New 988 Mental Health Crisis Response Hotline Highlights Need for Standardization

In the conclusion of this 3-part video, Margaret (Margie) E. Balfour, MD, PhD, and Sergeant Jason Winsky, BA, discuss tips for family members and clinicians during a mental health crisis, and the upcoming 988 hotline launching July 2022. They also share resources that blossomed out of this initiative, including where to find outcome measures, standards, and training, for those interested in creating or adjusting crisis services in their community.

The 988 hotline will connect to the existing National Suicide Prevention Lifeline, which is a network of hundreds of local suicide hotlines. Right now, you can access those hotlines through 1‑800‑273‑TALK, T‑A‑L‑K. This hotline “has the potential to transform the whole entire mental health, substance‑use emergency response system,” Dr Balfour states in the video.

Dr Balfour and Sgt Winsky recently published a paper titled, “Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies” that reviews best practices for law enforcement responding to mental health crises, strategies for collaboration, policy considerations, and more.

>>Catch up on Part 1: Tips From Program's Successful Collaboration With Law Enforcement During Mental Health Crises

>> Catch up on Part 2: Crisis Response Center Starts Mental Health Treatment Early, Successfully Partners With Community

>>Also Related: New 3-Digit Crisis Hotline Will Connect Callers With Mental Health Professionals

Read the transcript:

Dr. Balfour: If you have a family member who has mental health or substance use‑related emergencies, I would encourage families to maybe talk to their local NAMI, National Alliance on Mental Illness.

Try to find out what crisis services are available so that 911 isn't always the default. Many communities have some kind of crisis line. Some of them have mobile teams. Some of them may have some of these alternatives. There's a lot that should be coming. There's a lot on the horizon for the future. So, investigate the crisis services that are available in your community, maybe by talking to NAMI, the National Alliance on Mental Illness. Find out, is there a crisis line that people can call as an alternative to 911? Sometimes, that's 211. Sometimes it's a separate crisis line.

Find out, are there any crisis services that can come out and help with people like mobile teams instead of having to involve the police? If you do have to involve the police, Sgt. Winsky, can you tell us some tips on how to manage those interactions?

Sgt. Winsky:  I agree with Dr Balfour. The person, if I was a family member or maybe you're a health professional dealing with people in the community, absolutely, first figure out, educate yourself on what is available in my area, in my county, in my city, or my region. That'll help the person being affected, and advocate for the person who's in crisis.

If you have to call 911 for some of these crises, there are many, many police and sheriff's departments around the country that have CIT trained officers. CIT is in all 50 states. The first thing you want to do is ask if a CIT‑trained, crisis intervention‑trained officer is available, or deputy and ask for that resource.

Like Dr Balfour said, when the officer or deputy gets there, there could be low‑level domestic violence that happened, like disorderly conduct, maybe something in the house got broken. This plays in the stigma and the role of stigma in these situations. I would be upfront with the first responder and lead with what is the crisis.

Don't lead or focus so much on, "I want this person out of here. I want them arrested." Oftentimes, emotions are running high in these situations. If you have a reason to think, it could be a family member, it could be a complete stranger in a park somewhere, if you think there's a mental health crisis happening, just say that.

 I would be very open and upfront with the officer and just say, "I think this person needs a crisis intervention here." Part of that too is a 911 call, which Dr. Balfour touched on just a minute ago and the coming 988 project nationally. I'll let her talk a little bit about that as well.

Dr. Balfour: Like Sgt. Winsky said, it's really important to identify upfront when you're talking to 911 that this is a mental health emergency. That determines the whole pathway that goes from that 911 call, who they dispatch, how they treat it, and what's going on in the minds of the people who respond.

Are they responding to an agitated person who was tearing up furniture or are they responding to somebody in a mental health crisis? It's a very different mindset. Every community has a different way that these calls are handled.

[28:47] People are reluctant to call the police sometimes, especially people of color. They're trying to not have police interactions because of some of the historical disparities, and inequities, and how their crises get resolved. There is a new 3‑digit number, 988, that the law was passed to do that back in 2016. It goes into effect in July of 2022.

This will be a nationwide 3‑digit number that will go to a local crisis hotline. It will connect to the existing National Suicide Prevention Lifeline, which is a network of hundreds of local suicide hotlines. Right now, you can access those hotlines through 1‑800‑273‑TALK, T‑A‑L‑K.

This has the potential to transform the whole entire mental health, substance‑use emergency response system the way 911 did for EMS and trauma back however many years ago. The people call 988, they're going to be expecting some sort of level of service for those who can't have their crisis resolved over the phone.

States and the federal government, the ARPA funds, and all kinds of attention has been put on helping states plan to implement what kind of crisis system is 988 going to connect to. Currently, the lifeline receives about 3 million calls a year with their other crisis lines, for example, the one that I mentioned that covers Pima County that gets another 10 million or so calls.

Then it's estimated that the 911 system nationwide, probably, about 40 million calls a year going to 911 have a mental health crisis that's involved that could be handled potentially by 988. That's a huge number of calls that could be diverted away from the police response system to a health‑first response where you're getting trained clinicians on the phone.

You have mobile teams coming out to respond instead of officers if that's safe. The next step would be having crisis centers like ours or the mobile teams for people to come to instead of having to go to the emergency room. Those are some potentially transformative changes in our mental health emergency response system.

All these crisis services they vary widely across the country. There's not a national standard for crisis services right now. A lot of that is because a crisis has always been the responsibility of the state systems, state Medicaid or counties. It's flown under the federal radar. Every state does what it does differently.

With the advent of 988 and the increased attention on crisis services, there has been a drive to create some national standards. We at Connections down here in Tucson have worked quite a bit on that. We're data nerds here at Connections. We, years ago, published a set of outcome measures to be standardized, what outcomes crisis services are looking at.

That's been adopted across Arizona. It's in the new SAMHSA guidelines for crisis. For people who are wanting to start in their community and start to build crisis services, as I said, the Arizona model is frequently looked at as a national example. It's been invested in and developed over the last 15, 20 years.

I was part of a group with the National Council of Mental Well‑being that put together a report called "The Roadmap to the Ideal Crisis System" that lays out essential standards, best practices, and also talks about the governance and financing needed to sustain a crisis system.

There are lots of emerging resources to help people start to build these sorts of services in their communities. We also, for people interested...Do you want to talk about the learning sites, Jason?

Sgt. Winsky: One of the things that we want to end with, we usually do, is that if people are interested in what we're doing out here in Tucson, maybe they want to tour the Crisis Response Center or exchange information with my team on the law enforcement side, just go to Google and put in the search Law Enforcement‑Mental Health Learning Sites.

We are a Department of Justice learning site out here in Tucson. There is some funding available at the federal level for people to come out, take a tour of the CRC, and take a look at what we're doing out here. We will put the link to that website in the transcript.

Margie Balfour, MD, PhD, is a psychiatrist and national leader in quality improvement and behavioral health crisis care. She is chief of quality and clinical innovation at Connections Health Solutions, Tucson, Arizona. She is also an associate professor of psychiatry at the University of Arizona. Dr Balfour was named Doctor of the Year by the National Council for Behavioral Health for her work at the Crisis Response Center in Tucson and received the Tucson Police Department’s medal of honor for helping law enforcement better serve people with mental illness. She contributes to expert panels for SAMHSA and the DOJ. Her pioneering work on crisis metrics has been adopted as a national standard, and she co-authored Roadmap to the Ideal Crisis System: Essential Elements, Measurable Standards, and Best Practices. Dr. Balfour is a Distinguished Fellow of the American Psychiatric Association and serves on the Quality-of-Care Council. A native of Monroe, Louisiana, Dr. Balfour earned a BA in Biology at Johns Hopkins University followed by her MD and PhD in Neuroscience from the University of Cincinnati. She completed residency and fellowship in Community Psychiatry at the University of Texas Southwestern Medical Center in Dallas.

Sergeant (Sgt). Jason Winsky is a 17-year veteran of the Tucson Police Department (TPD), where he has led the creation and growth of mental health programs that serve the community's most vulnerable populations.  He supervises TPD’s pioneering Mental Health Support Team, a squad of officers, detectives, and peer co-responders dedicated to positive, compassionate responses to persons experiencing a mental health crisis, and he oversaw the development of the Substance Use Response and Homeless Outreach Teams.  A skilled educator, Sgt. Winsky trains police officers in communication and de-escalation techniques across southern Arizona.  He is a Mental Health First Aid Instructor and has taught over 1,000 officers in Crisis Intervention Team Training.  Under his leadership, TPD was designated a Police-Mental Health Collaboration Learning Site by the US Department of Justice and won the Mental Health First Aid Community Impact Award from the National Council for Behavioral Health.  Sgt. Winsky also serves on the Boards of both the Tucson Police Officers Association and the Combined Law Enforcement Associations of Arizona and leads their governmental and legislative affairs activities.  The Arizona Capitol Times named him the 2016 Healthcare Leader of the Year, and in 2021 he received the St. Thomas More Award for his lifelong dedication to community service and integrity in the field of law enforcement.  Sgt. Winsky is a native of Tucson and received a BA in Political Science from the University of Arizona prior to joining the Tucson Police Department.