While Impactful, 988 Mental Health Hotline Needs to Be Integrated with 911 to Realize Its Full Potential

Several weeks ago, 988, the Suicide and Crisis Lifeline, went live. Its predecessor, the National Suicide Prevention Hotline, was reached by dialing a 10-digit number (it will remain operational). The theory is that the new three-digit number and mental health hotline will be easier to remember and result in more people getting the help they desperately need faster.

The National Suicide Hotline Designation Act became law in October 2020, and 988 was designated by the Federal Communications Commission the same year. Today's lifeline differs from its predecessor in that its scope has expanded to include all mental-health and substance-abuse issues, not just suicides. But like its predecessor, the lifeline features more than 200 centers from coast to coast that are staffed with mental-health professionals. The idea is that people suffering from a mental-health or substance-abuse crisis can call or text 988 and receive the appropriate help as quickly as they would if they called 911 to report a home invasion or a house fire.

This step is a huge deal — here are a few statistics that back up that claim:

• The Centers for Disease Control (CDC) reports that nearly 46,000 people died by suicide in 2020; one person committed suicide every 11 minutes that year.
• Also, in 2020, suicide was the second-leading cause of death for people aged 10-14 and 25-34.
• That year 12.2 million people seriously considered committing suicide, 3.2 million people made plans to do so, and 1.2 million people attempted suicide.
• Suicide rates increased 30 percent between 2000 and 2020.

Mental-health and 911 professionals agree that the 988 and 911 systems working in concert will create a powerful, holistic approach to local crisis response. For that to happen, the two systems need to be well integrated.

Why Integration Makes Sense

• The call-routing technology that will be used initially by the 988 system is far less accurate when compared with the geospatial technology used by Next Generation 911 (NG911) systems. This weakness could be especially problematic if it is determined that a crisis incident also requires an emergency response.
• Right now, 988 calls cannot be transferred to the 911 system. If a 988 professional determines that emergency response is needed — e.g., if questioning indicates that the caller might hurt himself or others, perhaps imminently — the mental-health professional would need to manually identify the caller's location, determine the most appropriate 911 center to contact, and verbally relay the information to a 911 telecommunicator. Taking such steps is time-consuming and potentially prone to error.
  
  • The estimates regarding the percentage of mental-health calls that escalate to needing emergency response range from less than 2 percent to as much as 20 percent. Based on the 3.6 million calls, texts, and chats fielded by the National Suicide Prevention Hotline last year, the volume is between 72,000 and 720,000 calls, texts, and chats. The middle ground, or 10 percent, seems a more reasonable estimate, yielding 360,000 such calls — still an eye-opening and mind-numbing number.
• If the 988 and 911 systems were well integrated, all personnel could be cross-trained to perform in either center when one is busier than the other. This capability would be advantageous for the 911 community, where emergency communications centers (ECCs) are dealing with an acute nationwide staffing shortage.

Where an ECC Should Begin When It Comes to 988 and 911 Integration

In anticipation of 988’s launch, we have been working with a state 911 authority for months to address the integration of these two vital services. The comprehensive report that we delivered made the following recommendations as a starting point, and we are helping to implement those recommendations:

• Integrate an emergency mental health dispatch (EMHD) protocol into the emergency medical dispatch (EMD) protocol used by the state's ECCs and dispatch-only centers in the state.
• Train all telecommunicators in the state's ECCs and the dispatch-only centers on using the EMHD protocols and other crisis-response skills via a standardized training regimen.
• Establish a statewide EMHD protocol coordinator and a multidisciplinary committee comprising a cross-section of stakeholders to ensure effective communication and implementation of the EMHD protocols and to drive improvements as emergency mental-health service delivery matures in the state.

We welcome the opportunity to help your organization develop and execute a strategy to integrate the 988 and 911 systems in your state — please reach out.

Darrin Reilly is MCP's president and chief executive officer. Email him at DarrinReilly@MissionCriticalPartners.com.

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