When someone reports a behavioral health emergency, they usually make a phone call. And this is where the inconsistencies begin.
Many people call 911. Some call the National Suicide Prevention Lifeline (NSPL). Depending on local and state operations, mental health helplines and additional service numbers such as 311 and 211 could be alternatives for accessing mental health resources. At the other end of the line, similar emergencies could be handled very differently depending on which call operation is answering, and even differ from one 911 call center to another.
Some 911 callers must undergo standard training to help them identify a situation involving a behavioral health crisis and handle the call accordingly. Other call centers have more recently hired mental health clinicians to provide advice on individual situations. But a recent report from The Pew Charitable Trusts suggests that the majority of 911 call centers still face significant challenges in handling these complex emergencies, with many call operators lacking specialized training in behavioral health care and not tracking and sharing. not enough key data on the results of calls.
The emergence of 988 – which transitions the NSPL to this simpler three-digit number – provides an opportunity for statewide collaboration to consolidate call options and standardize approaches to behavioral health emergencies in 988 and 911 operations. But few states have fixed plans to promote, fund, and coordinate the launch of 988, and a review of those plans that do exist showed that most have not specified how 988 works in partnership with 911. And Pew’s outreach to some heads of state revealed that some are still unaware of 988 and its purpose.
Local officials face a complicated challenge: how to create more consistency between 911, 988 and other emergency call operations to ensure behavioral health needs are met no matter who calls or what number are they dialing?
They can address this by understanding who is involved in coordinating a response to a call, what options for improvement exist, and what information is relevant to the situation that would be immediately available to the person answering the call. .
To that end, here are key questions and related resources that local leaders can explore as they consider ways to improve how those involved in a behavioral health crisis get the help they need, no matter who asks or how.
Behavioral health emergency calls can involve people with a wide variety of needs, from mental health services to addiction treatment to housing assistance. These situations create the possibility that a range of stakeholders will intervene to meet different needs in the areas of public safety, health and social services. This response network can vary widely between states, regions, and even neighboring communities. Yet any department or agency that might be involved in handling an initial call can also be a critical partner that helps streamline the call center connection process and standardize their response protocols. Determining the list of people, agencies and organizations who might be involved in a given emergency, including people who experience these crises themselves, will not only help identify the different avenues that calls for emergency could borrow, but could form the basis of an informed planning process. by key perspectives.
- The Technical Assistance Collaborative’s 988 Implementation Framework, commissioned by Pew, not only emphasizes the value of knowing and involving the actors involved in a crisis call, but breaks down the categories of people who might be involved. and could share important perspectives in planning efforts.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) 988 Partner Toolkit provides local communities with a foundation of outreach materials to help successfully deploy 988 with sufficient outreach and coordination from the many stakeholders involved.
A dizzying array of needs and challenges in local emergency call systems can be overwhelming. To establish a priority list, begin by performing a system-wide assessment to determine key gaps and needs in local operations, including call center practices and protocols, volume of calls, staff capacity, skill set and existing training requirements. Call center administrators may be more likely to agree to proposed improvements if they are involved from the start, providing advice on evaluations. Assessments made could be shared between neighboring call centers to help inform each other.
- In addition to offering guidance on engaging key stakeholders when considering 988 launch, the National Association of State Mental Health Program Directors (NASMHPD) 988 Convening Playbook for Public Safety Answering Points helps communities and their call centers to prepare for the transition by highlighting several different areas to assess – from specialized operator training to information sharing – and associated best practices.
- Vibrant Emotional Health, a mental health service provider, used data to project future needs of populations and projected increases in call volume with the launch of 988, which could be helpful when considering funding needed and potential changes in labor demands.
- The Council of State Governments Justice Center identifies key ways that operators can successfully integrate a wider range of response options when handling a behavioral health crisis call.
The findings of the recent Pew report on 911 call centers suggest that the majority of them do not update call information, document call results or report data, even internally. Without standardized data collection protocols, shared among relevant decision-makers, any effort to improve the system will be difficult to follow. The call center needs assessment mentioned above could help highlight the main types of data that are currently being collected as well as gaps in collection or analysis. For example, call centers in a community might capture one type of data (e.g. location, call duration), while law enforcement tracks another. type (for example, that ends in a prison sentence) and that hospitals document another. These data streams, once integrated and shared, become the eyes and ears of any reform effort.
Strengthening operator training, reinventing call center protocols, improving data collection and analysis – such efforts require sustained funding and committed staff. Yet staff shortages and turnover are top concerns for many 911 call centers and behavioral health managers, and funding shortfalls pose a common challenge. Local officials have the opportunity to obtain grants, even to specifically support planning efforts, but these opportunities are often spread across different federal, state, and private streams. Identifying potential funding opportunities could help determine areas requiring more immediate action, as well as lay the groundwork for developing a comprehensive funding plan.
- In an overview of fundraising strategies used at the state and federal levels, the NASMHPD has compiled a helpful guide for local leaders to understand which fundraising opportunities might be worth pursuing, including those related to operations, assessments and call center improvements.
This publication is funded in part by The Pew Charitable Trusts with additional support from the John D. and Catherine T. MacArthur Foundation.