Article Spotlight

Most people cannot remember a time before 911, when people in an emergency dialed 0 for an operator or directly called or ran to the nearest police or fire station. For years, behavioral health¹ advocates and experts have pushed for a three-digit number for mental health, substance use, and suicide crises—a number that would be on par with and, hopefully, as ubiquitous as 911 is for medical emergencies. And, like 911, the innovation wouldn’t be just a number. Instead, experts envisioned a well-funded, interconnected emergency system for behavioral health crises, with a continuum of services and supports that would help foster parity while reducing stigma and criminalization.

The United States took a vital step toward this goal in July 2020, when Federal Communications Commission (FCC) Chairperson Ajit Pai announced a nationwide three-digit number that would “effectively establish ‘988’ as the ‘911’ for mental health emergencies.” Under Pai’s guidance, the FCC adopted rules requiring all phone service carriers to direct 988 calls by July 16, 2022, to the existing National Suicide Prevention Lifeline (2), which the Substance Abuse and Mental Health Services Administration (SAMHSA) funds. The Lifeline, run by Vibrant Emotional Health, is a network of about 200² accredited call centers. All 988 calls—and, potentially, texts—will go to the centers, filtered by area code unless callers press 1 to reach the Veterans Crisis Line, the national crisis call system operated by the Veterans Administration. Three months after Pai’s announcement, Congress passed the National Suicide Hotline Designation Act of 2020, supporting 988 implementation and allowing states to apply a monthly telecom customer service fee to pay for 988-related services. Many communities across the U.S., increasingly aware of gaps in the overall crisis response continuum, had already started or planned to re-engineer and build out their systems, including mobile crisis services and crisis facilities. Expansion plans have also included the evolution of crisis call centers into hubs that can dispatch mobile crisis teams and provide real-time data on and access to crisis facilities. As states move toward 988 readiness, communities must capitalize on this momentum to meet local needs.

This paper describes examples and new resources to improve the care of people experiencing behavioral health crises. We focus on imminent opportunities and provide links to resources helpful in regional or local crisis redesign efforts.

¹ The term behavioral health has evolved to include both mental and substance use disorders.
² As of November 2021, there were 194 Lifeline accredited call centers, with seven more in the final onboarding phase.