Michiganders in mental health crisis now have a short-cut for help: calling or texting 988.
The initiative — similar to 911 calls for general emergencies — is a federal link-up that connects residents to crisis counselors located throughout the state. There are currently more than 200 local and state-funded crisis centers that operate the 24-hour National Suicide Prevention Lifeline, now known as the 988 Suicide & Crisis Lifeline.
The existing services have struggled to handle a growing mental health crisis in Michigan and beyond. The global stress of the COVID pandemic, the nation’s spate of mass shootings and increasing drug overdose deaths have helped focus attention in recent years on the state’s thread-bare mental health system.
Advocates say the 988 program is a solid advancement in providing a hotline number that is easy to remember while making mental-health care more immediately accessible. And with at least $3 million in state funding set aside for more staffing and infrastructure, Michigan is the “best poised state in the nation” to build out its existing network, said State Rep. Mary Whiteford, R-Casco Township, near Saugatuck.
Whiteford spent roughly three years on a bill, signed into law last year by Gov. Gretchen Whitmer, establishing a statewide mental health crisis line system through the Michigan Department of Health and Human Services.
The 988 initiative connects to that still-expanding system.
“Everybody else is scrambling trying to figure out how they can have this work, and we have this whole platform set up,” Whiteford said.
Here’s how the 988 system will work:
What is 988?
It’s a three-digit shortcut to receiving mental health help. The service is meant for people beyond those contemplating suicide; essentially, anyone in a mental health crisis, such as with anxiety, substance abuse or other issues.
Secretary Xavier Becerra of the U.S. Department of Health and Human Services said in remarks last week the Biden administration has invested more than $400 million in beefing up crisis centers and other services around the country. But he added that 988 is not a federal program, “it is run by the states through their crisis centers.”
In Michigan, 988 callers are connected through the existing Michigan Crisis and Access Line (MiCAL) to call-takers throughout most of the state. Those call-takers are hired by Common Ground, a mental health services provider founded in 1971. The 988 line routes calls in Kent County to call-takers who are part of Network 180, and in Macomb County it connects to Macomb County Community Mental Health.
Calls are routed by the area code.
The idea is to connect people in crisis to local help. That means, however, that a person with a 248- area code living in California, for example, will be routed back to a hometown call-taker, said Jill Smith, senior director fo MiCAL. But ultimately the person answering the call can help the caller find services where they are currently living, she said.
If mental-health calls surge beyond capacity in Michigan, the national network can provide back-up, said Dr. Debra Pinals, medical director of Behavioral Health and Forensic Programs at the Michigan Department of Health and Human Services.
Services are provided in English and Spanish only, but staff can use translation services to provide counseling in over 250 additional languages. Text and chat are currently available in English only.
The new 988 system works on both landlines and cell phones.
No one should have to try to navigate a confusing patchwork of services to find help, said Whiteford, the lawmaker.
“The crux of our problem as a nation — definitely as a state but as a nation, too — is unsupported mental health needs, where people don’t know where to go,” she said.
Up and running? Sort off.
The new 988 is a “soft rollout” for now, until Michigan can beef up staff and resources by some time next year, said the state’s Pinals.
“We want to make sure that, before we do broad advertising, that we’ve got some kinks ironed out,” she said.
In the coming months, MiCAL will more than double its current staff of 43 full-time call-taking positions, said Common Ground’s Smith.
“We are always looking to grow that, because we will be constantly matching up to the demand and the volume,” she said.
Who can call, and what’s the cost?
The 24/7 service is free and confidential, and goes beyond those contemplating suicide. Mental health crises can vary from caller to caller, and they don’t always signal violence or suicidal ideation.
“The crisis,” Pinals said, “is defined by the caller.”
Kevin Fischer, executive director of Michigan’s chapter of the National Alliance on Mental Illness (NAMI) agreed: Stress, addressed early — even when the caller’s thoughts haven’t yet turned to self-harm — can avert tragedy.
“You don’t want to wait to call until someone has a knife in their hand,” said Fischer, who has lost a son to suicide.
And the police…?
The 988 digits provide an alternative to a police response that a 911 call often triggers, Fischer said.
No matter how well-intentioned, the presence of lights and sirens can sometimes escalate a mental health crisis. Others who call 911 end up in hospital emergency rooms for hours on end, when their issues could have been resolved by talking with a counselor over the phone.
That’s why some people in crisis, or whose loved ones are in crisis, are reluctant to punch in 911, Fischer said.
“I have tremendous respect for law enforcement, but if you call 911, you are always inviting, into your home, armed law enforcement,” the elder Fischer said.
Fischer recalled personal experience with that dynamic.
His son, Dominique, began having psychotic episodes when he went to college.
In one instance, a police officer realized Fischer’s son was in a psychotic crisis. The officer transported him to an emergency room for mental health help while alerting Dominique’s family.
Fischer still has a copy of the thank you note he wrote to the police department, he said.
But another time, the younger Fischer was jailed after internal voices led him early one morning to an empty parking lot. A police officer, questioning Dominique Fischer, mistook the psychotic episode for drunkenness, his father said.
“Police calls go wrong,” he said.
The three-digit 988 bypasses a 911 response.
Call-takers can still alert emergency crews (which may or may not involve police) as necessary — in cases of imminent danger. But by far, most calls are deescalated without a physical response, Pinals said.
“By calling 988, you have a significant opportunity — not a 100-percent guarantee, but a significant opportunity — to eliminate police from the scenario,” Fischer said.
How expert are these staff?
Calls are answered by trained counselors, who go through 96 hours of training by Common Ground before they begin taking calls. That training includes 16 hours of Applied Suicide Intervention Skills Training or ASIST.
Call-takers are not clinicians, but they are trained to make referrals to clinicians when necessary, Pinals and Smith said.
“The idea is that the counseling that they’re trained in walks people through a crisis,” Pinals said. “In most situations, the crisis can be resolved through dialogue and conversation from person to person.”