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Ensuring a Better Crisis Response in 2022

Answering the call of 988.

Key points

  • The intent of 988: Divert callers away from 911 and connect them to local mental health services and resources.
  • In July 2022, 988 will go live for all who seek help during a mental health crisis. 
  • The rollout of 988, if done correctly, can be a catalyst to solve several thorny societal problems.

By Tom Insel, M.D., and Jonathan Goldfinger, M.D.

On June 2nd, 2019, Taun Hall, concerned about her 23-year-old son with acute psychosis, called 911 for help. Less than an hour later, a confused Miles Hall was fatally shot by police. As someone with schizoaffective disorder, Miles’ story is like too many others’ highlighting how our emergency response for a mental health crisis is broken —unlike physical health crises, we send officers instead of health professionals for people with decompensating brain disorders.

What happened to Miles Hall was, unfortunately, a tragedy that’s become common in America. A person with a psychotic illness is 16-times more likely than someone without mental illness to be shot by police. One in four fatal shootings by law enforcement involves a person with serious mental illness.

How can we avoid these tragic encounters, traumatic to our families, communities, and officers? First, we can ensure the call to the police doesn’t happen.

In 2020, Congress passed a transformative bill that transitions the current National Suicide Prevention Lifeline to an easy-to-remember, three-digit number: 988. Its intent is to divert callers away from 911 and connect them to local mental health services and resources. Cities, counties and states nationwide have been preparing for this change in partnership with local, mostly non-profit, 988 Crisis Centers.

By July 16, 2022, 988 will go live for all citizens seeking help during a mental health crisis. Establishing such a bespoke alternative crisis response can avert both jail bookings and emergency room crowding. And because people with serious mental illness are more likely than those without mental illness to be involved in a police shooting, 988 can literally save their lives.

As we prepare to implement 988 nationwide in 2022, it’s important to clear up some confusion we’ve heard about who actually answers 988 calls, chats, and texts. 988 counselors are not 911 dispatchers; they’re teams of mental healthcare workers, essentially “digital-first responders,” specialized to save lives via telehealth.

Where 911 sends help quickly, 988 helps instantly. Calls to 911 average 20 seconds with an operator, while callers to 988 can spend anywhere from 20 minutes to 2 hours de-escalating and planning for safety with a counselor. Of the 988 calls fielded today by leading Crisis Centers, only about 4 percent need dispatched mobile responders for more acute cases, or dispatched law enforcement for public safety. That is, 96 percent of 988 encounters can likely be fully managed by the skilled crisis counselor answering the call or text. And unlike 911, 988 counselors call you back days or weeks later if there’s a high risk of suicide to make sure you’re safe and have access to ongoing care and resources.

The rollout of 988, if done correctly, can be a catalyst to solve several thorny societal problems: the criminalization of mental illness, dangerous crowding of emergency rooms, and tragic encounters with police, particularly for people of color who have a serious mental illness. A robust 988 system requires not only experts to call, but also experts to come and proven places to heal when more intensive care is needed. We need a crisis care continuum where 988 Crisis Centers deploy and monitor the ETA of mobile crisis response vans, staffed with a nurse, a social worker, and someone with lived experience for compassionate, culturally competent care to continue in the field. For those who need a safe environment, the mobile team can take them to a crisis stabilization unit, including for acute detox, or a crisis residential treatment facility. Not an emergency department or county jail.

We are in a mental health crisis exacerbated by the Covid pandemic and the Omicron surge. Rates of depression and anxiety in young people have increased by over 40 percent relative to 2019. Drug overdose and suicide deaths, so-called “deaths of despair,” during the pandemic have surpassed the number of Covid-19 deaths in young people. Parents of kids experiencing psychosis, particularly kids of color like Miles Hall, are understandably reluctant to call 911 for help.

With 988, we can answer their call, solving this mental health crisis once and for all, and more safely. In 2022, 988 will be a critical first step but only if we appreciate that 988 is not 911. It’s telehealth by digital-first responders and the first link in a continuous chain of humane, life-saving healthcare.

Provided by the NIMH Office of the Director
Tom Insel, M.D.
Source: Provided by the NIMH Office of the Director
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