How 9-8-8, Crisis Response, and EMS Can Improve Community Care

The July 2022 launch of the 9-8-8 three-digit suicide prevention hotline in the United States signified a major step forward emergency mental health care. But more needs to be done to address psychological crises, and in some instances, is being done today.

These and related mental health topics were discussed in depth during the July 23, 2022 webinar “Working Together: How 988, Crisis Response, and EMS Can Improve Community Care,” available to view at https://www.youtube.com/watch?v=DBk1N9pBGvY

The webinar was hosted by the National Highway Traffic Safety Administration’s Office of EMS in collaboration with the Substance Abuse & Mental Health Services Administration (SAMHSA). It examined opportunities for collaboration between the recently launched National Suicide Prevention Lifeline (9-8-8), crisis response, and EMS communities.

One of the first experts to speak was Richard McKeon, PhD, a public health advisor at SAMHSA. McKeon noted that the original 1-800-273-8255 suicide prevention hotline answered two million calls in 2021. “We are anticipating that number to go up significantly with the launch of 9-8-8, which is such an easier-to-remember number,” said McKeon. “We saw that in the first few days after the launch. We are anticipating, likely over the next year, more than 7 million calls, chats and texts.”

Three Horizons

The launch of the easier-to-remember 9-8-8 number is just the start of efforts to better prevent and treat potential suicides, McKeon noted. For its part, SAMHSA sees 9-8-8 as just the first of three “horizons” to be crossed in this campaign.

The second is the reaction of “mobile crisis services” to treat these patients immediately in the field. The third horizon is the creation of suicide-specific “crisis receiving and stabilization units” that mobile crisis services can deliver these patients to, “because not everybody needs to be brought to the emergency room,” he told attendees. “We know that there are times, unfortunately, that people may need to wait in emergency rooms not only for hours, but for days, and at times, even weeks. And crisis receiving/stabilization services can be a very important alternative for that.”

Daniel Gerard is president-elect of the International Association of EMS Chiefs (IAEMSC) and EMS coordinator for the Alameda (CA) Fire Department. His department has deployed a crisis mobile unit with positive results.

“We reduced [the number of] transports to hospital emergency departments and psychiatric facilities overwhelmingly,” Gerard said. In a selected one-month timeframe, “We had zero responses that went to the psychiatric facility by our crisis mobile unit. And when you look at patients that were involuntarily committed, we reduced that number by almost two thirds. I would say that overall you know the program is extremely successful.”

Gerard cautioned that the demanding nature of mobile crisis intervention requires extensively trained EMS personnel to perform this work on an ongoing basis. Moreover, “we need something that's designed for us based on our education or lack thereof moving forward,” he said. “We really need to be better prepared moving forward.”

Response Models Shifting

Colorado’s Gunnison Valley Health Mobile Crisis Services is a multi-agency response to the problems of emergency mental health, designed to fill serious gaps in this rural area’s medical health system.

“We engaged our critical access hospital and our local behavioral health experts to help us build what we now consider kind of a decentralized but highly coordinated crisis response model that has now been an operation for about a year,” said Sean Caffrey, president of the National EMS Management Association and CEO of the Crested Butte Fire Protection District. “The key to our decentralized approach here is really that our providers all maintain their traditional roles, but we coordinate our activities. This integrated approach allows us to match resources essentially to the needs of our patient population and hopefully deliver care appropriate to this situation.”

Jodie Chinn is the 9-1-1 communications specialist at Gunnison Regional Communications 9-1-1, which created “the policy and procedure on how mobile crisis would work within our emergency system,” she said. Once it was launched, “GVH Mobile Crisis became a user agency with our 9-1-1 authority. We dispatch them as we would any other emergency service agency.”

The results speak for themselves. In its first fiscal year of operation, GVH Mobile Crisis handled 156 calls, of which 143 led to patient assessments and 13 were canceled. Of those 143 assessments, 78% were handled without calling EMS to the scene, and 36% without calling in law enforcement for help. “80% of those assessments were safety planned and stayed in our community,” Chinn said. “0.14% went to our emergency rooms. The data demonstrates that emergency room visits weren't necessary in the majority of these calls.”

More ground was covered during the NHTSA webinar, but even this small sample demonstrates that 9-8-8 in combination with mobile crisis services can make a positive difference in improving outcomes of suicidally inclined patients, while reducing stress of public safety services.

James Careless is a freelance writer and frequent contributor to EMS World.