Five Common Misconceptions About 988

There are many myths about the national 988 hotline and its implementation. For funders who want to get involved, it is crucial to know the facts. Here, Dr. Tom Insel,  former Director of the National Institute of Mental Health, Founder of Mindsite News,  and Mindful Philanthropy advisor, shares the following five common misconceptions about 988 and corrections to these perceptions.

Myth 1: 988 is 911 for mental health.

Unlike 911, 988 is intended to support individuals in crisis with first-line telehealth-style support, rather than purely dispatching emergency services. Those answering calls can be supported by innovative, decision support tools (e.g. verbal language processing). With well-trained, well-equipped call personnel, approximately 80% of calls can be resolved over the phone, resulting in only 20% needing a mobile crisis response. Of that 20%, approximately 80% of people who need a person to come can be addressed through in person mobile crisis team support, leaving a small portion of callers needing to be transported to more intensive care environments. 

Myth 2: 988 will solve criminalization, emergency room boarding, and violent events.

In order to effectively address these significant systemic issues, callers to 988 need not only a person to call, but also in some cases someone to come and somewhere to go. 988 is an entry point into a full continuum of care. Alone it cannot address these systemic issues. In fact, creating new call centers or call infrastructure without capacity across the continuum will perpetuate the problem. Necessary components of the crisis continuum may look different in different jurisdictions, but should at the very least include a:

• Person to call (e.g. 988)

• Person to come (e.g. mobile crisis response teams or other integrated response teams)

• Place to go (e.g. crisis respite or stabilization center)

Myth 3: 988 crisis call is all about suicide prevention.

Due to the association with and legacy of the National Suicide Prevention Lifeline phone number, 988 is often thought of in terms of suicide prevention. However, 988 is intended to include all crisis needs, including but not limited to psychotic episodes, immediate needs associated with substance use disorders, and panic attacks. 988 should also consider and integrate alternative methods of contacting support, as Crisis Text Line’s 219 million text and message app exchanges with users in need since 2013 reminds us that phones are not just for voice calls.

Myth 4: 988 requires research to develop the model.

Many models exist for each component of the crisis continuum, including costs and financing needs. Local conditions will require adaptation, such as in rural vs. urban contexts, areas with high rates of homelessness, or limited mental health infrastructure and capacity, etc. But such models provide a starting point to start implementing. Measuring impact is an important part of iteration and improvement, but there is no reason to delay implementation of models that work.

Myth 5: 988 authorization includes an appropriation.

Because the current national legislation does not include appropriation (i.e. funding), every state will need to figure out financing. Other resources and structures are available and funded, which should be incorporated into local implementation approaches. For example, Certified Community Behavioral Health Centers (CCBHCs) are mandated to provide crisis services. Current hotlines and warm lines will also need to adapt. Philanthropy can help local teams build out workforce and infrastructure capacity, coordination with 911 and EMS, and measurement capability. Philanthropy can also support innovation.

Many reference a telecom fee, but unlike 911, a telecom fee will be insufficient to support the actual operations of 988. Therefore, thinking of 988 call centers as telehealth rather than dispatch may enable alternative solutions to financing (i.e. insurance reimbursement).

To learn more about how funders can support 988 implementation within a broader crisis response system, download Mindful Philanthropy’s latest guidance, A Call for Hope: How Philanthropy Can Support 988 and Mental Health Crisis Care. See our blog for more in this series on 988 and crisis reform.