Even the youngest child knows what to do in case of an emergency: Call 911.
But when the emergency involves a mental health crisis, a better option is about to arrive: Call 988.
The new 988 system, which goes live in New Hampshire on July 16, is meant to work in the same way as 911, an easy-to-remember phone number that connects callers with help immediately. In addition to calling, people will be able to reach out by text or chat.
David Mara, the governor’s adviser on addiction and behavioral health, said he’s proud of the work advocates and agencies in New Hampshire have done to roll out 988 and crisis services.
“I’m very excited about it,” said Mara, who was part of the steering committee. “Our hope is when somebody is having a crisis, they know there is a place where they can turn, and there are going to be professionals waiting to help them and guide them out of crisis and get them the help they need.”
New Hampshire has already been expanding its crisis response system as part of the state’s 10-year mental health plan when Congress approved the new three-digit number to call for behavioral health emergencies, according to Jennifer Sabin, the state’s suicide prevention coordinator in the state Department of Health and Human Services’ Division for Behavioral Health.
In January, the state’s new Rapid Response Access Point phone line (1-833-710-6477) went live, connecting people with mobile crisis teams that operate out of the 10 community mental health centers.
Even after July, “That number is not going away,” Sabin said.
Neither is the National Suicide Prevention Lifeline (1-800-273-8255).
But 988 is a lot easier to remember if you’re in crisis.
Some of the same people who have been answering emergency calls for years will be part of the new 988 system. It includes staff at Headrest in Lebanon, who answer calls to the suicide prevention hotline in New Hampshire.
Beacon Health Options, which has the state contract to operate the Rapid Response line, will begin answering 988 calls July 16.
Having two providers will help manage the expected increase in call volumes when 988 goes live, Sabin said.
She expects younger people will reach out for help through 988’s chat / text options. “We know that’s how young people prefer to communicate, so by adding chat and text availability, we’re going to start interacting with a different population in our state,” Sabin said.
Cameron Ford, executive director of Headrest in Lebanon, said the crisis line has been in existence for more than 50 years. “The founders… started it literally in a dorm room,” he said.
“We’ve had people call as young as 8 years old, talking about what’s going on in the next room,” he said. And on the other end of the age spectrum, “We get people calling who are in assisted living who are distraught.”
They also have their “frequent callers,” folks who call every day. “They’re just isolated and they want to check in, and we’re that resource,” Ford said.
Who’s on the other end of the line? “People with a caring heart and a dedication to helping people, and the training,” Ford said.
The new 988 number is simple, but the system backing it up is anything but, Ford said. “We’ll be able to work together to get help to someone who needs it in the best possible fashion.”
That could mean connecting someone with substance abuse treatment or mental health counseling, or engaging with someone who is actively threatening suicide – like the person who called a few weeks ago who had a gun to their head, Ford said.
“Our staff person was able to talk with them, keep them on the line and call the police, and the police were able to show up and help that person live for another day,” he said.
As of July, Beacon will be the primary call center handling 988 calls, while Headrest staff will handle 988 texts and chats. Any overflow calls will bounce to the other agency.
The change can feel a bit confusing. We already have 911 and 211, the Rapid Response line and suicide prevention hotline, and now there’s 988. Officials say they expect some technical issues will need to be worked out.
Not automatically routed
Unlike the 911 system, the Federal Communication Center did not authorize geo-location for 988, which would allow the calls to be automatically routed to a local call center, Sabin said.
“If you call 911, it doesn’t matter what area code (you have) because they can ping you,” Sabin said. “That did not get approved nationally” for 988, she said, though that may change in the future.
For now, the national 988 network is routed by area codes. So if you call 988 from a phone with a 603 area code, the call will go to a Beacon staff member.
But, Sabin said, about 25% of state residents have phones with other area codes. So for those people, calling the current rapid response line (1-833-710-6477) may be the best option, she said.
State agencies have been collaborating to make sure that emergency calls are handled appropriately here.
Mark Doyle, director of the division of emergency services and communications at the state Department of Safety, said agencies and advocates are working together to build a seamless system.
Many people who call 911 do not really require a law enforcement response but don’t know who else to call, Doyle said. “Now with 988, we have an opportunity to really point them in the direction for the right help that they need at the right time,” he said.
As of July 16, if calls for mental health issues come in to 911, that call center will be able to reroute those calls to 988 – and vice versa, Doyle said. “We are building a system so we can do the appropriate triage of the call and then transfer it to the 988 folks so they can handle it appropriately,” he said.
“It’s a no-wrong-door approach,” he said.
Headrest’s Ford praised the state 911 team’s commitment to making sure emergency calls are routed to the right place. The call center will keep someone on the line and use a second phone to call police or a mobile crisis team if that’s what’s needed, he said.
“The last thing a person in crisis wants to hear is ‘Hold, please,'” Ford said.
Kari Sanborn, director of rapid response at the Mental Health Center of Greater Manchester, said she hopes the new 988 system serves people who have not had access to mobile crisis services before.
“I think it’s going to make it easier for people to have one number to call and have access immediately to the services that they may need,” she said.
The ability to text and chat is critical for people who don’t want to talk on the phone, Sanborn said. “It’s a very easy way to reach out,” she said.
Sanborn said a rapid response team’s approach may look different in rural areas of the state than in the big cities. A peer support worker may respond in person and connect someone with a clinician using technology to ensure a quicker response, she said.
DHHS ‘Sabin said you don’t need to wait until you’re in a full-blown crisis or thinking of harming yourself to call 988.
“Part of the crisis system transition is really about getting people to call early and call often, and not waiting until the crisis is so bad that someone’s already hurt or someone needs to go to a hospital,” she said.
Sabin said the renewed focus on mental health has been a “silver lining” of the COVID-19 pandemic.
“It’s very normal right now to feel overwhelmed and feel not OK, and to need someone to talk to every once in a while,” she said. “No one is immune.”
Sanborn said there has been a cultural shift. “I think people are taking mental health seriously, and I think the pandemic has shed a light on it, with people being isolated and at home, and people starting to talk about anxiety and depression,” she said.
The new 988 system, Sanborn said, “is a way to decrease that isolation and get people connected quickly.”
Her message: “It’s OK to ask for help, and there’s an easy way to do it.”
The new rapid response system also is a step toward the parity for which mental health care advocates have long sought.
Imagine, Sabin suggests, that your house is on fire, so you call the fire station – but they send a police officer. You call them back and tell them your house is on fire, but they respond that “we only put out fires at the fire station,” she said.
“That’s what we’ve been doing with mental health and substance use for so long,” she said. “Why do you have to go to a hospital if you’re having a behavioral health crisis?”
Doyle from the Department of Safety said he’s optimistic the new system will make a real difference in people’s lives.
“I think it is a win-win for the first responder community, and I think it is a win-win for people who need access right away,” he said. “They’re going to call and they’re going to get the help they need.”
Those who have worked in the field for a long time say they hope calling 988 will someday be as routine as 911 has become.
“That’s really our hope, that there will be a time when we don’t remember the confusion about where to call when you’re in crisis,” Sabin said.
“I’m a millennial,” she said. “I don’t remember what it was like pre-911.
“And I can’t wait for my kids to not know what it was like before we had 988.”