#988 - New Number, Same Problems?
A chance to get right a new response to mental health and substance use crises
In an emergency situation, we are often told to dial 9-1-1, and some 240 million Americans do just that each year. However, as society is slowly coming to understand and as mental health professionals have known for some time, not every emergency requires a police, or fire, or EMT to address it. Mental health emergencies require nuanced responses that emphasize understanding, compassion, and nonviolent de-escalation. Most of today’s emergency responders and dispatchers, by their own admission, are not adequately trained to properly handle mental health crises, including substance misuse emergencies.
One study found that 1 in 4 fatal law enforcement encounters involves an individual experiencing a mental illness. The same study declared the risk of being killed during a police encounter is 16 times higher for a person with a mental illness than for other civilians.
Over and over, we have seen the consequences of this lack of training and a lack of a system to offer a different response. Last year, Linden Cameron, a 13-year-old boy in Utah who was diagnosed with Asperger syndrome, was shot eleven times by police after his mother called 911 and requested a crisis response team because her son was having “a mental breakdown.”
We are long overdue to have a comprehensive, federally supported system in place that can dispatch trained mental health professionals to properly address these types of crises when they arise. As I have written about here before, 988 is scheduled for nationwide launch next July, and mental health emergency calls will be routed to local call centers within the National Suicide Prevention Lifeline Network. Unfortunately, it appears only a handful of states have taken any sort of legislative action to advance 988, despite the launch being just seven months away.
That being said, there are some states that are starting to get prepared. One of them is Virginia, which is launching the “Marcus Alert” system, named after Marcus-David Peters, a 24-year-old high school teacher who was killed by a Richmond police officer in 2018 while he was experiencing a mental health crisis. The system, which is being rolled out this month and will expand through 2026, aims to care for those experiencing mental health emergencies by, among other things, reducing their encounters with law enforcement.
If implemented correctly, 988 has the potential to revolutionize mental health, substance misuse, and suicide prevention crisis response. However, we cannot make the progress we want unless we focus on building a broader continuum of care designed to not only effectively address those at the peak of a mental health emergency, but also provide the resources necessary to support crisis prevention. Well Being Trust has, along with several other mental health and addiction advocacy groups and organizations, produced a comprehensive set of recommendations for local and federal law and policymakers to transform mental health care in America and help 988 achieve the success we believe it can have.
988’s effectiveness will be largely dependent on significant investment in pre-crisis care. Prevention should not be a bad word. Public education campaigns should provide information about warning signs to help identify crises in their early stages. Schools should implement mental health and drug use screening protocols and ensure the presence of sufficient emotional support systems for students. Availability of “warmlines” should be expanded to help those who are struggling and avoid a full-blown crisis as well as offer post-crisis counseling and care.
A few mental health experts and citizens have made it their life’s mission to ensure that pre-crisis care is at the forefront of all of our minds. For example, Lorenzo Lewis founded The Confess Project to train barbers to be mental health advocates within their communities and Michele, a recent Social Health Lab micro grants awardee, helps her neighbors “erase their fears” every week. 988 can be an extension of such missions - but it’s going to take a whole of society effort, state and local legislation and funding in order to accomplish an outcome that benefits the whole of person and in turn, the whole of society. This problem can’t be solved on one front -- we have to, as a society, commit to dedicating the resources necessary to solve it on every front to support our communities, neighbors, family members, and even our barbers.
While prevention and pre-crisis care are key, we must simultaneously prepare our mental health care system for the influx of crisis calls that are sure to come with a new, easy to remember hotline. Our current system of health coverage must be thoroughly examined and revised to meet the needs of those who struggle with mental health, so we don’t continue to build new structures on a decrepit foundation. In addition, parity laws must be applied to all health plans and be readily enforced to ensure that all individuals’ care is covered when they do reach out for help through 988.
Law enforcement still has its place in this new, more equitable mental health landscape, but its crisis response role should be secondary to that of certified mental health professionals - of a new response. This will require coordination and additional training for all involved but will also necessitate a fundamental shift in mentality - viewing mental health crises as matters of public health rather than legal or criminal matters.
The reality is, we have just a few short months to focus on fortifying a foundation for mental health care and crisis response in this country. If we neglect to make the investments and commitments necessary to strengthen this foundation, we will all but doom 988 to have the same flaws and shortcomings as our current 911 response system, where law enforcement officers are used as default mental health providers. And to serve up the same inadequate care to our most vulnerable citizens under the guise of a new and improved system would be truly shameful.
This is the money shot here "988’s effectiveness will be largely dependent on significant investment in pre-crisis care. Prevention should not be a bad word"
As a volunteer crisis counselor I know I do my best to stem the abject pain and hurt my fellow humans feel during a crisis. I work hard to succeed in offering a calm voice that not only listens but hears. In the end when I've offered some help and comfort and support. I cannot help but feel I'm putting out a sofa fire. Their entire house is on fire and more needs to be done as you've advocated for. In case my point is missed MORE!!!!!
We all must keep the light of hope in our eyes ablaze and warriors in our heart strong to create change. We got this as individuals and collective voices screaming for change.