Year after 988 mental health line debuts, Nevada building crisis response teams to back it up
A little over a year ago, 988 replaced the former 10-digit suicide hotline phone number nationwide.
Since July 2022, the hotline has received more than 6 million calls, texts and chats. There were more than 38,000 contacts from Nevada and routed to the state. Each year, the hotline receives more calls — in August 2023 there were more than 3,000 contacts from Nevadans to the hotline.
It wasn’t just the number that changed — so did the way local jurisdictions respond to mental health crises. When the crisis intervention services were complete, those who called 988 could be assisted by crisis response personnel and designated crisis centers to provide more individualized care beyond the phone-based services.
The services around 988 get mixed reviews. When 988 was first implemented nationwide, some people praised the move toward making mental health services more accessible, while others warned 988 was not helpful because it involved the police unnecessarily in some cases, further traumatizing someone in crisis, and sometimes forcing people into treatment.
The changes to the state’s mental health crisis hotline are taking place as the state ranks 50th in mental health services as of 2022. The low ratings stem, in part, from a lack of access to behavioral and supportive services as the state faces a shortage of mental health care providers.
Reporting from the Nevada Division of Public and Behavioral Health also indicates that the Silver State has the 39th highest suicide rate in the nation, with more than 19 deaths per 100,000 caused by a person taking their own life — higher than the national average of about 14 deaths per 100,000 people.
Julia Ratti, the director of programs and projects at Northern Nevada Public Health — formerly known as the Washoe County Health District — said Nevada’s current mental health crisis response system is largely the same one that responds to medical emergencies, crime and fires. Without a full continuum of care system in place, a family in crisis will usually call 911.
“When they call 911, the response they’re going to get is either law enforcement, fire or an ambulance,” she said. “And those are all wonderful, important parts of an emergency management system, but they are not a behavioral health system.”
If individuals experiencing a mental health crisis cannot get their needs met on scene, they are often transferred to an emergency room or jail.
Ratti said all the recent work across the state and nation is to try to change the reflex to call 911 to one to call 988, so the crisis has a chance to be resolved through phone, text or chat. If a situation escalates, a mental health professional can then be dispatched rather than an ambulance or law enforcement officer.
“In all of those cases, there's two brilliant things that happen. One is the care is a better match for one’s individual needs,” she said. “It's also more cost effective. Because law enforcement, ambulances, jails, emergency rooms are all expensive.”
When a person calls 988 now, they are greeted with a message directing them to the Veterans Hotline or Spanish language services. If the person chooses the option to stay on the line, they are directed to a local Lifeline crisis center near their ZIP code. If the local crisis Lifeline is unable to answer, the person is directed to a different center.
Once the call is routed, a trained counselor answers the phone to provide support, listen and share resources if needed. There are also chat, text and video call services available.
If, during the call, the counselor thinks the person calling may be in danger, the counselor will connect the person to local emergency services such as 911. If the person hangs up in the middle of a call, the counselor may call them back.
Local governments trying to bolster crisis response
According to the American Psychological Association, at least 20 percent of all calls to police are related to mental health.
UNLV Psychiatry Professor Lisa Durette said there are several unintended consequences of taking a purely law enforcement approach to behavioral health, such as giving individuals experiencing a mental health crisis the impression they are in legal trouble and pushing those who need help away from seeking it.
“The goal in dealing with the behavioral health emergency is to address whatever is happening, [such as] an acute suicidal crisis,” Durette said. “Our goal is to really drive people into getting the end treatment rather than unnecessary visits into emergency departments and unnecessary involvement with the legal system.”
Local jurisdictions differ in where they are in the process of developing complete 988 services. SB237, a measure passed during the 2023 legislative session, added a 35-cent surcharge every month to all phone bills and is aimed at generating funding to support the program — a clean up of a law established after the 2021 session that only added the surcharge to landlines. So far, 988 services have received $1.9 million in telecommunication fees since the passage of SB237, Caleb Vasquez-Stading, the public information officer for the Nevada Division of Public and Behavioral Health, told The Nevada Independent in an email sent Sept. 29.
No funds from this surcharge the state began receiving in July 2023 have been allocated to counties yet, according to Vasquez-Stading. He said that would come after the state selects a vendor to launch the 988 call center.
“Due to the limited amount of time the Division of Public and Behavioral Health (DPBH) has been collecting fees, an accurate projection cannot be made of the annual revenue from the surcharge,” he said.
Local health care agencies and government organizations are currently receiving funds from the state through federal allocations or grants, Ratti said.
In Southern Nevada, Clark County Commissioner Justin Jones and Las Vegas City Councilman Brian Knudsen are working together to increase the mental crisis response systems in Las Vegas.
Knudsen said the goal is “making sure the state and the county and the cities work together on building out a more comprehensive system that doesn't put the pressure of mental health on a police officer because that’s not appropriate.”
Jones said crisis intervention is the main priority for him right now.
“There's other initiatives that we're working on, but definitely crisis intervention has been the focus,” Jones said.
Knudsen added that providing care for people experiencing crisis is the priority in building a mental health crisis response system but said the investments will also free up police officers, firefighters and health care providers “so that they can deal with more acute medical emergencies and public safety emergencies.”
Though police could still be involved in responding on a scene or to calls for mental health crises, the hope is once the infrastructure for 988 is complete, the services will put less strain on inpatient care, emergency departments and legal systems within the state.
Clark County Sheriff Kevin McMahill said during his inaugural speech early this year that mental health in his department and the community was one of his priorities, and incarceration is not the answer to mental health problems. The sheriff’s office said McMahill declined to comment on 988 services.
By the time the project is complete, there should be an estimated 13 to 17 teams that include social workers, case managers and peer support to respond to calls and several crisis response centers to serve the Las Vegas area, according to Knudsen.
Northern Nevada is working on rolling out its complete crisis response system, Interim Crisis Response System Program Manager Rachel Isherwood told The Nevada Independent. Its current priority is selecting a vendor to help do that.
The region is also continuing to engage city and county partners, as well as state agencies to find the best way to complete the rollout of the crisis response system.
“These efforts are aimed at ensuring that Nevadans in need have prompt access to the necessary resources and support,” Isherwood said.
In the meantime, there are resources available to Nevadans going through a mental health crisis beyond calling 988. That includes calling various hotlines, including those geared toward specific demographics such as veterans, survivors of sexual assault and members of the LGBTQ+ community.
The Southern Nevada chapter of the National Alliance on Mental Illness also has a guide for individuals and loved ones on what to expect when a person is put on a 72-hour mental health hold, usually within a health care or mental health crisis facility, following an emergency call.
Updated 10/26/2023 at 2:17 p.m. to correct Lisa Durette's field of study, correct a paraphrasing of Durette's interview and make an addition about what a person might experience when calling 988.