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988: To call or not to call?

By Deanna Ryan

It’s difficult to know what to do during a crisis, especially a mental health crisis. According to The Washington Post “Fatal Force” database, at least one in five people shot by police were experiencing a mental health crisis.

As of July 16, 2022, 988 was rolled out as a new, easy-to-remember, three-digit number for the National Suicide Prevention Lifeline (NSPL). Site coordinators express their hope the hotline will not only be easy to call, but will also lower police involvement and forced hospitalizations through de-escalation.

Some people who have experienced being in crisis have taken to social media to warn people against dialing 988, or at least consider the risks, like Liz Winston. Her instagram post warns, “988 reduces the likelihood a cadre of police with guns drawn will respond to a mental health crisis, but 988 will arrange for some police or a mobile crisis team to transport the person to an emergency room or psychiatric facility. I speak from personal experience: these places are terrifying.”

Since intent doesn’t always equal enactment, The Crossroads Chronicle interviewed an anonymous 988 crisis counselor, Erica Stokes, Community Relations Coordinator for Community Service Board of Middle Georgia, for information on local public behavioral health facilities, and Jeff Breedlove, Chief of Communications and Policy at The Georgia Council on Substance Abuse.

How does 988 work? Crisis calls, chats and texts to 988 in the state of Georgia are answered by Georgia Crisis and Access Line (GCAL) 24/7. At the beginning of a call, a recording directs the caller to a different line for veterans in crisis. Anyone who is not a veteran, choses between Spanish and English, then a crisis counselor responds. For purposes of this article, a call was placed to 988. The response time was under one minute. The caller’s name and zip code were requested to help the system generate local outpatient service providers. The counselor assured the caller that all calls are kept confidential. When asked about who would respond to the call locally, the counselor looked up the Swainsboro region while stating that not all regions, especially rural ones, had mobile crisis units, but most, in Georgia did. After a two-minute wait, the counselor verified that Swainsboro was part of region 6 and a mobile crisis unit, if needed, could arrive anywhere between twenty minutes to two hours. When asked if the police would ever be sent for a call, the counselor responded, “only when the caller reports being in possession of a firearm and is considered in danger of hurting themselves or others.”

Yet a quick, direct call to a local public mental health provider, such as Ogeechee Behavioral Health Services (OBHS) is still answered by an initial recording that suggests calling 911 if experiencing an emergency, and it will remain this way for some time, says Erika Stokes, “At this point it has not been clearly established how 988 will roll out on the local level, and we are not sure of how OBHS will be affected because 988 is in its infancy stage.” The change may take a few years to 30 years as it did for the full roll out of 911 in emergency situations.

Slow changes can sometimes be the result of slow funding. Monies for funding the 988 program fall into national, state and local hands. According to Jeff Breedlove, the projected cost to set up 988 is $497 million. As of August 2022, Georgia has funded $213.3 million, or 43% of the costs.

A full, successful rollout of the 988 program, Breedlove states, relies on funding three pillars.

First is establishing the main phone line and the responder. Not all responders will be from the city or state of the caller, but they will be responsible for linking the caller to a counselor closer to them. This is currently funded to the tune of $12.9 million from the state. $4.6 million has been federally funded as a one time setup fee. The project currently needs $10 million more to be fully funded.

The second pillar is to have someone who can respond locally to the caller. In some states, like Georgia, mobile crisis units will drive out to the caller to respond by assessing and counseling towards next steps. The state has committed $29 million to this, while the federal government has allotted a one-time amount of $300,000. The projected need is $53.8 million, states Breedlove. Certified Addiction Recovery Empowerment Specialists (CARE) or peer counselors are people who have experienced addiction and/or mental health issues and are in recovery. Breedlove, a person in long term recovery, hopes like Winston that the state will make sure to have trained peers available as part of the solution, since the people who can connect best are the ones who have had the most experience. Winston states what is best is a peer counselor who handles each person on a “case-by-case basis” not one size fits all, which can be the problem for large solutions.

The third pillar is an available place the person in crisis can go to to recover that is not jail, rather a bed or room in a medical or therapy environment. The state has provided $171 million, but the federal government has not committed any money at this level. The projected need is $215 million. Without support at this level, people in crisis may be kept in emergency rooms or psychiatric wards. Winston’s Instagram warns that being held in emergency rooms or psychiatric wards can be “terrifying” because they are often “overcrowded, chaotic holding pens that decide whether to involuntarily hospitalize the person.”

Addressing people hesitant of using the number, Breedlove wants to confirm a lot of money and knowledge of behavioral health and addiction is going into making 988 work. Breedlove says, “If you or your loved one is in crisis, trust the process. I can say this as someone who has been in crisis. Trust that the people on the other end of the phone are a new group of people who respect our community and are trying to help us. Please don’t be afraid to call 988.”