On Saturday, individuals in suicidal and mental health crisis will have a new option for help—911 flips to 988, a mental health crisis hotline.
The new number takes the police out of the picture and diverts individuals toward mental health services. When calls come in, trained mental health crisis counselors work to deescalate the situation, navigate the individual or family to resources and deploy mobile crisis units as needed. The 988 number also replaces the National Suicide Prevention Lifeline, folding all mental health crisis services into one hotline.
Santa Clara County Superior Court Judge Stephen Manley, who founded one of the first behavioral health courts in the country, is a proponent of 988. He and County Supervisor Susan Ellenberg declared a mental health and substance use public health crisis in the county this year.
“I have found that many criminal cases for the mentally ill start with a call to 911,” Manley told San José Spotlight. “988 is a new pathway to find help and assistance from mental health professionals immediately, and if that assistance is provided, we can hopefully see a decrease in arrests of mentally ill individuals.”
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Santa Clara County ‘s mental health and substance use crisis has seen a record increase in suicides and drug overdoses compounded by the pandemic. Schools have seen an unprecedented number of youth and teens suffering from severe depression and anxiety. For adults, the issue is further exacerbated by an inadequate number of beds in treatments facilities and the overuse of prisons to incarcerate those in need of treatment.
The road to 988
There are 13 crisis centers in California certified by the National Suicide Prevention Lifeline to respond to 988 calls. Calls to the federally funded national hotline are redirected to the appropriate network. Santa Clara and Kern counties are the only two counties that operate crisis call centers. The other 11 are operated by nonprofits.
This gave Santa Clara County a head start soon after 988 became law in October 2020, said county Suicide and Crisis Services Manager Lan Nguyen, who has been leading the crisis center transition.
There are 15 cities in the county, but only 13 have their own 911 dispatch operations. Los Gatos-Monte Sereno and Saratoga police calls are dispatched through the Sheriff’s Office, as are calls from unincorporated parts of the county. The switch from 911 to 988 requires a reworking of services that has been in the works for close to two years, Nguyen said.
District 3 Supervisor Otto Lee, who supported Assisted Outpatient Treatment, also known as Laura’s Law, for those with severe mental illness, said 988 is a game changer.
“988 is now our one-stop hotline phone number for mental health emergencies, and is long overdue,” he said. “(It) will help us save lives.”
Prepping for 988
Since mid-May, Santa Clara County has been quietly testing 988 through its behavioral health center. Calls are going directly to crisis counselors, and Nguyen told San José Spotlight there have been no surprises. The focus is on making sure resources and services flow smoothly from crisis counselor to community handoff in anticipation of increased call volume, Nguyen said.
Part of that success depends on the response time of the mobile crisis teams, a new resource for the crisis center. Coordinating where and when to respond takes planning, similar to triaging patients in a hospital’s emergency department.
Three mobile response teams will operate under 988. The Mobile Crisis Response Team, which serves adults, receives $3.5 million in annual county funding. The Mobile Response Stabilization Service Team, which contracts through Pacific Clinics—formerly known as Uplift—serves youth and young adults ages 18–21. The unit received a $2 million grant which enables the team to expand into North and South County and the West Valley.
The third team is Trusted Response Urgent Support Team, which serves all age groups and contracts through Pacific Clinics. The team received $7 million in funding through the Mental Health Services Act. It will launch in the fall.
Karen Meagher, clinical director of Pacific Clinics who oversees two of the mobile crisis teams, said arriving on the scene is just the beginning of the process. The key is continuity of care from a 988 handoff to the mobile crisis team to helping support the person after that initial contact, she said.
“As much as I believe in mobile units and how important they are, what’s really going to support decreasing recidivism are those follow up services,” Meagher told San José Spotlight. “Can we get the people connected to the support and services needed long-term? Some of our teams can do follow ups for 30 days and offer that support.”
Numbers don’t lie
Currently, one out of eight calls to the National Suicide Prevention Lifeline originates in California, according to the Substance Abuse and Mental Health Services Administration, the agency that provides federal funding for 988. The volume increased by 67% between 2016-2020 to more than 304,000 calls. The agency estimates that number will skyrocket by 300% to more than 899,000 calls once 988 is activated.
In Santa Clara County, the number of crisis center calls received last year totaled 52,429, according to county records. If that volume doubles, more than 100,000 calls could be fielded locally. Nguyen said six months from now he will have a better handle on what the future may look like.
Yet there is concern about behavioral health workforce shortages, the lack of treatment facilities and supportive services, especially with 988 going live.
Sandra Hernandez, county behavioral health division director for mobile crisis response for adults, acknowledges the workforce challenges ahead and wonders where the county will find the people.
Until those numbers rise, Hernandez said, “We need to continue being as creative as possible and looking at the options to connect people to community services.”
The county’s 988 call center has 12 full-time crisis counselors on staff and 70 volunteers who have 80 hours of extensive training in mental health crisis counseling.
The current budget for the crisis center is $1.3 million, through a combination of funding agencies. Last year, the California Department of Health Care Services announced $20 million in funding to support the 13 Lifeline agencies. These one-time funds must be spent on technology upgrades, training, and a shared platform by the end of December. Another $14.4 million earmarked for staffing will be awarded to the state in January 2023 through the Substance Abuse and Mental Health Services Administration.
After 30 years in the mental health field, eight of which have been managing the suicide and crisis center, Nguyen remains upbeat and confident crisis counselors will make a difference.
“We will be able to offer support for any mental or emotional crisis situation,” he said. “Well trained and caring counselors will be there to talk to callers.”
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