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The New “988" System: Promises and Problems

Electronic Summer 2022  |  Issue 51

The New “988" System: Promises and Problems
By: Mark J. Heyrman
Chair, Public Police Committee
Mental Health America of Illinois

In July 2022, a new mental health crisis line will go into effect across the United States. The new 988 number is intended to replace and dramatically enhance the existing suicide hotline system and to divert persons from the criminal justice system. Persons in any mental health crisis, and others on their behalf, can call 988 instead of using either the existing 10-digit suicide number or 911. This new number is federally mandated for the entire United States. Additionally, the Federal government has given the states start-up money to implement the system. 

The 988 system. The new 988 system has three key components:

1. A Number to Call. 
A new three-digit number (988) will be staffed by trained personnel. This will be an improvement over the suicide hotline because it is only three digits and will be available for not only suicide concerns, but also other mental health emergencies. Currently, the suicide hotline system is understaffed so that, in many places (and particularly in Illinois), there are often substantial delays in answering calls and the calls may be answered in another state. The 988 system is also intended to divert persons with mental health emergencies from the 911 system. The 911 system has several problems:
  • 911 dispatchers are frequently not well trained to respond to mental health crisis
  • Calling 911 almost always results in the dispatch of police officers, rather than mental health professionals. Fortunately, more police officers are getting training (typically Crisis Intervention Team (CIT) training). However, there is some evidence that even trained officers react inappropriately to persons in mental health crisis, sometimes with tragic results. Chicago and other jurisdictions are experimenting with sending mental health professionals to accompany the police, but this is still rare.
  •  When police are dispatched, it is more likely that the person in crisis will end up in the criminal justice system, when that is often unnecessary and inappropriate. Moreover, persons who need transportation to a mental health facility are usually taken in squad car, which is often unnecessary and stigmatizing.
2. Persons to Send. 
If it is necessary for someone to respond in person to a 988 call, that person will be a trained mental health professional or peer rather than a police officer. That person can do an in-person assessment of the person in crisis and determine whether further help is needed and, if so, what type of help. Whomever is sent will be responsible for transporting the persons in crisis to the services that they need. This avoids the problems outlined above in Section 1(b) and (c). 

3. A Place to Go. 
Frequently the police who are responding to a person in a mental health crisis who may have committed a crime but, due to the nature of the crime, have discretion not to arrest the person. However, research has shown that the police are reluctant to exercise this discretion unless there is a treatment program that will accept the person. Experienced police officers learn that many people in mental health crises are not in need of inpatient psychiatric care and will be turned away by a psychiatric hospital. This leaves the officer with no choice but arrest. Additionally, for persons in mental health crises who are taken to an emergency department, the staff in these facilities are often faced with the choice of either placing those persons in the hospital or releasing them with no treatment. This often leads to unnecessary hospitalizations or to a denial of needed care. The new system will work to expand the types of treatment alternatives to hospitalization. Such alternatives include the “living room” model which provides a safe, non-medical environment where persons may remain for up to 24 hours. These programs allow persons to recover and allow the staff time to determine what services the person may need going forward. 

The Problems:
A. Funding.
While the Federal government has provided states with start-up funding to help ensure that the 988 system is in place in July, states will need to identify a source of permanent funding. Some states have enacted a tax on cell phone services, similar to the tax which funds the 911 system. However, thus far, Illinois has not created a permanent funding stream.

B. Staffing. 
Illinois, like every other state, is facing substantial shortages of trained mental health professionals, including shortages of psychiatrists, psychologists, and social workers. We will need more trained people to staff each of the three components of this new program listed above. One of the main reasons for these shortages is a lack of funds to pay competitive salaries. We must increase funding to community providers. Illinois has enacted legislation to provide loan forgiveness for mental health professionals but has not yet funded this program. We must do so. Among the ways to ameliorate the shortage of professionals is to dramatically increase the use of persons with lived experience, usually called “peers.”

C. Infrastructure and coordination. 
Illinois has created working groups across the state to coordinate services. However, the coordination effort remains a work in progress. For example, there is not yet an identified 988 call center in Cook County where more than 40% of Illinoisans live. Additionally, we must ensure that there is a seamless system for linking the 988 system to the 911 system. Sometimes calls to 988 may in fact require a police presence (for example, if the person in crisis has a firearm). Alternatively, mental health crisis calls may be made to 911 when that is not appropriate or necessary and the caller should be transferred to the 988 system.

For the reasons listed above, it is unlikely that we will have a well-run and adequately funded 988 system in July 2022. However, the new system does start us down the road to better outcomes. When fully implemented, the 988 system will: (1) reduce the number of people with mental illnesses in the criminal justice system; (2) reduce the number of people in psychiatric hospitals; (3) reduce the number of tragedies which occur in interactions between the police and people with serious, untreated mental illnesses; and (4) link people in mental health crises to more appropriate and less restrictive services. Mental health advocates and providers must work together with state and local governments to ensure that the new system is adequately funded and thoughtfully implemented.
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