Emergency

988 Is the New 911 for Mental Health

02/06/2023

​​​​​​In this episode, Margie Balfour, MD, PhD, speaks about the new 3-digit code for people experiencing a mental health crisis. Starting July 16, 2022, people can call or text 9-8-8 to be connected to a mental health professional.

Additional Resources:

Margie Balfour, MD, PhD, is a psychiatrist, the Chief of Quality and Clinical Innovation at Connections Health Solutions, and a professor of psychiatry at the University of Arizona (Tucson, AZ).

 

TRANSCRIPTION: 

Jessica Bard:

Hello, everyone, and welcome to another installment of Podcast360, your go-to resource for medical news and clinical updates. I'm your moderator, Jessica Bard, with Consultant360 Specialty Network.

There is a new 3-digit dialing code for people who are experiencing a mental health crisis. Starting July 16th, 2022, people can call or text 988 to be connected to a mental health professional. Dr Margie Balfour is here to speak with us today about the upcoming implementation of 988. Dr Balfour is a psychiatrist, the chief of quality and clinical innovation at Connections Health Solutions, and a professor of psychiatry at the University of Arizona in Tucson, Arizona.

Thank you for joining us today, Dr. Balfour. To start, provide us with some recent statistics regarding mental health.

Dr Margie Balfour:

Yeah. So, 1 in 4 adults in the U.S. will experience some sort of mental health issue or need in any given year. And then with COVID, those numbers have been increasing, and people coming into the emergency room, especially young people, with suicidal thoughts is one of the fastest-growing segments of ER visits in recent years. And so the loneliness and the isolation and the stress of work and finances and loss has just really created even more mental health needs in the U.S.

Jessica Bard:

Let's talk about 988. What are the five Ws? The who, what, where, when, why of 988?

Dr Margie Balfour:

988 is going to go live on July 16th of this year. So just in a few weeks, and it was created to have a hotline or a three-digit emergency number for people to call for mental health emergencies, particularly suicidal thoughts. Because currently people call 911, and that usually results in a police response. And that's not what people in mental health crisis need. They need to be connected to clinicians who can take care of them and help work them through their crisis. So it's going to be a three-digit number nationwide. It links the current national suicide prevention lifeline network, which is a network of over 200 crisis call centers around the country. But this will link them all into one network and also bring in other call centers, eventually link into 911 in many communities so that when people call that number for help, they're getting someone who can provide help and the resources that they need.

Jessica Bard:

Now, you mentioned in the beginning of this conversation, the impact of COVID-19 on mental health. Elaborate a little bit more. What really was the impact of COVID-19?

Dr Margie Balfour:

Well, what we're finding, as you look through the data, is that it actually has impacted different parts of the population differently. So, we've seen increases in depression and anxiety, which is not too surprising given how I think everybody felt a little anxious during the pandemic. But there's actually a bit of disparity in terms of race and ethnicity and socioeconomic status. There was a study done in Maryland looking at death records and saw that for white Marylanders, the suicide rate actually decreased, but for black residents living in Maryland, the suicide rate doubled.

So, it's affecting different parts of the population differently. And some of that could be due to loneliness and isolation. Some of that is due to loss. I forget the exact number, but it's in the hundreds or tens of thousands of children who've lost a primary caregiver. COVID really shined a light on the lack of a safety net for a lot of folks in our country. So there are stresses over financing for people who lost their job. There are stresses over housing and eviction. And then there are the people who is the opposite of losing their job. They were the essential workers who've been working through this entire pandemic. And so healthcare workers, in particular, are having lots of trauma and grief and depression and anxiety as well.

Jessica Bard:

Now you mentioned before, too, some collaboration, but really talk to us about the importance of collaboration in solving the mental health crisis.

Dr Margie Balfour:

Sure. So in a mental health crisis... when we think of 911 today, we can't really think of it without thinking about the emergency response system that comes behind it. So your 911 call-takers, the ambulances and EMS and emergency rooms, and we need that kind of response for mental health crises as well. Right now we often rely on the police to respond and take people to emergency rooms that aren't equipped to handle what people need. Or worse, the police, they don't really have a place to take people. The emergency rooms often make them wait for hours with people. And so jail becomes the path of least resistance. So mental health crisis response is really about building the response that's going to address the person's mental health or substance use need and get the right kind of response to them. So, when they call a three-digit number like 988, they need to get a clinician who knows how to work with people in crisis, knows how to help people resolve their emergencies, and then if they can't do that over the phone, be able to link them to the right care that they need.

So that means mobile crisis teams that can come out to where the person is and be able to address their crisis and help try to figure out what they need to be able to remain stable. But if that's not possible, then bring them to a crisis center where there are multidisciplinary staff, so anywhere from psychiatrists to nurses or social workers, but also people with their own lived experience with mental illness who can help work with them and try to get that crisis stabilized.

And then law enforcement are always going to be involved somehow because they may come upon people in crisis. They may come to a scene where you thought it was something else, but it turns out there was a mental health crisis involved, and they need a way to bring people to treatment rather than taking them to jail.

And they're getting lots of training on this. They're getting training on how to recognize signs and symptoms of mental illness, how to deescalate that so that it doesn't end up in a tragic outcome like police shootings, and then divert that person to treatment. But then it's on the treatment community in the medical system to make it easy for those police officers to do the right thing. And so crisis services really need to collaborate a lot with law enforcement to make it as easy as possible for them to drop that person off or get that person transferred into care so that they can go on about their police business. And that's how you decrease the numbers of people with mental illness in our jails and prisons.

Jessica Bard:

I think warning signs are a really big thing that we need to talk about today. What are warning signs that we should all really be looking out for?

Dr Margie Balfour:

Ultimately, because different people, they may manifest their mental health crisis differently, and so one thing you want to look for is a change from how the person normally is. So, if someone who's usually extroverted ends up spending a lot of time isolated and alone, or someone stops doing the things that they used to enjoy, those are big warning signs. If someone who used to sleep a lot is now not sleeping very much or someone who used to like to sleep a lot, she's now wanting to sleep all the time, changes in appetite, those are big warning signs. And also if people start talking about life isn't worth living or feeling like they're a burden on people, those are warning signs. And then changes in people's substance use intake, starting to drink a lot more than you used to or smoke marijuana a lot more than you used to. So, just changes are the big warning signs.

Jessica Bard:

What would you say are the overall take-home messages from our discussion today?

Dr Margie Balfour:

I think that 988 is coming. It's going to catalyze a transformation in our mental health crisis response services. That's going to take time to build all of that. But in the meantime, there is an alternative number to call besides 911 for people and families who are in crisis. And that as the crisis response infrastructure grows, they'll get more and more of the more specialty response to what they need.

Jessica Bard:

Is there anything else that you'd like to add today?

Dr Margie Balfour:

I don't know if I'm allowed to be political, but there are a couple of bills in Congress that are bipartisan bills that are trying to build the infrastructure that we need to create the crisis response system that we need. One of them is the Behavioral Health Crisis Services Expansion Act. Another one of them is the 988 Implementation Act. And both of these are bipartisan-sponsored bills. They do things like increase planning grants for the states to be able to plan for things like crisis mobile teams to respond, to plan for crisis facilities for people to go to. They also do things like setting national standards, and most importantly, currently, private insurance does not pay for crisis services. So states that are leading the way in crisis care have services available, but it's financed mostly through Medicaid and taxpayer funds. And even though anybody can access them, private insurance doesn't pay for it. And so that's one of the things these bills do as well is create equal parity coverage where everyone's health insurance would pay for a mental health emergency in addition to the medical emergencies they already pay for.

And if you're interested in what an ideal crisis system looks like, there is a report that was released in the last year called the Roadmap to the Ideal Crisis System. And this was a joint project between the national council for mental well-being and the group for the advancement of psychiatry. I was part of the group that wrote the report. But it really lays out what are the fundamental elements of a high-performing crisis system and not just what those are services are, but what is the governance and the oversight and the financing that you need to support a sustainable system. So, if you're interested in advocating in your community for crisis services, this was designed for that purpose. It has a report card where you can do a self-assessment of your community, and it's really designed to help stimulate discussion and to help people start planning for having a crisis response system. And there'll be a link to the report in the show notes, or you can go to crisisroadmap.com and download it.

Jessica Bard:

Well, thank you so much for your time today. This is a really important topic, and it was a pleasure speaking with you.

Dr Margie Balfour:

Thanks. Thanks for having me.