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### **988: Working With the New Mental Health Crisis Number**

December 2022 | Volume 15 | Issue 12

Though the National Suicide Prevention Lifeline has long been a valued resource, remembering the 10-digit phone number isn’t easy during a crisis.  As a result, many people dial the 911 police emergency line, with calls for help that should have gone to mental health specialists instead.

Now there is an easy-to-remember three-digit number to call, chat, or text for 24-hour, confidential access to mental health specialists: 988.

Launched by the Federal Communications Commission (FCC) in July 2022 to connect callers to the National Suicide Prevention Lifeline, which connects the calls to mental health service call centers across the country, 988 is managed by Vibrant Emotional Health, a nonprofit organization which administers a variety of mental health services and programs, and is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA).

##### Benefits to Police and the Community

A long needed resource, the 988 Suicide and Crisis Lifeline can be of great benefit not only to individuals in distress but also to police departments burdened with growing numbers of mental health calls, which the Vera Institute of Justice estimates to account for more than 30 percent of calls to 9111 in some departments. 

Because of this large number of calls, the National Alliance on Mental Illness (NAMI), estimates that 20 percent of law enforcement staff time is spent responding to and transporting people in acute psychological distress.

Moreover, the outcomes of these interventions can be tragic. Many individuals calling 911 with mental health emergencies end up in jail or languish in hospital emergency departments, waiting hours or even days to get care. And they often return to the street, jail, or the hospital.

##### Expanded Service on 988 and the Lifeline

In states that do not yet have 988 service, callers can still reach the Lifeline—which has more than 180 local crisis call centers in 50 states—at its original 10-digit number, 800-273-8255.

Both numbers will connect callers to therapists who can officer advice, referrals, resources, and other forms of support to individuals experiencing mental health issues, emotional distress, and substance abuse problems, as well as suicide crises. They also offer support and resources to friends, families, or bystanders who wish to help people who need mental health support.

When additional resources are needed, the mental health counselor can also request a mobile crisis unit, the fire department, a rescue squad, or the police. 

##### Tips for Successful 988 Implementation

SAMHSA’s 988 Suicide and Crisis Lifeline guide is a very helpful tool for implementing the new service.

Here are some suggestions based on it:
              - Develop cross-system partnerships connecting mental health and other health care professionals, police, and fire responders with the agency that runs the call center and the services that can be dispatched.
              - Engage key stakeholders, including government and community leaders.
              - Ensure that the community has the resources and infrastructure to help patients. SAMHSA’s National Guidelines for Behavioral Health Crisis Care can be used to identify which crisis services exist locally, regionally, or statewide.
              - Review policies, procedures, and training materials to ensure that 988 is effectively incorporated into your crisis responses.
              - Take steps to ensure calls can be seamlessly transferred between 988 and 911 and show responding officers how they can use 988 when encountering a person in crisis.
              - Promote 988. The public, as well as local law enforcement officers, will need to be educated on 988 as it becomes available.
              - Coordinate with federal stakeholders to make sure your department and community have the most up-to-date information about what is available in your state.

##### Collaboration and Coordination to Support 988

Collaboration with local law enforcement is essential to implementing 988. The two systems, 988 and 911, will need to be closely coordinated to seamlessly connect callers to appropriate response for each crisis encounter. Communication and dispatch policies should be established at the outset of planning to make clear when 988 counselors must call for law enforcement backup or when 911 dispatchers should connect calls to 988. States and local communities will need to work together to effectively implement 988, identify the types of services that will be available to callers, and establish plans for oversight and reporting. Some are developing and building out their behavioral health crisis continuum to connect those who reach out through 988 with additional services like mobile crisis units or crisis stabilization, where appropriate.

##### Implementation in Virginia and Texas

In Virginia, which was the first state to implement 988, Fairfax County Police Department’s (FCPD) Crisis Intervention Team Commander, Lieutenant Eric Ivancic, said 988 will reduce calls for service made to the state’s Public Safety Dispatch Centers, thereby reducing the strain on police and fire and rescue resources.

The county already had the infrastructure for providing mental health services in place; the Mobile Crisis Unit (MCU) provides on-scene evaluation, treatment, and crisis intervention. Now, its link to 988 ensures a coordinated response of behavioral health services for the entire region.

Lieutenant Ivancic said the FCPD is working on identifying the other types of resources that can be offered, what additional procedures should be in place, and which calls the department will hand off to 988 and which 988 will direct to them. To support this effort, they are launching a four-tier triage system so that Dispatch can categorize the calls.

The FCPD has created relationships with regional crisis centers across the state and attends biweekly meetings with all stakeholders, including the fire departments, regional agencies, and each of the police departments in their county, as well as college campus police.

Said Lieutenant Ivancic, “Our county Board of Supervisors support us, and the community, mental health professionals, and law enforcement are excited about it. It’s a win-win situation. The biggest struggle is staffing, finding clinicians.”

When asked what the challenges were in coordinating Texas 911 and 988 services, BJ Wagner, Senior Vice President of Health and Public Safety of the Meadows Mental Health Policy Institute in Dallas, said, “One of the biggest was standing up a new contact number for work that was already happening.

“Texas has always been a leader in response to crisis calls, so this isn’t much of a change, but more of an opportunity to get more services to people in need of immediate care,” she said. “A lot of our communities have civilian mobile crisis teams who respond to mental health emergencies that pose no risk to public safety. What we’ve been missing is comprehensive programs for those that do pose public safety risks.

“We now provide an alternative public safety response to mental health crisis with programs that include paramedics and clinicians as well as law enforcement personnel. With 988, these teams can work together on calls that pose moderate or high public safety risk.

“But we have to think about which calls to send to 911 or 988 – and develop a responsibility matrix for transferring calls over to 911 if safety is a concern. In Houston, they’ve been doing a lot of work in clinical triage for call centers to better understand which ones need police response.”

As for the public acceptance of the 988 service, Houston’s Harris Center for Mental Health reported a 40 percent spike in calls originating with 988 and expects the volume of those calls to double in the first year.2

##### Performance Data Indicate Success

Though Lifeline volume increased substantially following 988’s implementation, and that is likely to continue as public awareness grows, the consensus of all involved is that calls to 911 will continue and law enforcement officers will still need basic training in handling them. However, the belief is that the 988 number will greatly reduce those calls, allowing officers to spend more time on their primary role of supporting public safety.

And there is also already some evidence of 988’s success. SAMHSA’s Lifeline Performance Metrics show that 308,921 calls to 988 were answered in the month of September 2022.

According to Laura Evans, the Director of Policy for Vibrant Emotional Health, the administrator of the 988 Lifeline, during that month, answered calls to 988 increased by 40 percent compared to calls to the 10-digit Lifeline number in September 2021, answered chats increased by 218 percent, and answered texts by 153 percent. 

Faye C. ElkinsSr. Technical WriterCOPS Office

##### References

1 “911 Analysis: How Civilian Crisis Responders Can Divert Behavioral Health Calls from Police” (New  York: Vera Institute of Justice, 2022),https://www.vera.org/downloads/publications/911-analysis-civilian-crisis-responders.pdf.            
2 Sara Willa Ernst, ““Nearly 40 Percent Increase in Calls after Rollout of 988 Suicide and Crisis Hotline in Houston,Houston Public Media, last modified September 9, 2022, , https://www.houstonpublicmedia.org/articles/news/houston/2022/09/09/432545/nearly-40-percent-increase-in-calls-after-rollout-of-988-suicide-crisis-hotline-in-houston/. 

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