Staff Perspective - Call 988

Staff Perspective - Call 988

Dr. Libby Parins

Since 1968 Americans have known to call 911 during emergencies to activate either the police, fire department, or emergency medical response. When my own house caught fire in late 2019, as I ran to find a garden hose in the dark, I yelled to my then 15 year old son, “call 911.” It’s a phrase so ingrained in our American psyche that we instinctively know to activate that response in our times of panic, fear, and need. But each year millions of 911 calls are made due to issues related to emotional distress or mental health problems for which police, fire, rescue, and EMS services are not always the optimal responders.

As I was researching this blog, when starting to type in google “police kill”, the auto-complete feature provided the phrase “police kill mentally ill” as one of my top 3 search options, illustrating some of the potential problems with a traditional 911 call for a mental health/emotional crisis. By providing a three digit mental health crisis lifeline number, as many as 2.4 million calls (about 2% of total calls) could be deflected from 911 each year for persons in need of counseling. Enter the new 988 Suicide and Crisis Lifeline number that went live nationally on July 16th.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes the need to address the mental health crisis in America with services appropriate to the caller’s needs, and the first step is a crisis line that can provide access to a trained counselor 24/7 rather than the dispatch of emergency services. The new 988 number is the same service that was previously known as the National Suicide Prevention Lifeline, which is made available around the clock to respond to individuals experiencing emotional crises or distress, including substance use and suicidal thoughts.

Currently, there are approximately 200 988 call centers around the country. SAMHSA has provided funding to state and local call centers to expand staffing to handle the increased volume expected with the roll-out of the 988 number. The calls centers are not all federal agencies, but rather are a collection of state and local organizations that may be staffed by paid counselors, or in some cases by trained volunteers. There is a national call center supported by funding through SAMHSA, that will handle excess call volume when the local centers’ staff are unavailable due to high local call volumes.

SAMHSA has 5 overarching principles that they aim to address. Those are:

  1. preventing overdoses
  2. enhancing access to suicide prevention and crisis care
  3. promoting children and youth behavioral health
  4. integrating primary and behavioral healthcare
  5. using performance measures, data, and evaluation

It is the second goal overlapping with the first goal that are heavily targeted through the strengthening and enhancement of the Crisis Lifeline. The 988 Crisis Lifeline is the first step in transforming and strengthening what SAMHSA considers the crisis continuum of care, by adding mobile crisis units, crisis facilities, and post-crisis wraparound services completing the steps. The vision of the new response model is to allow persons in crisis to access the least restrictive level of care appropriate for their level of distress and reduce emergency department visits, inpatient hospitalization, and incarceration.

When using the number, callers will first hear a recorded message while their call is routed by area code to the nearest call center. Veterans will have the option to press #1 to be connected with their local VA hospital or services. If the caller presses #2, they will be connected with Spanish translation services. There are also text services for those not wishing to make a voice call and internet chat services.

Having calls routed by the caller’s area code is a known limit to the 988 system as many cell phone users may not be located in the region of their area code at the time of the call. For example, I live on the East Coast, but my cell phone number has a West Coast area code. If I were to call 988, based on my phone number I would be routed to a call center in the Seattle area. Clinicians should be aware of this in case their clients will be using the number from another area code. For most calls, this geographic distance will not be a problem as the counseling services will be appropriate regardless of where the caller and the counselor are located. However, in the event that 911 services are needed for a caller, any geographic disconnect will need to be addressed.

This highlights a significant difference between 988 and 911 calls. Given that 988 is designed to provide counseling to individuals in emotional distress or crisis, there is a strong need to offer callers privacy and confidentiality. Most callers do not need emergency services, and the ultimate goal is to have 988 connected with mobile crisis units and crisis facilities that can be contacted as needed rather than relying on traditional 911 services. This is an ongoing expansion of the nation’s crisis response system and SAMHSA offers a thoughtfully considered vision for the next five years of steps to take and issues to be addressed. The capability to geolocate to better match calls to the callers’ actual location, and to assist callers needing emergency services while balancing privacy concerns is something being carefully considered by SAMHSA. They have released a very thorough website full of information and resources for those interested in learning more about 988 with an extensive FAQ page which can be found at this link:

In the same way that America has learned to call 911 during an emergency, we need to teach our friends, family, and patients to call 988 during a crisis. A three digit number is significantly easier for people to recall than a traditional 10 digit number, which can be crucial for those feeling overwhelmed by distress. The information in today’s blog is easily available from SAMHSA’s website, but it is important to spread the word about this fantastic new step towards addressing the mental health crisis in our country.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Libby Parins, Psy.D., is the Chief of Staff at the Center for Deployment Psychology (CDP). Dr. Parins has worked at CDP since 2007, serving in many different capacities including as a faculty member on APA-accredited psychology internship programs, and as a project developer and trainer in military and civilian programs. She began her professional career as a Naval Officer where she served in San Diego, California and Bremerton, Washington as a psychologist