How Does 988 Work?
988 was established in July 2022 to improve access to crisis services in a way that meets our country's growing suicide and mental health-related crisis care needs. 988 provides easier access to behavioral health crisis services, which are distinct from the public safety purposes of 911 (where the focus is on dispatching Emergency Medical Services, fire and police as needed).
911 continues to operate as it does across the state. For serious and life-threatening situations, 988 call centers work with local mental health providers to support appropriate interventions.
The Oregon Health Authority (OHA) and Oregon's 988 call centers are collaborating with 911 Public Safety Answering Points to develop a roadmap on how 911 and 988 can coordinate with each other in the future.
988 crisis counselors are trained to use the least invasive interventions. Oftentimes, responding to a call, text or chat is all that is needed to help someone in crisis. In fact, more than 95 percent of current calls are resolved over the phone.
If a 988 call cannot be resolved over the phone, a mobile crisis team or first responder may be dispatched.
What is a mobile crisis team?
Community-based mobile crisis teams typically use face-to-face professional and peer intervention teams, deployed in real time to the location of a person in crisis, to provide assessment, de-escalation and referral services as needed.
What is a first responder?
A first responder is an Emergency Medical Technician or police officer who is trained to handle behavioral health crises or emergencies. If a 988 counselor determines a caller is in danger of harming themselves or others, they will send first responders trained in trauma-informed care.
Other important facts to know:
- 988 is available through every landline, cell phone and voice-over internet device in the United States, as well as text and chat.
- The current technology for 988 routes callers by area code, not geolocation.
- 988 is not currently available when phones are locked or do not have prepaid minutes.
- The transition to 988 does not impact the availability of crisis services for veterans and military service members. They can call 988 and press 1 to connect with the Veterans Crisis Line.
- For support in Spanish, callers can press 2 to connect with the Red Nacional de Prevención del Suicidio.
The 988 Suicide and Crisis Lifeline has an infographic with more information on what happens when people call, text or chat.
Vision for 988 and the Crisis Response System
The launch of 988 is an exciting opportunity to reimagine how crisis services are provided in Oregon and the United States. However, the full vision of a transformed crisis care system —
with 988 at its core —
will not be built overnight. Transformation of this scale will take time and will require continued collaboration, commitment and support
from both the public and private sectors to make it effective, appropriate and sustainable.
The most recent data from the Centers for Disease Control and Prevention show:
- In 2020, Oregon had the 13th highest rate of suicide in the United States with a total of 833 deaths. The Oregon rate of suicide has stayed well above the national rate since 2000.
- In Oregon, suicide is the second leading cause of death among youth aged 5-24.
Investments in Community-Based Mobile Crisis Intervention Services
OHA works with communities with lived experience in the behavioral health system to guide the design, implementation and policies of 988 and a broader crisis response system, especially through the Crisis System Advisory Workgroup (CSAW). OHA recognizes that many individuals and families with lived experiences and from disproportionately affected communities have experienced adverse impacts of the crisis response system due to systemic and historical social injustice. The CSAW is driving policy decisions that will lead to changes in statutes, rules and contracts to ensure that people in Oregon experience crisis services at a quality they recommend.
With community partnerships and insights from those with lived experience, OHA hopes the 988 Behavioral Health Crisis System implementation can provide an empowering, personalized, high quality and culturally responsive experience for individuals in crisis and that the system will meet the unique needs of groups disproportionately impacted by health inequities, including youth, rural populations, communities of color, veterans, people currently in the military, Tribal communities and people who identify as LGBTQIA2S+.
The Association of Community Mental Health Programs (CMHP) has also convened a workgroup to plan implementation of enhanced community-based mobile crisis intervention services in each Oregon county. This CMHP workgroup is working closely with the CSAW to ensure they implement the quality of mobile crisis service that people in Oregon want to experience.
The Oregon Legislature, through House Bill 2417 (2021) and other other transformative investments is strengthening and expanding the state's behavioral health crisis system so that, eventually:
- 988 can be the initial point for individuals to seek out behavioral health crisis services, and
- People in need can be more easily and quickly linked to community-based behavioral health treatment, with the goal of diversion from emergency departments and jail.
As of July 2022, approximately $7 million has been invested in Oregon's two eligible 988 call centers to build staff capacity for culturally, linguistically and developmentally specific services. Approximately $39 million has been allocated to Community Mental Health Programs to enhance and expand community-based mobile crisis intervention services.
In the longer term, OHA's vision is to build a robust crisis care response system that links callers to community-based providers who can deliver a full range of crisis care services in addition to connecting callers to tools and resources that will help prevent future crisis situations. This more robust system will be essential to meeting crisis care needs in Oregon. We envision a day when everyone across our country has someone to call, someone to respond, and a safe place to go for crisis care.
The Federal Communications Commission (FCC) recommended the use of 988 as the 3-digit code for the National Suicide Prevention Lifeline. FCC staff consulted with SAMHSA, the Department of Veterans Affairs, and the North American Numbering Council.
The FCC adopted rules designating this new phone number for people in crisis across the United States to connect with suicide prevention and behavioral health crisis counselors and set July 16, 2022, as the implementation date.
Congress passed the 988 National Suicide Hotline Designation Act and called on states to establish a statewide coordinated crisis services system and provide the appropriate funding for its success.
The Oregon Legislature passed House Bill 2417, which:
- Sets aside General Fund dollars for Oregon’s 988 implementation and infrastructure.
- Outlines the requirements for the infrastructure and resources to implement the 988 emergency call system and a behavioral health crisis service system that can support 988. The bill:
- Directs OHA to convene a work group to study and evaluate methods for continuing to fund mobile crisis intervention teams and other behavioral health supports.
- Expands crisis stabilization services, including crisis stabilization centers meeting criteria adopted by OHA by rule, short-term respite facilities, peer respite centers, behavioral health urgent care walk-in centers and crisis hotline centers.
The first phase of 988 is launched.
Who Will Pay for 988?
The legislature has set aside General Fund dollars to implement 988 call centers and infrastructure. As the 988 crisis response system expands, additional funding will be required to sustain the call centers, response units, and other services.