988: Three Digits That Could Transform America’s Mental Health Response
If you’re having a heart attack, you call 911. If you’re contemplating death by suicide, you call 1-800-273-8255. That’s … not easy to remember. Fortunately, starting tomorrow, you can dial 988 and be connected to a local crisis hotline. If no local counselor is available, the call will be routed to the 24/7 national Suicide and Crisis Lifeline.
As part of a broader push around the launch of 988, the federal government allocated nearly over $400 million to upgrade and expand the number of crisis call centers across the country. Given that last year 1 in 5 calls to a suicide crisis hotline resulted in a dropped call while other people in crisis waited hours for help, these resources could not be more welcome.
Yet, for mental health professionals and advocates, 988 is not just a more user-friendly crisis hotline, but a catalyst for a desperately needed transformation in how the country responds to acute mental health issues.
The Basics:
As Dani Blume explains in the New York Times, though 988 started as an easier way to access suicide prevention help, starting tomorrow, “anyone experiencing a mental health or substance use issue can call 988. Counselors on the other end of the hotline are trained in handling a wide range of mental health issues, including self-harm, addiction and suicidal ideation[.]"
Here’s a helpful graphic from the national Suicide and Crisis Lifeline depicting what happens when a person calls 988:
The Bigger Vision:
Saturday’s launch is the first step. 988 crisis counselors will handle an anticipated 6 to 12 million calls and texts over the next year. As Steven Ross Johnson reported in U.S. News and World Report, “80% to 98% of [those] calls can be resolved over the phone.”
The next three steps of the vision are in their infancy—and success will depend on state and local governments taking the lead and committing significant resources:
Mobile Crisis Response Units. In the 2% to 20% of situations where a 988 counselor is unable to resolve a situation over the phone, an in-person response is needed. But there is no national in-person infrastructure in place that mirrors the national crisis lifeline. Instead, mobile crisis teams are deployed at the local level. As a recent report from USC’s Schaeffer Center and Brookings detailed, in places where a mobile crisis unit exists, a 988 counselor can dispatch a team of behavioral health professionals with the training and experience necessary to identify signs of mental illness, de-escalate tense situations, and assess appropriate responses to keep both the person in crisis and the community safe.
Stabilization Centers. The mobile crisis response team can bring the person to a stabilization center if needed. The Washington Post’s Larry Bernstein paints a helpful picture of these centers as places where “psychologists, doctors, nurses and other specialized personnel provide everything from urgent mental health care to drug treatment medication [, which] keeps people who may be considering suicide or have other acute mental health needs out of emergency rooms and jails, reduces police and EMT involvement in behavioral health cases and speeds aid to the people who need it.”
Post-Crisis Follow-up. After the acute situation that triggered the 988 call is resolved, a crisis counselor can follow-up with the person and connect them with any needed programs and services. John Draper, executive director for the National Suicide Prevention Lifeline, told Yahoo News, “...follow-up calls have also made a difference in keeping people safe. About 80% of the time, people who've received follow-up calls from us have said that those calls made a difference in keeping them safe, and half of them said that they're the reason they're alive. So being there for somebody in that moment of darkness can really be a life-changing event for them.”
Getting From Here To There:
There is a vast, but bridgeable gap between the ideal vision of how 988 relates to a broader transformation in the delivery of acute mental health services and what actually exists across the country as 988 launches tomorrow. Here are three components that will influence the distance and speed with which the chasm closes:
$$$. States need to provide dollars to support local crisis centers. In some localities, these local centers don’t yet exist. In other places, the crisis centers exist but need funding to continue or meet expected demand for services. And yet, only four states have enacted comprehensive funding plans for 988—Washington, Colorado, Nevada, and Virginia (this interactive map from National Alliance on Mental Illness tracks relevant state legislation).
Federal Support Spurred 988’s Launch, But Mobile Crisis Response and Stabilization Centers Require State And Local Government To Lead The Way. Mobile crisis response programs are popping up all over the country—including recently launched units in Denver, Houston, New York City, Oakland, and Portland. But many programs are in their infancy, and most Americans do not live in a place where healthcare experts are regularly dispatched to handle mental health and substance use calls. Similarly, there are far too few crisis stabilization centers that exist today (The Washington Post recently covered one in Tucson, Arizona). And consistent post-crisis follow-up calls are at best very spotty (The Wall Street Journal recently covered a crisis center line in Massachusetts that conducts follow-up calls).
Integrating 911 And 988. Even if the launch of 988 triples the volume of calls to crisis hotlines over the next year, the total volume of calls will still be a small fraction of the calls about mental health and substance use that 911 call centers receive. The upshot is that police officers and firefighters often are dispatched instead of available mobile crisis response teams specially trained to handle these situations. “The problem is that 911 wasn't set up to address mental health needs. Either callers end up in a frenetic emergency room, waiting for hours and sometimes days to get care, or they end up interacting with law enforcement, which can lead to tragedy or trauma,” NPR’s Rhitu Chatterjee explains. That’s why, though still the exception and not the rule, tight integration between 911 and 988 is so important. In Los Angeles County, for example, linking 911 and 988 call centers will allow both 911 and 988 dispatchers to bring each other into a crisis call so that staff from both centers are on the line.
Good Vibes: The barriers to realizing the full vision for the delivery of acute mental health care are substantial, but at a time where political optimism is in the tank and Republicans and Democrats can’t agree on the color of the sky, lawmakers seem downright enthusiastic about the opportunity that 988 presents:
Tony Cárdenas, a Democratic state lawmaker from California said: “988 is giving us a historic opportunity to change the way mental health crises are treated in America, and together, we can work towards a future where mental health isn’t criminalized. My hope is that people in need, anytime and anywhere, can call 988 and when they do, they’ll find the support they need.”
Mark Tisdel, a Republican state lawmaker from Michigan said: “For years, the National Suicide Prevention Hotline has supported people in moments of crisis, and now, calling the lifeline will be simpler than ever. Qualified, compassionate counselors answer every call to lend a listening ear and offer professional, mental health assistance. Everyone should familiarize themselves and their loved ones with 988 — the quick, easy number anyone can call for help.”
Tina Orwall, a Democratic state lawmaker from Washington said: “This is more than a three-digit phone number. We’re using this opportunity to rebuild the whole crisis system.”