988 has been designated as the new three-digit dialing code that will route callers to trained counselors at the National Suicide Prevention Lifeline. In many states, the calls are being transferred to state and regional crisis centers. Effective July 16, 2022, people in mental health crisis can dial 988 for assistance. Is your Emergency Communications Center ready?

History of the Law

S.2661 – National Suicide Hotline Designation Act of 2020, designates 988 as the three-digit dialing code to the National Suicide Prevention hotline, became law on October 17, 2020. The Federal Communications Commission (FCC) has required telephone providers to make calling to the hotline accessible by July 16, 2022. Additionally, on November 18, 2021, the Commission adopted a Second Report and Order to expand access to the National Suicide Prevention Lifeline by establishing the ability to text 988 to directly reach the Lifeline to better support at-risk communities in crisis, including youth and individuals with disabilities.

Why Now?

The suicide rate has climbed nearly 30% since 1999. 988 can open the door for millions of Americans to seek the help they need. No longer will a person in crisis be required to remember a ten-digit telephone number or decide which one to call.

988 is not only addressing a caller’s immediate needs but is also making appropriate and accessible referrals and creating a system that connects people to a continuum of care at critical moments.

What are States Doing?

Washington, Maryland, Georgia, Arizona, Colorado, Nevada, and Virginia have already hit the ground running by strengthening their existing statewide mental health crisis systems. The State of Virginia has already deployed 988 and has added it to their current Marcus Alert legislation. Passed in 2020, Marcus Alert is a statewide mental health framework designed to ensure that behavioral health experts are involved in responding to individuals in crisis. The Virginia Department of Health worked collaboratively with 911 to create specific qualifications for levels of response between 988 and 911.

Many other states are in various stages of preparation to support 988. If you are not sure what your state is doing, reach out to your state Department of Behavioral Health and or Department of Justice.

911 and 988 Working Together

Developing systems is only one part of the equation. States must think holistically about creating processes and procedures to coordinate 988 calls with 911 centers. There needs to be policies or orders in place that guide both 988 counselors and 911 telecommunicators to ensure that situations where law enforcement is not needed can be handled by the 988 counselors and, in cases of potential violence, that 911 is involved.

Many public safety agencies have Crisis Intervention Teams in place in which clinicians respond collectively with law enforcement in mental health situations.

As part of the Marcus Alert Act and the anticipated 988, the State of Virginia, Department of Health worked with the emergency communication centers to develop four levels of mental health response.

The 911 centers have the individual ability to decide who are the appropriate first responders to send for Level 3 and Level 4 calls. They also attempt to involve behavioral health as soon as possible for Level 3 and Level 4 calls.

Level 1: Routine (911 transfers the call to 988 line)

• Distressed caller appropriate for phone intervention with trained behavioral health professional
• No homicidal thoughts, intent, or behavior
• Suicidal thoughts acceptable if no plan and or means

Level 2: Moderate (911 transfers the call to 988 line)

• Distressed caller with imminent need of in-person behavioral health support
• No homicidal thoughts, intent, or behavior
• Suicidal thoughts with no plan or no direct access to lethal weapons
• Minor self-injurious behavior

Level 3: Urgent

• • Active aggression
• Florid psychosis
• Homicidal thoughts with no active behaviors or intent
• Active cutting (self-injurious behavior) with concern for medical risk
• Suicidal thoughts with plans and access to lethal weapons
• Magistrate-issued emergency custody order, if available and requested by law enforcement

Level 4: Emergent

• Direct, immediate threats to life
• Active suicide attempt
• Active assault on others with ability to cause significant harm
• Any gun present and accessible
• Magistrate issued emergency customer order issued with immediate security threat

A Virginia based Emergency Communications Center’s Operation Manager, stated that they were fortunate to already have an established Crisis Intervention Team (CIT) program in place. All their telecommunicators are trained CITs, so the transition to working with 988 was minimal. They had 988 counselors attend their CIT training course and they have incorporated the four levels into their APCO Institute’s EMD program.

Another Virginia based Emergency and Customer Communication’s Deputy Director, stated they set up their program very similar to their current nurse triage call processing. The information is captured in CAD, and when they transfer the call to 988, they leave the CAD incident open for a short period of time in case the call is transferred back to them.

This is just a sampling of what some of the 911 centers across the United States are doing. They are working collectively with their local and state health departments to help end stigma toward those seeking or accessing mental healthcare.

Technology Supporting 988

Emergency Medical Dispatch. Most of the centers interviewed are using or planning to modify their current pre-arrival medical software to help support the triage needs to determine the level of response for mental health crises. The 988 centers should consider using similar software programs and or setting up their initial questions to match those of the 911 centers. This allows the ability to easily transfer a call from 911 to 988 or 988 to 911 with critical information being shared and less time spent asking repetitive questions.

Intelligent HUB CAD to CAD. Some of the centers are planning to utilize their regional CAD to CAD to support the transfer of data between the 911 centers and the 988 centers.

ESInet. 911 centers equipped with ESInet should consider setting up their 988 centers as Trusted Entities. Trusted Entities are those agencies, departments, and organizations considered critical to public safety response operations, especially during the time of major events. During a major event, there is extraordinary stress on the Public Switch Telephone Network (PSTN) as everyone is trying to utilize the phones to check on friends and family. This stress applies to both landline and cellular networks and can cause carriers to invoke call congestion restrictions. ESInet provides a secure and dedicated voice and data communication network amongst all established Trusted Entities and supports critical communications during catastrophic events.

Text to 988. We were not able to find any of the 988 centers that support the ability to receive and send texts but anticipate this service to become part of the standard offering.

Next Steps

Some states are advertising that they are rolling out 988 but have not involved the 911 centers. Depending on the rollout status of 988 in your region or state, it is imperative, at minimum, that you understand their plans, educate your staff and update your policies and procedures.

It is not too late to reach out to your State Department of Health and or State Department of Justice to find out the status of 988 and offer to help them develop a plan for working collectively with your 911 center.

Winbourne Consulting has the expertise and resources to assist you with developing and implementing a plan to successfully support 988 in your region and or state. Please feel free to contact us for more information.