Even the youngest child knows what to do in an emergency: Call 911.
But when an emergency involves a mental health crisis, the best option is about to arrive: Call 988.
The new 988 system, which went live in New Hampshire on July 16, is intended to work the same way as 911, an easy-to-remember phone number that instantly connects callers to help. In addition to calling, people will be able to communicate via text or chat.
David Mara, the governor’s advisor on addiction and behavioral health, said he’s proud of the work New Hampshire’s job advocates and agencies have done to roll out 988 and crisis services.
“I am very excited about it,” said Mara, who was part of the steering committee. “Our hope is that when someone is going through a crisis, they know there is a place where they can turn around, and there will be professionals waiting to help and guide them out of the crisis and get the help they need.”
New Hampshire was already expanding its crisis response system as part of the state’s 10-year mental health plan when Congress approved the new three-digit number for calling for behavioral health emergencies, according to Jennifer Sabin, the state’s suicide prevention coordinator at the State Department. From the Department of Health and Human Services for Behavioral Health.
In January, the new Rapid Response Access Point phone line (1-833-710-6477) went live, connecting people to mobile crisis teams operating from 10 community mental health centers.
“That number is not going to go away,” Sabine said even after July.
There is also no National Suicide Prevention Lifeline (1-800-273-8255).
But remembering the 988 is a lot easier if you’re in a crisis.
Some of the same people who have answered emergency calls for years will be part of the new 988 system. This includes Hydrast workers in Lebanon, who answer calls to a suicide prevention hotline in New Hampshire.
Beacon Health Options, which has a government contract to operate the rapid response line, will begin answering 988 calls on July 16.
Sabine said having two providers will help manage the expected increase in call volume when the 988 is operational.
And she expects younger people to reach out for help through the 988’s chat/text options. “We know that’s how young people prefer to communicate, so by adding the ability to chat and text, we’ll start interacting with a different demographic in our state,” Sabine said. “.
Cameron Ford, Headrest Lebanon CEO, said the crisis streak has been around for more than 50 years. “The founders … literally started it in the bedroom,” he said.
“We’ve been approached by people as young as 8, 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 people in a stupor.”
They also have “always callers,” the people they call on a daily basis. “They’re just isolated and they want to check in, and we’re that resource,” Ford said.
Who is on the other end of the line? “People with a kind heart and a dedication to helping people, coaching,” Ford said.
Ford said the new 988 is simple, but the system that supports it is anything but. “We will be able to work together to get help to those who need it in the best possible way.”
That could mean hooking someone up with substance abuse treatment or mental health counseling, or getting involved with someone who threatens suicide — like someone who called a few weeks ago and had a gun to their head, Ford said.
“Our staff were able to talk to them, keep them on the line and call the police, and the police were able to show up and help that person live another day,” he said.
As of July, Beacon will be the main call center handling 988 calls, while the headrest crew will handle 988 text messages and conversations. Any excess calls will be returned to the other agency.
The change can be a little confusing. We already have 911 and 211, a rapid response line and a suicide prevention hotline, and now there are 988. Officials say they expect some technical issues to be resolved.
It is not routed automatically
Unlike the 911 system, the FCC did not authorize the 988’s geolocation, which would allow calls to be automatically routed to a local call center, Sabin said.
“If you call 911, it doesn’t matter what area code (your) has because they can call you,” Sabine said. “This has not been approved nationally,” she said, for 988, although that may change in the future.
Currently, the national 988 network is routed by area codes. So if you call 988 from a phone with area code 603, the call will go to a Beacon employee.
But, Sabine said, about 25% of the state’s residents have phones with other area codes. For these people, she said, calling the current rapid response line (1-833-710-6477) may be the best option.
State agencies are collaborating to make sure 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.
Doyle said many people who call 911 don’t really need a law enforcement response but don’t know who to call either. “Now with the 988, we have a chance to really point them in the direction to get the right help they need at the right time,” he said.
As of July 16, if calls for mental health issues reach 911, that call center will be able to forward those calls to 988 — and vice versa, Doyle said. “We are building a system so that we can do proper triage of the call and then pass it on to 988 people so they can handle it appropriately,” he said.
“It’s not a wrong approach,” he said.
Hydrist Ford praised the government’s 911 team’s commitment to making sure emergency calls are directed to the right place. He said the call center would keep someone on the line and use a second phone to call the police or a mobile crisis team if that was what was needed.
“The last thing anyone in a crisis wants to hear is ‘Wait, please,'” Ford said.
Carrie Sanborn, director of rapid response at the Mental Health Center in Greater Manchester, said she hopes the new 988 system will serve people who did not have access to mobile crisis services before.
“I think it will make it easier for people to have a single number to call and have immediate access to services they may need,” she said.
Sanborn said the ability to text and chat is critical for people who don’t want to talk on the phone. “It’s a very easy way to communicate,” she said.
Sanborn said the rapid response team’s approach may look different in the state’s rural areas than in the larger cities. She said a peer support worker may respond in person and connect someone to a doctor using technology to ensure a faster response.
DHHS’ Sabine said you don’t need to wait until you’re in full crisis or thinking of hurting yourself to call 988.
“Part of the shift in the crisis system is really about getting people to call early and call often, not to wait until a crisis gets so bad that someone is already injured or someone needs to go to the hospital,” she said.
Sabine said a renewed focus on mental health has been the “sun side” of the COVID-19 pandemic.
“It’s very normal right now to feel overwhelmed and feel unwell, 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 very seriously, and I think the pandemic has brought it into focus, with people isolated and in their homes, people are starting to talk about anxiety and depression,” she said.
Sanborn said the new 988 system “is a way to reduce this 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 is also a step toward parity that mental health care advocates have long sought.
Imagine, Sabine suggests, your house is on fire, so call the fire station — but they send a police officer. I called them again and told them that your house was on fire, but they replied that “we only put out fires at the fire station,” she said.
“That’s what we’ve been doing in mental health and substance abuse for a long time,” she said. “Why should you go to the hospital if you have a behavioral health crisis?”
Doyle of the Department of Safety said he is optimistic that the new system will make a real difference to people’s lives.
“I think it’s a win-win situation for the first responder community, and I think it’s a win-win situation for people who need access right away,” he said. “They’ll call and get the help they need.”
Those who have worked in the field for a long time say they hope that calling 988 will one day be as routine as 911.
“That’s really our hope, that there will be a time when we don’t remember confusion about where to call when you’re in a crisis,” Sabine said.
“I’m a millennial,” she said. “I don’t remember what it was like before 911.
“And I can’t wait for my kids not to know what it was like before we had a 988.”