Behavioral health experts are envisioning Arizona’s 988 crisis response system to provide individuals experiencing behavioral health emergencies with the same level and urgency of care as individuals experiencing medical emergencies.
Justin Chase, CEO of Solari Crisis & Human Services, Rachel Rios-Richardson, Evaluation Associate at LeCroy & Milligan Associates, Inc, David Covington, CEO & President at RI International, and Wendy Farmer, Director of Account Management at Beacon Health Options, discussed this topic during a panel at our 2022 Arizona State of Reform Health Policy Conference in May.
Rios-Richardson said that, according to a survey distributed by her organization to people in the state with lived experience calling crisis lines or 911 for behavioral health emergencies, people in Arizona are very excited about 988 and prefer to call a 3-digit number, and so the state is preparing for a major shift in volume.
Chase said that although the volume of calls to 988 is expected to be high, he believes the state is well-positioned and ready for the new crisis response system to be rolled out.
“We think we’re gonna see more of the statewide calls shift over to 988, but the delta of what the total volume is going to be may not be as big of an impact on Arizona because the [crisis response] system and infrastructure is quite robust as it is.”
Starting Oct. 1st, a single statewide 800-number crisis line, operated solely by Solari, will go into effect, consolidating the 23 advertised crisis lines that currently operate in the state. 988 calls, starting July 1st, will be routed to both Solari and La Frontera Arizona. The statewide crisis line will work in tandem with the 988 line.
Chase emphasized the importance of the state system and the 988 system working together, stating that about 23,000 calls are captured per month in the central northern parts of the state on the existing state system, making the existing system the point where the majority of Arizonans are currently accessing crisis care. This constitutes 3,000 mobile crisis units being dispatched in a month.
However, Chase also highlighted that the call centers are stabilizing the majority of calls over the phone and are not needing to dispatch higher levels of care.
“The value of 988 is different. It’s not just a relay service, getting people to higher cost downstream services that aren’t necessary … It’s the assessment triage and potential therapeutic intervention taking place at the call center level. If [the call center] is not able to meet the needs, then it moves off to a higher level of care.”
Covington said it’s important for the 988 system to maintain the same level of care urgency for behavioral health emergencies as medical emergencies while simultaneously shifting response services away from law enforcement, emergency medical services (EMS), and hospital emergency departments.
“What we have today is a system where certainly many are involved with law enforcement on the front end,” he said. “But if you need intensive support, virtually everyone is going through the choke point of a hospital emergency department.
They’re spending, in most cases, days … if you’re an adolescent, it can be a week or more spent just detained in a small, sometimes windowless emergency department room, without treatment, without support, without engagement. 988 and mobile crisis services and directly accessible crisis facilities give us a way to let 911 and hospitals do what they do—respond to overt criminal activity, explicit threats to public safety, and obvious medical emergencies that are not psychiatric in nature.”
Chase also emphasized the importance of rapid response times on the 988 crisis line.
“We have to answer as fast and as good as 911 does if we’re going to maintain that performance expectation for individuals, because one bad experience can divert an individual to care,” he said. “With mobile teams, we’ve gotta get out on the scene fast enough, and with receiving facilities, to be able to have that open door for folks to walk in or a place for first responders to drop individuals off in a swift process.”