988: Reimagining Crisis Response


Starting Saturday, July 16, every person in every community nationwide can dial “988” to reach trained crisis counselors who can help in a mental health, substance use or suicide crisis. Learn how 988 can help you in a crisis and what it might mean for your community with these FAQs.
 

988 is the first step in reimagining our crisis response, but there’s more work to do to ensure everyone receives the help they need — and deserve — in a crisis.

Too often, people with mental illness do not receive a mental health response when experiencing a mental health crisis. Instead, people in crisis often come into contact with law enforcement rather than a mental health professional. People in crisis deserve better. The lack of a robust mental health crisis system leads to tragic results. One in four fatal police shootings between 2015 and 2020 involved a person with a mental illness, and an estimated 44% of people incarcerated in jail and 37% of people incarcerated in prison have a mental health condition — and people with mental illness are booked into the nation’s jails around 2 million times every year. Millions more end up in emergency departments that are often ill-equipped to address mental health crises, often waiting hours or days to access care.

NAMI is committed to advancing efforts to reimagine crisis response in our country. We believe that every person in crisis, and their families, should receive a humane response that treats them with dignity and connects them to appropriate and timely care. NAMI is calling for a standard of care for crisis services in every community that includes — 24/7 call centers that answer 988 calls locally, mobile crisis teams and crisis stabilization programs — that end the revolving door of ER visits, arrests, incarceration and homelessness.

In 2020, the nation took a significant step forward with the enactment of the National Suicide Hotline Designation Act, a bill NAMI advocated for that created a nationwide three-digit number (988) to assist people experiencing a mental health or suicidal crisis. The Federal Communications Commission (FCC) determined that this number would be available — by both phone and text — in July 2022, and is now available in communities across the country.

What is 988?

988 is the new three-digit dialing code connecting people to the existing National Suicide Prevention Lifeline (now the 988 Suicide and Crisis Lifeline) where compassionate, accessible care and support is available for anyone experiencing mental health-related distress — whether that is thoughts of suicide, mental health or substance use crisis, or any other kind of emotional distress. People can also dial 988 if they are worried about a loved one who may need crisis support.

The goal of the 988 Suicide and Crisis Lifeline is to provide immediate crisis intervention and support. When someone calls 988, a trained crisis counselor will answer the phone, listen to the caller, understand how their problem is affecting them, provide support and share resources, as needed. Crisis counselors are trained to help in a variety of crisis situations, and no caller is required to disclose any personal information.
 
For most callers, calling, texting or chatting 988 is the intervention. Crisis counselors will be able to resolve the urgent needs of the majority of callers on the phone or via text or chat, reducing the need for an in-person response overall. Additionally, SAMHSA, which oversees the 988 Suicide and Crisis Lifeline, states that, “Currently, fewer than 2% of Lifeline calls require connection to emergency services like 911.” However, NAMI is advocating for everyone to have resources like mobile crisis teams in their community (see below). Communities that currently have robust crisis services estimate that more than 80% of crises are resolved on the phone, and mobile crisis teams, staffed by behavioral health professionals, are dispatched when an in-person response is needed — with most dispatches resolved in the community. The work is ongoing to make this available everywhere. (see FAQs to learn more about how 988 works and what to expect when you reach out to 988). 

You can reach the 988 Suicide and Crisis Line by calling 988, texting 988 or chatting via Lifeline’s website.
 

988 FAQs
 

While an easy-to-remember number is important, we need more than a number. We need crisis response services that provide a mental health response to mental health crises.

What Does the Ideal Crisis Response System Look Like?

NAMI is leading efforts to urge policymakers to invest in a crisis system that provides people with someone to talk to, someone to respond and somewhere to go. It will take federal, state and local action to implement the national best practices for crisis care in every community to ensure everyone in crisis gets the help they need, when they need it.

 


 

In addition to calling on federal policymakers to require that crisis services be covered by all health insurers and to provide substantial funding to states to build out crisis services, mental health advocates need to urge their state leaders to action. Advocates must educate state policymakers about how our current response to crisis falls short, and how a reimagined crisis response system will help. This system should include:

  • 24/7 Local Crisis Call Centers
    “Someone to talk to”

    All calls to 988 should be answered locally by staff who are well-trained and experienced in responding to a wide range of mental health, substance use and suicidal crises. Crisis call centers should be able to connect people to local services, including dispatching mobile crisis teams and scheduling follow-up appointments with local providers.

  • Mobile Crisis Teams
    “Someone to respond”

    Mobile crisis teams should be available for people in crisis who need more support than can be offered over the phone. Staffed by mental health professionals, including peers, these teams can de-escalate crisis situations and connect a person to crisis stabilization programs or other services. Mobile crisis teams should collaborate closely with law enforcement, but only include police as co-responders in high-risk situations.

  • Crisis Stabilization Programs
    “Somewhere to go”

    Some individuals in crisis will need more assistance from crisis stabilization programs that provide short-term observation and stabilization. These trauma-informed programs may also identify additional treatment needs and provide a “warm hand-off” to follow-up care, from peer supports and outpatient services to more intensive services, such as hospitalization.
 

The legislation that created 988, which routes through the 988 Suicide and Crisis Lifeline (previously referred to as the National Suicide Prevention Lifeline), expanded the scope of the Lifeline to include mental health crises. Recognizing that this expanded scope and greater visibility for the Lifeline would create greater demand and expectation of response, the legislation also allows states to charge fees on phone bills to help fund these services. Many NAMI State Organizations across the country are working with state policymakers to implement state legislation that outlines the crisis services that will be available statewide to respond to the needs of people calling 988 and implement these fees, which are similar to 911 fees, or other funding sources.

Learn more about model state legislation to build 988 crisis response services.

Want to know what your state legislators are doing to support 988 and crisis response? NAMI has an up-to-date, interactive map tracking legislation across the country.

State Map
 

Get Involved

Mental health advocates across the country have the power to demand that a comprehensive crisis system be offered in every community, to every person who needs it. You can help by making legislators aware of both the problem — our inadequate crisis system — and the solution. Here are six ways you can act today:

  1. Sign NAMI’s petition to show your commitment to reimagining crisis response in your community.

  2. Share your story to power our advocacy by telling us your own crisis response experience. The real-life experiences of people who’ve encountered good or bad crisis response help policymakers understand why change is needed.

  3. Email your members of Congress to tell them to fund a crisis response infrastructure.

  4. Explore how your community can #ReimagineCrisis. Find helpful information and timely resources to use in your advocacy efforts to build a better crisis response system.

  5. Learn about ways to influence your state policymakers. See if there is any current legislation in your state and connect with your NAMI State Organization to learn how they are supporting legislation and how you may get involved.

  6. Recruit other advocates by posting on social media to demand a mental health response to mental health crises.


Take Action
 

988 & Crisis Response Public Opinion Polling

NAMI-Ipsos polling released in Fall 2021 and Spring 2022 show broad support for creating and funding 988 and a full crisis response system.

Fall 2021 (conducted Oct. 22–25, 2021 and surveyed 2,049 adults)

 Spring 2022 (conducted May 20-22, 2022 and surveyed 2,049 adults)

Roadmap to Guide Mental Health Crisis Response

Fifteen of the nation’s leading mental health professional organizations, advocacy groups and funders published this plan offering federal and state policymakers an evidence-based toolkit for implementing a continuum of mental health and substance use care in conjunction with the federally mandated 988 crisis hotline for mental health emergencies

Additionally, SAMHSA released National Guidelines for Behavioral Health Crisis Care to help mental health authorities, agency administrators, service providers, state and local leaders think through and develop the structure of crisis systems that meet community needs

Resources

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