Oct 7, 2021

Guest blogger Monica Luke, Executive Director for The Living Assistance Fund, explains the importance of 988: a 24/7 line that will reimagine behavioral health crises response.

In July 2020 the FCC designated a new emergency number for behavioral health crises – 9-8-8. The initial goal was to provide a universal three-digit number to replace toll-free numbers for suicide prevention hotlines. While an easy to remember number for suicide hotlines is important, the promise of addressing a range of behavioral health needs quickly became the vision.

Whether or not you, a family member, or a friend have ever needed help for a behavioral health crisis, you are being affected by the current patchwork system. And 988 goes live – ready or not – on July 16, 2022.

If you’ve ever been in an emergency room and there are a lot of people milling about and some of them have been there a long time… you might not realize that you’re seeing folks who are being “boarded” in the emergency room. This happens because emergency rooms are not really the best places to deal with a behavioral health issue. Staff and clinicians are trained for trauma and physical health emergencies at a much deeper level than behavioral health.

Of course, when ED personnel are working outside their area of expertise, their work becomes less efficient. As a result, behavioral health patients stay longer, taking up more and more resources. And … you and your issue may not get addressed for several hours.

And then, there are the police shootings. It’s tragic when the news reports that a person with a mental health condition is shot and killed in a police encounter. This is a symptom of not having a fit-for-purpose behavioral health crisis response system.

The current EDs and police response are not what is needed for individuals with behavioral health concerns.

A robust implementation for 9-8-8 would address the problems above and more. As an alternative to 9-1-1, 9-8-8 will have mental health workers to triage crises. More often than you would think – 80-90% of the time – people in a behavioral health crisis (including a suicide situation) mostly need someone to talk to. If they need more support than is possible by phone, sending a mobile crisis team staffed with mental health professionals and peer counselors usually de-escalates the situation and gets the person in crisis to the care they need.

In states where such teams have been responding to crises for years, police backup is needed for only 5% of calls. Just like having the right tool for the job makes things work better, aligning the right type of response to the situation at hand has extraordinarily good results.

What kind of care is needed for a person in a mental health crisis? Well, it depends. But, we know that in states that have established crisis stabilization centers – think of them as emergency rooms dedicated to behavioral health concerns – the data is compelling. The initial crisis is handled, but just as importantly, the person gets connected to ongoing supports that meets their needs.

Not only is having the right system the right thing, it’s also amazingly financially efficient. Data from over four years in Maricopa County, AZ (annualized results)[1]

  • Reducing psychiatric hospitalization costs by $260 million
  • Freeing up 37 police officers to focus on public safety
  • Reduction in emergency room boarding by 45 years’ worth of wait time.

The path forward

It’s not going to be easy to implement a robust crisis response system. There are a lot of details to consider and many rules and regulations that will need to be adjusted (like allowing an ambulance to transport someone to a crisis stabilization center). And there’s not a lot of time, so we need to get moving. But there are a lot of seasoned, knowledgeable people working on these details across the country and providing guidance at CrisisNow.com.

What can you do?

If this issue is important to you, then learn more at CrisisNow or 988: Reimagining Crisis Response on NAMI’s website. Connect with your local NAMI or local MHA affiliate. Sign the petition here. Spread the word about 9-8-8 in your community and raise the issue with your local officials.

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