The “988” Opportunity: Improving Our Response to Behavioral Health Crises

Everyone knows to call 911 in an emergency. Behavioral health advocates hope that a new three-digit number will soon be added to our collective memory bank. In September, Congress passed a law designating “988” as the dedicated number for suicide and other behavioral health crisis calls; it’s scheduled to go into effect in July 2022.

Why create a new number? A previous 1-800 number originally dedicated to suicide prevention was of course longer. The hope is that 988 will be easier to remember and may help destigmatize behavioral health crisis as it becomes accepted in similar fashion to 911. Also, as with 911, 988 will soon facilitate a new “care traffic control” system specifically dedicated to behavioral health issues.

Importantly for states, the 988 designation enables them to assess fees on landline and wireless bills to finance the state and local organizations that serve as the frontline for behavioral health crisis response, just as they do for 911. Calls to 911 that involve a behavioral health crisis will seamlessly transfer to the 988 line for appropriate response.

This federal recognition — with the 988 designation — of the need for easier access to behavioral health crisis services is part of a trend for strengthening the continuum of behavioral health care to include a wide array of community-based services, as well as inpatient services through public and private hospitals.

Behavioral health crises are a growing problem, exacerbated by the COVID-19 pandemic, which creates enormous challenges for every corner of society, including families, law enforcement, courts, emergency medical services, and emergency rooms. Alabama and Alaska are working with local behavioral health organizations to create behavioral health crisis systems starting at the regional level. While many of these programs get started in a given county or region, several states, such as Arizona, Georgia, and Tennessee have progressed in creating a statewide system.

Two important and complementary goals for an effective behavioral health crisis care system are: 1) make it easy for someone who needs immediate help to access the system, and 2) divert behavioral health crisis cases away from law enforcement and emergency rooms. The behavioral crisis care systems not only provide more appropriate care but can also save money by reducing the use of expensive institutional services.

The 2020 publication of National Guidelines for Behavioral Health Crisis Care, by the Substance Abuse and Mental Health Services Administration, is another recent federal policy development that has created an opportunity for states to advance their crisis care systems. The guidelines describe the three core service components for a behavioral health crisis system:

• A 24-hour call center
• Mobile response teams
• Crisis stabilization in participating facilities

State efforts to implement behavioral health crisis care systems in Arizona, Georgia, and Tennessee are described in more detail in Building State Capacity to Address Behavioral Health Needs Through Crisis Services and Early Intervention, a new Milbank issue brief by Stuart Yael Gordon of the National Association of State Mental Health Program Directors. In addition, the Fund has compiled lessons from a forum of state health policy leaders about expanding and sustaining a behavioral health crisis system in a new slide show (see below). Key findings from the state leaders’ experience include:

• Keep the vision of a consistent, comprehensive, and coordinated system of behavioral health care in mind even though these systems are often built incrementally.
• Engage a wide variety of sectors, including health care, law enforcement, judiciary, and social services, early in the process.
• Understand that funding complexity (using Medicaid, state general funds, local contributions, and various grants) makes it challenging to build a sustainable model.
• Collect data and report on program outcomes to sustain political and funding support.

The death of Daniel Prude in police custody in Rochester, New York, this past March — hours after being released from a hospital emergency room — demonstrates the tragedy that can result from a poor response to a behavioral health crisis. Federal designation of “988”and state and local efforts to knit together call centers, mobile responses, and stabilization services give some hope that better behavioral health crisis systems are possible. With this model in place, the next frontier will be a stronger, follow-up support system for ongoing community-based behavioral health care.