Our Current Response
Every year, millions of mental health or suicidal crisis calls are made to 911 and local crisis lines. A mental health or suicidal crisis is any situation in which a person’s behavior puts them at risk of hurting themselves or others and/or prevents them from being able to function effectively in the community. For example, a person in crisis may experience one or more of the following: actively thinking about suicide or self-harm; erratic, unusual, risky or harmful behavior; delusions, paranoia or other psychotic symptoms; or extreme withdrawal from everyday life.
Unfortunately, when in-person help is needed, law enforcement — not a mental health professional — is often the only response available. As a result, people in crisis, their families and their communities face avoidable trauma and tragedy.
- Between 2015-2020, nearly 1 in 4 fatal police shootings have been of people with mental illness (214 killed in 2020 alone), with 1 in 3 being people of color.
- People with mental illness are booked into the nation’s jails around 2 million times every year.
- Over 90,000 people died of a drug overdose in a 12-month period – a 30% increase from the previous year.
- Over 47,500 people died by suicide in 2019.
It doesn’t have to be this way. We can and we must do better, because a mental health crisis deserves a mental health response.
The Promise of 988
In 2020, Congress took an important step in reimagining crisis response by passing bipartisan “988” legislation, the National Suicide Hotline Designation Act of 2020, to designate 988 as the new nationwide, three-digit number for mental health and suicidal crises. Available nationwide by July 2022, 988 will connect people to trained crisis counselors that can provide de-escalation and mental health intervention services by phone, and ideally coordinate connections to additional services and help in their community.
While this is a great step forward to help people more easily access help, it’s only the first step. Right now, the full system we need to have in place to respond to people in crisis who call 988 is not available in most communities. The additional mental health crisis services for counselors to connect a person to are only available in some communities — and often at insufficient levels to meet the demand.
We Can #ReimagineCrisis
The time is now for federal and state policymakers to reimagine our response to mental health and suicidal crises.
A well-designed crisis response system can be the difference between life and death for people experiencing a psychiatric emergency. There are three core elements of the National Guidelines for Crisis Care:
1. 24/7 Crisis Call Centers
When 988 is available nationwide in July 2022, it will operate through the existing National Suicide Prevention Lifeline (800-273-TALK), funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and administered by Vibrant Emotional Health. The scope of the Lifeline was expanded by Congress to include mental health crises.
When someone dials 988, their call should be answered by a local crisis call center with staff who are well-trained and experienced in responding to a wide range of mental health, substance use and suicidal crises.
These crisis call centers should be able to connect people to local services, including dispatching mobile crisis teams,scheduling appointments with local providers and conducting follow-up calls. The majority of calls can be de-escalated over the phone (roughly 80 percent).
Most states do not currently have capacity to answer all calls locally, which means calls that cannot be answered by an in-state call center will go to a national back-up center. As many calls as possible should be answered by local call centers so they can connect an individual to additional services.
2. Mobile Crisis Teams
For someone in crisis who needs more support than can be offered over the phone, mobile crisis teams should be available to de-escalate crisis situations, create rapport with the person in crisis and connect the person to services and supports. Current crisis lines estimate that an in-person response is needed in 10-20 percent of calls.
Mobile crisis teams travel to an individual and provide assessment and stabilization, or they may help an individual go to a place that can offer a higher level of care. Mobile crisis teams should be staffed by behavioral health professionals, including peers with lived experience.
Mobile crisis teams should also collaborate closely with law enforcement in the community, but only include police in the response when absolutely necessary. Typically, less than five percent of dispatches in communities with mobile crisis teams need law enforcement back up. However, we continue to need police trained in de-escalating crisis situations and close coordination with law enforcement agencies.
Unfortunately, too few communities have mobile crisis teams in place. Funding is needed to help create these teams and fill in costs that can’t be billed to Medicaid or other insurers. Mobile crisis teams should be available to every person in crisis if they need it to reduce law enforcement involvement and help individuals get connected more quickly to behavioral health services.
3. Crisis Stabilization Programs
If someone needs more intensive care, there must be an alternative to going to the emergency room. Crisis stabilization provides that alternative, and it is needed in about 20-30 percent of mobile crisis team calls.
This is often provided in a living room-like setting, providing short-term observation and stabilization services, often for less than 24 hours.
Ideally, strong crisis stabilization programs include peer supports, detox facilities, accept all police referrals with zero rejections and have dedicated areas for first responders to drop off an individual and turn around within 5-10 minutes.
Crisis stabilization programs should provide a “warm hand-off” to follow-up care, from peer supports and outpatient services. About 20-30 percent of individuals in crisis stabilization programs may need more intensive services, such as hospitalization or connection to short-term crisis facilities and crisis residential care.
Very few communities have access to crisis stabilization programs. To make them more widespread, we need to remove barriers to insurance coverage of crisis stabilization services, as well as resources to cover infrastructure costs of building “bricks and mortar” centers.
By building and providing this continuum of crisis services across the country, we can end the revolving door of ER visits, arrests, incarceration and homelessness — and ensure that every person in crisis receives a humane response and is treated with dignity and respect.
Policymakers Must Act Now
It will take federal, state and local action to implement this life-saving system of care in every community and ensure every person in crisis gets the help they need, when they need it.
Federal policymakers should require that crisis services be covered by all health insurers and provide substantial funding to states to cover services and costs that can’t be billed to insurance, like building capacity for the Lifeline and funding start-up costs for mobile crisis teams and crisis stabilization programs. The federal government can do this in a few ways:
- Provide funding to both the national Lifeline network to improve technology and capacity as well as local call centers to increase their ability to answer in-state calls
- Make the 10 percent set-aside for crisis services in the Mental Health Block Grant permanent to help states fill the gaps in needed crisis services
- Fund a new $100 million grant program to help states stand up mobile crisis teams
- Make permanent a new increase to the Medicaid federal matching rate for mobile crisis team response, originally passed in the American Rescue Plan Act in March 2021
- Make Certified Community Behavioral Health Clinics (CCBHCs) available nationwide, as they can provide important crisis services
At the state level, policymakers must pass legislation that sets requirements for 988 call centers and crisis response services, including mobile crisis teams and crisis stabilization programs, that will be available statewide. States must also create oversight for the design and operation of the system, and provide a way to sustainably fund 988 call centers and crisis services.
For the funding piece, Congress provided states with a way to get needed funding, in addition to state appropriations. The Congressional legislation not only put 988 into law, but it also provided a tool—monthly fees on telecommunications bills—to help states build a system that ensures a mental health response to mental health and suicidal crises. These are similar to 911 fees that people across the country already pay on their phone bills. The federal law (P.L. 116-172) specifically allows these fees to pay for the efficient and effective routing of calls, personnel, and the provision of acute mental health crisis outreach and stabilization services.
It’s urgent that policymakers act now, before 988 “goes live” in July, to ensure there’s sufficient statewide capacity to help people experiencing a mental health or suicidal crisis. We cannot wait to #ReimagineCrisis.
NAMI-Ipsos 988 Crisis Response Research
A poll, conducted by Ipsos on behalf of NAMI, shows that creating and funding a 988 crisis response system shows broad support for a robust mental health crisis system, as well as federal and local action to fund it. The poll was conducted Oct. 22–25, 2021 and surveyed 2,049 adults.
- 86% of Americans agreed that building and providing mental health crisis services can prevent people from cycling in and out of emergency rooms, arrests, incarceration and homelessness.
- Three-quarters (75%) of Americans are not content with the status of mental health treatment in this country, regardless of political affiliation, while 54% of Americans say there is significant room for improvement in addressing mental health and suicide crises. That number is far higher than for the need to significantly improve other medical emergency responses (26%).
- While 72% of respondents have a favorable opinion of law enforcement in their own community, 4 in 5 people believe that mental health professionals should be the primary first responders when someone is having a mental health or suicide crisis rather than law enforcement.
- An overwhelming majority — 90% — support the creation of 24/7 mental health, alcohol/drug, and suicide crisis call centers and 87% support requiring all health insurers cover mental health crisis services, while 81% support providing follow-up mental health care, including medication or therapy, regardless of one’s insurance coverage or ability to pay.
- Americans support state (85%) and federal (84%) funding for 988 call centers and crisis response services.
- Nearly three-quarters of adults surveyed — 73% — would also be willing to pay a monthly fee on phone bills to support the 988 system, similar to fees charged on phone bills for 911. More than one-third of respondents were willing to pay a $1 or more per month.
- Once respondents were told that 911 fees average $1 a month, overall support for a fee increased slightly (78%) but support for paying at least $1 grew (44%), indicating many prioritize the 988 number at least as high as 911 emergency services.