Quick Take: 988 and the future of crisis response

This article was originally posted Nov. 3, 2021. It has been updated.

In 2020, the National Suicide Hotline Designation Act created a nationwide three-digit number (988) to assist people experiencing a mental health or suicidal crisis. As of July 16, 2022, the FCC will require phone service providers to direct all 988 calls to the existing National Suicide Prevention Lifeline.

The implications of this change were explored in the webinar, 988 and the Future of Crisis Response: What Criminal Justice Professionals Need to Know, presented by Shannon Scully and John Snook and the Justice Clearinghouse, an online educational platform with an audience of over 120,000 justice practitioners. Scully is the Senior Manager of Criminal Justice Policy at the National Alliance of Mental Illness (NAMI). Snook is the Senior Vice President of National Policy Innovation for the Meadows Mental Health Policy Institute.

Here are some of the top takeaways from this webinar.

Established to steer mental health issues to mental health professionals

The 988 dialing code is intended to steer people with mental health issues to mental health professionals who are specifically trained to address their needs and away from calling 911 and subsequent encounters with police who are not. This is why Congress passed the 988 legislation in July 2020.

“This honestly is the first time that many policymakers realized just how broken the system had gotten and that we were spending a fifth of law enforcement staff time responding to and transporting people with mental illness,” said Snook. “It’s costing us a billion dollars a year as a nation, and we are seeing just an overwhelming number of people with mental illness ending up in really tragic situations.”

Two key elements to the 988 law

In making 988 the universal three-digit dialing code for mental health crisis response, Congress and the FCC achieved two goals.

First, “the legislation expanded the purpose of the National Suicide Prevention Lifeline,” Scully said.

Second, “the legislation allowed for new resources to be generated that are going to support the implementation of 988 and, and any kind of services attached to it.”

What 988 will cover and could cover

988’s mental health/suicide prevention mandate is focused on specific present-day issues, said Scully. But it could do more, and likely should.

“Currently when we’re talking about mental health and suicidal crises, what we’re talking about are things like when someone is actively thinking about suicide or self-harm, any erratic or unusual behavior due to mental health or substance use symptoms, delusions, paranoia, psychotic symptoms, or extreme withdrawal from everyday life,” she told the online audience. “There’s opportunity to expand into the wide array of behavioral health crises that I think land on law enforcement and the criminal justice system to address. But at this moment, that’s kind of what we’re talking about.”

The three pillars of effective 988 response

During the webinar, Shannon Scully outlined the three pillars of effective 988 response.

“They should have someone to call,” said Scully. “They should have someone to respond to them. And they should have somewhere to go.”

Balancing 988 with 911

The purpose of 988 is not just to direct mental health calls away from 911, but also to reduce the deployment of police to manage people in acute psychological distress.

“It’s this idea of ‘Intercept 0,’ the idea that we need to get to people before they’re in the sort of crisis that requires law enforcement to be called,” Snook said. “We need someone to respond to people when they’re at the 7-11 obviously in need of care, but not rising to the level that they need law enforcement involvement.”

At the same time, 988 operators will encounter situations where 911 and police may/may not need to be brought into the loop. Speaking on behalf of those 988 operators, Snook queried, “How do we deal with someone who may be talking about violence? How do we ensure 911 is aware of those situations? How do we ensure that calls don’t get dropped in between the two? Those are important conversations that we need to have because these 988 lines are coming on quick.”

988 crisis teams required

Using 988 to direct distraught callers to the National Suicide Prevention Lifeline is just the beginning of managing mental health crises more safely and humanely. To complete the process properly, mental health professionals must be assigned to “988 response teams” to meet and treat distressed people directly.

“If you’re going to set up 988, you have to have available mobile crisis teams,” said Snook. “We have to ensure that these teams coordinate effectively with our 911 systems and coordinate effectively with our community.”

He cited Denver’s STAR (Support Team Assisted Response) program as a good example of doing this right. “They have done a really good job of reaching the homeless population and individuals who have health concerns that cause them to cycle in and out of law enforcement engagement, mental health involvement or hospitalizations,” Snook said. “They have done a really good job of addressing that population before a crisis occurs and they need to respond with law enforcement.”

Patchwork legislation to date

The fact that 988 goes live on July 16, 2022, doesn’t mean that all 50 states are ready to support it. They aren’t. Although some have passed the necessary laws and financial support provisions, others have yet to do so.

“There are so many states where legislation hasn’t happened,” said Scully. “But that doesn’t mean conversations aren’t happening.”

Summary

The 988 mental health crisis dialing code offers great potential for dealing with psychologically distressed callers more appropriately, safely, and with far better outcomes for everyone involved. For more information, see 988: Reimagining crisis response.

NEXT: How behavioral health crisis calls are handled in the dispatch center