988 Shows Promise, Room to Improve a Month After Launch
by Ron Manderscheid, PhD 08/24/2022:
As envisioned, the 988 Suicide and Crisis Lifeline is a new national approach to emergency response for individuals experiencing a mental health or drug crisis. The Lifeline seeks to be appropriately responsive and sensitive to personal needs, while overcoming the drawbacks and problems associated with the earlier 911 system, such as police involvement.
This is an essential vision for today. A system operated by behavioral health professionals and peers should be able to reduce and eventually eliminate jail incarceration, emergency room care, and forced treatment, as well as their related fears and traumas. The new Lifeline commenced operation on July 16.
We have just reached the end of the first month of operation for this new emergency response system. Thus, it is important that we pause and reflect on some of the feedback that is beginning to come in from the field. Many reports from the field, such as a new RAND report, point to a serious shortage of trained professionals and peers at the county level to respond to emergency situations. These individuals are needed to respond to calls from Lifeline call centers and to staff emergency outreach, including mobile crisis team responses. Miriam Delphin-Rittmon, PhD, the assistant secretary for mental health and substance use at the Department of Health and Human Services (HHS), has championed this issue and has sought federal funding to begin to address the shortage. As a result of her efforts, more than $180 million was provided in fiscal year 2021, and another $240 million is anticipated for FY2022. Going forward, further funding also will be needed to hire local workers, as well as to expand the pipeline of behavioral healthcare professionals and peers working in the field.
Other reports suggest that a significant subset of the calls now being received do not involve a current crisis. Rather, the caller is requesting support to address a present issue or concern, such as failure to receive a monthly check, a lost job or lost housing, etc. These calls usually concern problems focused on the social determinants of health. If not addressed, these issues could lead to subsequent behavioral health crises. Although 988 was not designed for this type of call, per se, it will be important to explore mechanisms to address these issues. For example, one community has developed an arrangement with the local religious organizations to work with these callers to seek solutions.
Recent concerns in the consumer community have been raised about the potential for police involvement, incarceration, emergency room care, forced treatment, and privacy violations. (See more information on first responder privacy requirements) Clearly, no one wants to see the long-standing problems of 911 transported into 988. If problems in these areas are identified in specific call centers and local counties, then actions will need to be taken to rectify them. Peers can be particularly valuable in identifying these problems and in suggesting ways to overcome them.
Finally, one wonders whether calls to 911 now are being appropriately referred to the Lifeline when they involve a mental health or substance use crisis. The success of this effort will depend on the accuracy of the coding systems for calls deployed in 911 and the training that 911 call staff have in using these codes. Stephanie Hepburn has explored this issue.
The 988 Lifeline is an essential tool for those with mental health and substance use crises. Each of the potential issues identified above can be addressed. Doing so will help us have a much better behavioral healthcare system throughout the United States.
Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
Cantor JH, Holliday SB, McBain RK, et al. Preparedness for 988 throughout the United States. RAND Corporation; 2022.
Navigating confidentiality in first responder deflection. Focus: PHI; 2022.
Hepburn S. The troubling history of 911 and how 988 can avoid the same missteps. #CrisisTalk. Published online May 25, 2021.