Seeking help for mental health crises and substance abuse issues is about to be as easy as dialing three digits this summer. The number to call for the national suicide prevention and mental health crisis hotline will be 988.
The National Suicide Hotline Designation Act of 2020 will be put into motion in July. The bill requires the Federal Communications Commission to designate 988 as the universal telephone number for those undergoing a mental health crisis.
The Department of Health and Human Services and the Department of Veterans Affairs will jointly report on how to make the use of 988 effective across the country, and HHS must develop a strategy to provide access to competent, specialized services for high-risk populations such as lesbian, gay, bisexual, transgender and queer (LGBTQ) youth; minorities; and rural individuals.
Dr. Claire Wang, associate deputy director for research, from the Division of Substance Abuse and Mental Health at Delaware Health and Social Services, is one of many spearheading the implementation of the 988 line.
“This is a monumental moment for mental health innovation in crisis response,” she said.
Dr. Wang said the 911 emergency number already responds to many mental health-related crises, so to alleviate some of the confusion, they are teaching three main differences between the two lines.
Firstly, the majority of calls coming to behavioral health crisis lines, which will soon be the universal 988 line, can often be solved just by talking.
“They are talking to counselors. So 80 to 90 percent of the time, the crises were managed by talking, so dispatch is only needed for a small percentage of calls,” Dr. Wang said.
The length of calls also differs. The average handle time is around 16 minutes for a suicide or mental health crisis line, whereas 911 calls rarely last longer than 30 seconds. Additionally, mental health hotlines often follow up with callers within one to three days, especially those marked as moderate to high risk for suicide.
“The way that we are planning it, 988 is not the same as a call and dispatch center, but is definitely complementary,” Dr. Wang said. “We are partnering and communicating with 911 stakeholders in the state and we learned a lot from them. Because 911 has been in operation for so long, we learned a lot from how they work and how they approach these mental health calls. But we also have great discussions on how our services should be complementary and we need to work in partnerships.”
Several police departments on the state, county and local levels in Delaware are already prepared for those partnerships because of increased focus on Crisis Intervention Team training and additional instruction on deescalation.
“Our officers regularly work with Crisis Intervention teams, which are administered by the state of Delaware and involve teams of trained professionals who respond to assist those facing mental health issues,” said Dr. David Karas, police policy and communications director for the Wilmington Police Department. “Often, they respond first to work with and support an individual in need, and those teams will request police assistance if necessary.”
WPD also has a Youth Response Unit that includes a coordinator, youth intervention specialist and two trained clinicians who support youth exposed to, and affected by, violence.
“In 2020, even in the midst of the COVID-19 pandemic, this team fielded more than 150 referrals and worked directly with more than 100 clients,” Dr. Karas said. “In 2021, the team received more than 250 referrals and supported over 200 clients. That team works closely with the Victim Services Unit, which supports victims of crime ranging from domestic violence to murder.”
Retired Lt. Charles Sawchenko, who is now the special projects and behavioral health coordinator for the Delaware State Police, said DSP started partnering with the Division of Substance Abuse and Mental Health about a year ago to provide care managers and peers who work with troops.
“The care managers and peers do assess holistically,” Lt. Sawchenko said. “So even though they’re primarily there for substance abuse -related issues, they’ve also assisted us on many other things, including mental health- and homeless-related issues. Our first prearrest diversion was based on individuals who are homeless in Troop 3 jurisdiction in Kent County. So that is part of our program now.”
There are several different types of diversions and interventions police perform in cooperation with DSAMH, all with the same goal — to not only reduce overdoses and deaths, but also to reduce the amount of complaints that police respond to based on behavioral health issues, which in turn will reduce crime rates, Lt. Sawchenko said. He said the key to one method, social voluntary contact, is to make a “warm handoff” to a care manager or peer to follow up with services.
“We’ve had several celebrated cases,” he said. “The latest stats as of the end of November show that 26 percent of the individuals contacted, who were asked if they wanted help for their addiction, said ‘yes’ and went into treatment. And that is a phenomenal number when the national average for people getting help on their own for a substance abuse disorder is about 11 percent. So that intervention … those experts right then and there are able to assist with that behavioral health issue right away.”
DSP also conducts interventions for overdoses and a “pre-arrest intervention,” where an individual will not be charged if they meet certain criteria — no violent crimes on their record and not currently on probation — and if they agree to enter treatment.
“It is a very complicated crowd, especially when you have that comorbidity with substance abuse and mental health,” Lt. Sawchenko said. “But as police officers, we are on the front line. We see this every day, we deal with behavioral health issues every day, and the goal is to bring up those services right there with us.”
New Castle County Police runs a similar operation recentered around securing help and treatment for people who call for assistance.
“The biggest change that we’ve seen is the culture of the police department,” said Senior Lt. Allen Herring. “Realizing that we’re not going to arrest our way out of it. Every problem isn’t a nail and every solution isn’t necessarily a hammer. So let’s see if we can help treat our way out of it.”
NCCP has two different units: the Hero Help Addiction Unit, which started in 2016, and the Mental Health Unit that started in 2018.
In the Mental Health Unit, officers and mental health professionals respond together to in-progress calls for individuals in mental health crises or help connect individuals to care in order to prevent repeat calls for service.
Members of the Hero Help Addiction Unit provide outreach and Narcan for non-fatal overdose victims, treatment in lieu of arrest for low-level crimes and ongoing case management to assist with bridging gaps in treatment.
In October 2019, with funding from state and federal grants, the NCCP merged the two into the Behavioral Health Unit in partnership with a team from ChristianaCare, which hired six caregivers to work alongside police officers: a mental health professional, two case managers, a licensed clinician, a registered nurse and a child advocate.
Lt. Herring said securing the scene when they arrive is an important first step, which then gives them time to talk to an individual and the ability to treat them with a trauma-informed approach, understanding that they may not be dealing with that individual as they normally would.
“These behaviors are coming from something that may have happened in the past,” he said.
“Working with them and taking away that threat of arrest to say, ‘Let’s work on your mental health,’ and see what we can do to get them connected to the right level of care rather than just arresting them. Part of the grant is decriminalizing mental health and diverting from unnecessary hospitalizations and not taking everybody that has mental health issues to the ER. And then trying to divert individuals from unnecessary criminal charges when they’re dealing with a mental health concern.”
Lt. Sawchenko added that a common concern among law enforcement is someone calling the 988 line, when they really need 911 services, which is why fluidity and partnership between crisis hotlines and police must be seamless.
“For example, if someone is calling us and we realize there is a weapon present, then definitely we will engage the police in that situation,” Dr. Wang said. “In some cases, law enforcement officers, when they consider conditions to be safe, will also call DSAMH to dispatch a mobile crisis team to support the individual. So these are ongoing conversations on how to make that better and how we leverage technology better.”
Lt. Herring noted, however, that anyone with a kitchen knife technically has a weapon in their home. He is concerned that in a situation like that, suddenly 10 officers would be dispatched when it would only take two. Lt. Herring also added that a lot of resources need to be funneled into the 988 project in order to turn it from a “great concept” to a working one.
“The best option is to make social workers and mobile crisis a legitimate first responder,” he said. “Give them the resources that they need to respond and do their job. That way we can take it off the police department. But until they have the social services and social workers and mental health professionals, and have the infrastructure of a first responder, such as the fire department or police department, ultimately a lot of these calls are still going to fall back on us.”
In the immediate future, Dr. Wang said they are working on increasing their capabilities to be in compliance with the 988 mandates, which include handling calls 24/7 statewide as well as providing text and chat options. She noted that Delaware already has three crisis call centers that have working relationships with 911, so they aren’t starting from scratch.
Although Delaware is in an “enviable” position compared to other states, Dr. Wang said staffing is one of their biggest challenges right now due to the labor shortage. She added that compassion fatigue and burnout plays a role in recruitment and retention, too.
Dr. Wang said they are also still working on acquiring funding for resources. The Designation Act, although a mandate, does not come with any funding. She said Delaware is one of 20 states that did receive funding for a planning branch from Medicaid in order for the state to expand mobile crisis and to serve Medicaid-eligible individuals.
Dr. Wang added there will be a higher federal match in the next few years for expansion of mobile crisis.
The federal law details that a state may impose and collect a fee for providing 988 services. However, this fee must be held in a designated account to be spent only in support of 988 services, and the FCC must submit an annual report on state administration of these fees.
The 988 plan is due to be released at the end of January, according to Dr. Wang. It will be a living document, flexible to change based on new guidance and information acquired along the way. In the meantime, the current number for the National Suicide Prevention Lifeline is 1-800-273-8255.