A new three-digit dialing code, 988, has been designated to route calls and texts to the National Suicide Prevention Lifeline. It launched over the weekend, on July 16.
The hotline, whose existing number will remain in operation, will expand to help callers more broadly in emotional distress. The launch has been funded in part by Health and Human Services.
“What’s been really cool out of this is actually that a lot of the states have used the funding to implement mental health crisis response teams,” vice president of clinical operations for NeuroFlow Matt Miclette, R.N., told Fierce Healthcare. NeuroFlow offers tech-powered engagement tools for providers, including a platform that will show the 988 number in two separate places for patients.
In the past, NeuroFlow had to work with law enforcement to respond to emergency situations.
Now, many states are enacting legislation related to 988 like establishing mental health crisis response teams for referrals instead. “The best thing about that is we’re limiting the amount of police encounters,” Miclette said.
The new number is “an opportunity to rethink how we handle crisis response,” echoed Robert Gebbia, CEO of the American Foundation for Suicide Prevention (AFSP). The organization has been on the forefront of advocating for the shift to 988 and expanding access to life-saving care. Gebbia is also on the Lifeline advisory committee.
“This is a system that kind of developed in a way because it wasn’t thought through,” Gebbia said. “Crisis services have been undervalued and underfunded.”
Preparing for the launch
Stakeholders are bracing for an influx of calls to the hotline that may quickly outstrip supply. Past data shows that, even before 988, one in six calls never made it to a counselor on the other end.
“We know there’s going to be more calls coming in, so we need better infrastructure to support that,” Miclette said.
Intermountain Healthcare has been working to expand its offerings for months and has partnered with the Utah behavioral health crisis response commission on the 988 rollout. It teamed up with the state to offer a COVID-19 emotional relief line and added behavioral health services to its virtual urgent care.
It also set up emergency services within select hospitals known as Access Centers that can stabilize up to 60% of referrals. It expanded Medicaid billing codes, receiving a bundled rate for Access Centers, for instance. The health system also has a navigation line that works with the state crisis line to refer people to 988, and vice versa.
“We know the need is more than what we have in behavioral health right now,” said Kimberly Myers, behavioral health clinical program manager at the health system. That’s why building trust and relationships with other stakeholders is key. “We have to interweave our services together to create the safety net that we’re all trying to accomplish.”
The easy-to-remember line also has the potential to further reduce healthcare costs through preventative care and interventions. For small employers, for instance, the service can meaningfully reduce high emergency room costs.
“That affordability leads to an access that is necessary for these companies to compete,” said David Berg, president and co-founder of Redirect Health, a telehealth platform and plan provider.
Blue Shield of California is doing work to get the word out about 988 on its site and in programs like care management. Awareness is critical not only to people in crisis but also to their loved ones who may not know how to respond. The plan is partnering with medical groups and health systems to scale collaborative care.
“We’re really focused on building out an ecosystem of care and support,” said Jennifer Christian-Herman, Ph.D., vice president of Mind Body Medicine at Blue Shield of California. Preventative approaches like screening through primary and pediatric care are key.
The plan is helping practices figure out how to screen for mental health and track it, how to staff up and plan the logistics. “It’s really about integrating the care,” she said.
To help mitigate strain on resources, stakeholders should be looking to diversify their offerings. However, that should not include discouraging people from calling 988.
“While patients can have access to it, know how to use it—a skilled or trained provider might identify some other resources that might be more beneficial,” Miclette noted.
Providers should track what other initiatives or policies come out of the 988 launch, and how those are relevant to the communities they serve. Some states have peer-run warmlines, for instance, that offer emotional support. NeuroFlow is looking to help primary care practices identify social determinants of health and other stressors and intervene early. A more accessible approach could also harness telehealth.
Additional funding will be necessary to ensure expanded crisis call center capacity and to help educate the public. While some have concerns about the capabilities of 988, it is nevertheless a part of the healthcare infrastructure.
“It’s shortsighted to say this isn’t part of that system,” Gebbia of the AFSP said. “In a way, that view has continued to undervalue crisis services.”
By: Anastassia Gliadkovskaya
From: Fierce Healthcare