Wednesday, Mar 1, 2023

988: Bridging the Gap to a Future of Behavioral Health Equity for All

Nishi Rawat, M.D., MBAChief Clinical Officer, Bamboo Health

HLTH Foundation

Overview of the Stats of 988 Since its Launch in July of 2022 


The National Suicide Prevention Lifeline made history in July 2022 with the launch of the newly renamed 988 Suicide & Crisis Lifeline, a three-digit easy-to-remember dial code akin to 911 for behavioral health crises and other needs. Since its launch last summer, 988 has made great strides in making vital behavioral health care accessible to individuals in the moments they need it most. 


In fact, in December 2022 vs. December 2021, calls answered increased by 48%, chats answered increased by 263%, and text answered increased by 1,445%, according to Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Department of Health and Human Services (HHS). Although 988 is still in its infancy, the increase in volume and improved response has been very encouraging. 


Despite the initial reported success, the unfortunate reality is that there is still much work to be done to ensure equitable access to the 988 Suicide & Crisis Lifeline and associated behavioral health treatment. This is especially true for the members of historically underserved populations who have experienced lack of crisis response and overall healthcare services including BIPOC (Black, indigenous, and people of color) communities, LGBTQ+ (lesbian, gay, bisexual, transgender, and queer) communities, neurodiverse individuals, disabled individuals, older adults, non-English speakers, refugees, immigrants, and more.


For example, a study from The Trevor Project found 45% of LGBTQ+ youth seriously considered suicide, while 14% attempted suicide. Additionally, 60% of LGBTQ youth who wanted mental health care in the past year were not able to access it. 


988 FROM A HEALTH EQUITY PERSPECTIVE: DEMOCRATIZING ACCESS TO BEHAVIORAL HEALTH


The vision for 988 is for it to provide those in crisis or with other behavioral health needs to have someone to call, someone to respond, and a safe place to go. The goal is for behavioral health to be treated with a behavioral health response, instead of with law enforcement or a necessary ambulance trip or emergency room visit. This is particularly of importance from a health equity perspective as traditionally marginalized populations are at higher risk of a mismatched response.


From a national perspective, SAMHSA is taking steps to address health equity and disparities in care among vulnerable populations. Among several health equity initiatives, SAMHSA is putting a large focus on Certified Community Behavioral Health Centers (CCBHCs) to increase behavioral health access. These centers play a significant role in providing culturally sensitive/competent care for communities across 46 states. CCHBCs are often partnered with school systems and are connected to crisis stabilization units for referrals for individuals in need of crisis care. CCHBCs will continue to a vital resource for crisis care in the future thanks to a $300 million increase in funding announced in August 2022.


TECHNOLOGY INFRASTRUCTURE AND ITS ROLE IN 988 HEALTH EQUITY


While the work to date has been positive steps forward, technology plays a vital role in bridging gaps in our current behavioral health system. An effective behavioral health crisis response system is an essential component for enabling communication and coordination among stakeholders and services at the city, county, or state level. With technology, providers can quickly and accurately assign individuals in crisis to the appropriate level of care, improving patient outcomes and driving clinical efficiency.


Technology-enabled, real-time behavioral health data offers patient-level analytics and decision support to give providers more control, confidence, and insight than ever before to help address many of the behavioral health challenges states commonly face including: 

  • Emergency department (ED) boarding
  • Per capita overdoses and suicides
  • Unnecessary ED visits and inpatient encounters 
  • Prevention of individuals from progressing to more acute states and increased risk scenarios


This is where technology and interoperability are paramount. A solution that creates an interoperable infrastructure among key stakeholders can expedite access to assessment and treatment for those in a behavioral health crisis. A closed-loop referral system also plays a critical role in helping to close gaps in care. By tracking the initial call all the way until treatment, stakeholders can ensure patients do not fall through the cracks, and instead, get the care they need the most.


For example, operators answering the phone or responding to a text waste valuable time entering multiple systems to direct a caller to care. Technology can help states connect the dots and thread the response process together, ensuring there is no-wrong-door access for those who call 988.


About 20% of crisis line calls cannot be de-escalated over the phone. In these instances, technology can enable clinicians to conduct digital intake and assessment, dispatch mobile crisis teams using GPS-enabled technology, and gain situational awareness about the availability of treatment resources using digital networks to get every caller to definitive assessment and treatment. 


Through real-time care coordination, mobile crisis response teams, local community organizations and other behavioral health stakeholders can coordinate their efforts, ensuring integrated access to the appropriate level of care for all. 


THE FUTURE OF HEALTH EQUITY FOR 988


988 is proving to be a vital tool for shining a light on behavioral health crisis response in the United States. To truly tackle our nation’s behavioral issues head on, it is imperative that our country can connect anyone facing a crisis with the right care in real time, and this starts at the local level. 


While technology alone cannot wipe away the mental, economic, and physical pain present, innovative technology solutions available today can play a critical role in amplifying the human moments, bridging critical connections, and elevating how life-saving treatments are delivered to those most in need – toward a future of behavioral health equity for all.


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