New 3-Digit Crisis Hotline Will Connect Callers With Mental Health Professionals

Margie Balfour, MD, PhD, chief of quality and clinical innovation, Connections Health Solutions, Tucson Arizona, shares information about the new 3-digit number “988” that will connect callers to mental health professionals who have the training and expertise to assist people during mental health crises. In this video, Dr Balfour explains the importance of the 988 hotline, when it will be more widely available, and the impact that COVID-19 had on mental health.

Effective July 16, 2022, phone companies will be required to transition the current mental health emergency hotline (1-800-273-TALK) to be accessible via "988".

More With Dr Balfour: Identifying Warning Signs of Mental Health Crises, Depression During the Holiday Season

Read the transcript:

Meagan Thistle: Welcome "Psych Congress Network Family." We are here today with Dr Margie Balfour. If you'd like to introduce yourself?

Dr Balfour:  Hi. I am a psychiatrist in Tucson, Arizona. I am the chief of quality and clinical innovation at an organization called Connections Health Solutions, and we operate in mental health and substance use crisis centers across Arizona.

Question: If you could first talk a bit about the implementation of 988, and what we can all expect?

Dr Balfour:  988, for those who don't know, it's really exciting. It is going to be a 3‑digit number like 911, but it will connect to mental health professionals who have the training and the expertise to help people with mental health crises.

Question: Could you talk a little bit about the impact of COVID‑19 and how it's impacted mental health as a whole?

Dr Balfour:  COVID[-19] has truly changed the world in many ways. With mental health, it's the isolation of the lockdowns, the stress of the uncertainty of the pandemic, people losing loved ones, people not being able to work, being uncertain about their income and their support in terms of housing, food, transportation, all of that has really taken a toll.

We've seen up to 5 or 6 times increases in the prevalence of anxiety and depression. There's been increases in suicides. One study that was recently done show that there's a racial and ethnic disparity in some of those impacts. It's uncovered a lot of the gaps in our social safety net and underscored the importance of people being able to get on‑demand treatment for their mental health needs.

Question: Could you dive a little bit deeper into how clinicians can collaborate on addressing the issues you just mentioned, and why collaboration is important when trying to solve the mental health crisis?

Dr Balfour:  Mental health spans so many different aspects of our different systems. It affects families, it affects the individuals in crisis, but also when people need crisis care, they often end up calling 911. The default first responders for that are often police. Then they often get taken to emergency rooms which are not really equipped to handle mental health crises.

Then they wait for hours, sometimes days even, to be transferred to a mental health hospital. Then after that, even if you're trying to prevent the crisis ahead of time, it's hard to get quick access to mental health treatment. That's just for adults. You talk about kids. The schools are often the first line of detecting when there's mental health issues.

All of these different components need to collaborate so that we can figure out how to identify someone before they have a crisis and get them the care that they need as quick as possible.

That's one of the reasons why 988 is so exciting is because if you think about how it works today, is you have a crisis, you call 911. Oftentimes, it's the police that show up.

Many places, they have training in how to deal with mental health issues, but you're still putting a person in crisis with an arms law enforcement response versus what happens if you have chest pain and you call 911. You get an ambulance with trained health professionals who are there to take care of you and to bring you to an emergency room where you get the care that you need.

988 actually has the potential to transform the way we respond to crisis, similar to the way 911 did back in the '60s, '70s, '80s when it was ramping up where it transforms the way that emergency medical systems work.

Ultimately, what you would want to see and we do see this in some model communities, especially out here in Arizona, is that there is a crisis response system that is on par with what you expect for medical emergencies.

For example, out here in Arizona, you may have heard people talk about a model called Crisis Now, which was pioneered out here in Arizona and a lot of it by our organization Connections.

If you call 911 down here in Tucson, there is a crisis hotline. You can either call that hotline directly, or some of that staff is co‑located with 911. They intercept that call and have a trained mental health professional try to de‑escalate that crisis. They can de‑escalate about 80% of those crises over the phone. If they can't, then they are able to dispatch clinical crisis mobile team.

Two clinicians go out and do a face‑to‑face like how an ambulance would go out and see somebody with a medical emergency. They're able to resolve about 70% of those crises out in the field.

Then for people that still need more acute care, that they may be a danger to themselves or others, agitated, psychotic, suicidal, intoxicated, having withdrawal symptoms, there are facilities like ours that are able to accept those folks from either the mobile teams, or if police had responded, they're able to drop people off faster than they could if they took them to jail.

It's not only is a way to get people the help they need, but it's a way to keep them out of the justice system, where they're not going to get the care they need. Then in our facilities, we're able to resolve about 60‑70% of those crises after an overnight stay, and then get them connected to the care that they need out in the community so that they can stay well in the community.

Question: Could you share where 988 is going to be available and the rollout and implementation plan?

Dr Balfour:  The hotline is going to roll out July 2022. The legislation was passed back in 2016. Then Congress authorized states to add a telecom fee to your cell phone bill to help fund that. Every state is implementing it a little differently. You might want to contact your state [National Alliance on Mental Health] NAMI or your state mental health advocates to see what's going on in your own state.

What's also happening is that the states and the federal agencies like [Substance Abuse and Mental Health Services Administration] SAMHSA are realizing that that 988 number, it's going to need something to connect to. There are some planning grants from the feds to the different states to help plan for that.

There's funding in the American Rescue Plan Act and some other recent legislation that's percolating through Congress to help fund these crisis services. It's a little different in every state. There are some national guidelines that are starting to come out.

The Substance Abuse and Mental Health Services Administration [SAMSHA] put out some national guidelines. The National Council for Behavioral Health also put out a report called the "Roadmap to the Ideal Crisis System" that gives community tools to start to implement those things.

A lot of states are looking to Arizona because Arizona has a very robust and mature crisis system that is managed primarily through the Medicaid system, although it blends funding from other sources as well, or you hear sometimes called the Arizona Model is one that a lot of the states are trying to emulate.

That's that system that I talked about before where there's the crisis hotline that connects and works as a system and coordinates with the mobile crisis teams and then the crisis facilities and then the outpatient providers to have a whole system of care.

Thistle: Thank you so much for joining us. We will definitely be including links to some of the resources so everyone can check that out, as well as the number that you mentioned in addition to the 988. Again, thank you so much for being with us, and hope to talk with you again soon.

Dr Balfour:  Thank you. Thanks for having me.

Margie Balfour, MD, PhD, is a psychiatrist and national leader in quality improvement and behavioral health crisis care. She is chief of quality and clinical innovation at Connections Health Solutions, Tuscon, Arizona. She is also an associate professor of psychiatry at the University of Arizona. Dr Balfour was named Doctor of the Year by the National Council for Behavioral Health for her work at the Crisis Response Center in Tucson and received the Tucson Police Department’s medal of honor for helping law enforcement better serve people with mental illness. She contributes to expert panels for SAMHSA and the DOJ. Her pioneering work on crisis metrics has been adopted as a national standard, and she co-authored Roadmap to the Ideal Crisis System: Essential Elements, Measurable Standards, and Best Practices. Dr. Balfour is a Distinguished Fellow of the American Psychiatric Association and serves on the Quality-of-Care Council. A native of Monroe, Louisiana, Dr. Balfour earned a BA in Biology at Johns Hopkins University followed by her MD and PhD in Neuroscience from the University of Cincinnati. She completed residency and fellowship in Community Psychiatry at the University of Texas Southwestern Medical Center in Dallas.