By Mel Wilson, LCSW, MBA
When the National 988 Suicide Prevention Crisis Hotline goes into effect July 16, 2022, it will probably be the most significant public policy initiative impacting behavioral healthcare since the Medicaid expansion.
While 988, the new congressionally mandated three-digit calling code for the National Suicide Prevention Lifeline, was originally conceptualized as a national standardized system for comprehensively responding emergency behavioral health crisis calls, it has evolved into a reimagined national crisis response model that:
- Creates an efficient paradigm for preventing suicide and other crises that are behavioral health-related
- Creates paradigms for linking persons in crisis to stabilization and long-term treatment services and
- Develops crisis response models that de-emphasizes the role of law enforcement as first responders to behavioral health crisis calls.
That one of the key components of this momentous transformation includes aspects of law enforcement reform —while coincidental— is important for two reasons. First, it potentially can facilitate a reduced reliance on law enforcement as being the first responders to behavioral health crisis. And second, it has resulted in an increased emergence of community-based behavioral health mobile crisis models that function collaboratively with local law enforcement — but are managed and staffed by non-law enforcement entities.
Collaboration Between Federal and State Government and Community Stakeholders
Preparations for the transition to 988 has been a federal, state, and non-governmental stakeholders’ effort that began over a year ago. In fact, states have already begun to reimagine their crisis response models by expanding their mobile crisis services to ensure crisis teams include appropriately trained and credentialed behavioral health specialists. They have also taken steps to adhere to a behavioral health crisis continuum of care that seeks to not only respond to the immediate crisis, but to link the individual to appropriate stabilization facilities and long-term treatment. That said, there are those who feel that the states still have a lot to do to be ready for the July 2022 start of 988.
Additionally, the federal Center for Medicaid Services (CMS) is committed to allowing jurisdictions to use Medicaid funds to cover expanded behavioral health crisis response and services.
While the implementation of the 988 behavioral health crisis draws near, we must not assume the transformation will be flawless. Challenges include:
- Effectively integrating the new 988 crisis response service with the existing 911 system
- Developing uniform national crisis response and crisis service standards and
- Developing best practices emergency crisis communication models for Regional Crisis Call Hubs.
On the behavioral health practice side, challenges include changing to a crisis services paradigm that ensures that a continuum of crisis services exists in every state—especially in rural and inner-city communities.
In any event, the significance of this make-over should not be understated. Not only will the changes —if they meet expectations — improve upon the “crazy quilt” system of crisis response that we currently have, but it will also result in a greater demand to expand the behavioral-health crisis intervention workforce.
Given that the social work profession is a principal component of that workforce, it is critical that we become fully informed about the implications of the advent of the 988 system for us. This means that social workers have a significant role in helping to form and strengthen a reimagined behavioral health crisis response model.
Crisis Talk (#CrisisTalk – Transforming Crisis Services (crisisnow.com) is a highly recommended resource for comprehensive information on the current state of behavioral health crisis services.
Crisis Jam (Learning Community – #CrisisTalk (crisisnow.com) is a weekly webinar sponsored by Crisis Talk. This a participatory “real time” discussion on issues, challenges and policies related to implementing the 988 Crisis Hotline.
Mel Wilson, LCSW, MBA, is the retired Senior Policy Advisor for the National Association of Social Workers. Prior to retiring, Mr. Wilson served for close to 20 years as NASW’s lead staffer on social justice policies and legislation, and related matters. He continues to be active on a range social policy area including youth justice, immigration, criminal justice, and drug policy. He is a co-chairperson on the Justice Roundtable’s Drug Policy Reform Working Group.