This differentiation between actual emergencies and ones that can be managed by a professional on the phone allows teams to spend less time responding to calls that can be otherwise managed and more time quickly responding to calls that need team response. The fewer calls the team has to go out on, the faster their response time to the calls that need them.
The primary goal of 988 is to provide support for people in a mental health crisis in the moment. Most calls to the center do not require emergency services activation. While some safety and health issues may require law enforcement or EMS services to be activated, the hope of 988 is that it will help decrease the number of mental health crisis calls emergency services have to respond to. Diverting mental health calls will allow them to provide care in the least restrictive manner and enable emergency services to focus on true emergencies.
Any time the number of calls a team has to respond to is decreased, the level of care they can provide improves, and the amount of time it can take to respond decreases. The U.S. had one death by suicide every 11 minutes in 2020. Suicide was the second leading cause of death for young people aged 10-14 and 25-34. From April 2020 to April 2021, more than 100,000 people died from drug overdoses. These calls need rapid response from crisis teams and emergency services. These calls need co-responder focus, and 988 will help with that.
2. Improved screening of Mental Health Crisis Calls
The 988 and 911 systems will need to coordinate closely to allow for the seamless referral of callers for appropriate care or response that addresses the unique circumstances of each crisis encounter. SAMHSA is working with 911 counterparts at the federal, state, and local levels to plan for smooth coordination between the two services to meet this stated goal.
This is a new program, so work is actively underway to aid in cooperation nationwide. Co-responder and crisis intervention programs can benefit heavily from getting involved in this work so that care coordination is set up appropriately for their communities.
Preliminary data indicates that 988 handles a high percentage of these calls in-house. North Carolina released their initial data showing that fewer than 5% of 988 calls had to be handed over to emergency services.
Tulsa World hailed 988 as a great addition to emergency services and noted in just two months, about 5,000 Oklahomans have dialed 988 seeking help, and a minute percentage have required law enforcement involvement. They allow law enforcement and crisis teams to focus on the most imminent need.
Georgia reports that 988 has helped 500 potential suicide victims get help.
Florida reports a significant increase in calls routed to 988, with only about 2% requiring law enforcement or EMS assistance.
3. Improved access for co-responder teams
One of the identified problems with the 911 system being used for mental health crisis response is that some individuals experience significant fear about reaching out as they do not want to be hospitalized or have some fear of law enforcement. This fear is exacerbated by media reports of police interactions gone wrong, with very few reports of the many police interactions that go right.
This hesitance has led to several individuals falling through the system’s cracks and ending up with negative life experiences or, worst of all, injuring themselves or others in the process. The 988 system is set up to reach these individuals. It is operated by trained mental health professionals who can identify those needing high levels of help and direct emergency services through co-responder teams or crisis response teams to aid these individuals in receiving needed services. Additionally, these specially trained professionals can route non-emergency calls to community resources, some of whom might have never received the information due to fear.
988 Lifeline data for August 2022, which is the first full month of service, shows an increase in the number of calls responded to, while at the same time, it has decreased waiting time. In a statement last week, the Department of Health and Human Services released data showing a 45% increase in volume last month compared to August 2021. There were 152,000 more contacts in all.
This data shows that the 988 system is working as intended and indicates that now is the time for communities to work together to ensure that connections are built, and resources are shared with the individuals in need. By working together, 988 provides a triage system for the community’s mental health needs, reaching more individuals and allowing specialized care.
4. Improved resources for co-responder teams
The current administration has also invested over $400 million in crisis centers and mental health improvement to help the 988 system succeed. There is a recognition that funding improvement for mental health services has long been overdue.
The Safer Communities Act, signed by President Joe Biden, allocated 150 million dollars to support the transition to 988. This investment builds upon the $432 million already provided by the Biden-Harris Administration, which includes $105 million in grant funding to improve response rates, increase capacity to meet future demand and ensure calls initiated in their states or territories are first routed to local, regional, or state crisis call centers. A list of these call centers by state is available on the SAMHSA website with the hope of more local resources to come.
Throughout September, which is National Suicide Prevention Month, HHS looks to award $25.3 million in suicide prevention grants, which includes funding dedicated to:
●$9 million for Innovative Community Crisis Response Partnerships grants for states, territories, tribes, and public or private nonprofit entities to create or enhance existing mobile crisis response teams to respond to mental health crises in place of law enforcement or emergency medical responders.
●$7.3 million for the Garrett Lee Smith (GLS) State/Tribal Youth Suicide Prevention and Early Intervention Program to aid in youth suicide prevention and early intervention programs in schools, universities, juvenile justice systems, substance use and mental health programs, foster care systems, and other organizations that serve children and youth.
●$2.2 million for the GLS Campus Suicide Prevention Grant Program to support programs that improve mental health services on college campuses with students who are at risk for suicide, substance abuse, and other at-risk behaviors.
●$6.8 million for School Based Trauma-Informed Support Services and Mental Health Care for Children and Youth. SAMHSA aims to enhance and improve trauma-informed support and mental health services for children and youth by linking school systems with trauma services informed care.
The renewed emphasis on making mental health resources more available ensures that co-responder and crisis teams will have the opportunity for more help, more referral sources for individuals in need, and, ultimately, more time to focus on the cases that need their attention.
5. Improved Options for Coordination of Mental Health Crisis Calls
Just as case managers have improved co-responder programs, coordination with 988 can improve co-responder programs and care for individuals in need. We know that the more services work together, the more the access to care and quality of care improves.
One of the primary obstacles to overcome when joining agencies together is data sharing. Several laws regulate privacy practices for health services, mental health services, and legal services. Your community has to work together to manage all of these data-sharing needs. One option to simplify this coordination of care is Julota; this program allows all systems to communicate needed information while maintaining privacy to comply with regulations and federal privacy laws.
The Julota platform allows several organizations to pool their resources and access it all via cloud computing. Julota is accessible using technology everyone regularly carries, such as a smartphone, tablet, or laptop connected to the Internet. It is compliant with all data privacy and security regulations that govern law enforcement and behavioral health information systems, including compliance with HIPAA, 42 CFR Part 2 (to protect substance use treatment records), and CJIS (Criminal Justice Information System).
988 can become another layer in your community’s support system. If all systems coordinate and share data, an individual with multiple suicidal attempts or behavior and a history of law enforcement involvement could be routed appropriately and quickly. Hence, a crisis or co-responder team is ready to intercede quickly.
Another individual with no history of 911 involvement but with a history of hospitalization after attempts could be identified as someone who needs only a clinician or unmarked car response to improve any in-person crisis interactions.
Yet another individual with a long history of calling 911 repeatedly and needing to be talked with and referred to community sources could be managed entirely by the clinician answering the phone at 988. They are allowing the co-responder team the ability to focus their time elsewhere.
In any emergency, the more information the team has about what they are walking into, the better the likely outcome for everyone. The higher the success rate the greater the chances that individuals receive the help they need and everyone walks away safe, which is the goal of emergency services everywhere.