Fifty years ago, people had to remember the different local seven–digit phone numbers to reach their police, fire, or medical services. Accidental (and preventable) deaths and injuries had become an epidemic. Enter 911, the standardized national number for emergency services. Fast forward fifty years, and 988 hopes to be the 911 of mental health emergencies: the number to call for the suicide hotline as well as during behavioral crises which don’t require police intervention.
In July of 2022, the federal government launched the three–digit 988 number as an easy–to–remember alternative to the 10–digit National Suicide Prevention Hotline (which is still in service). Its implementation is left up to the states.
“I think the promise of 988 is great, we just need to follow through. The story of mental health care is really good intentions and no follow up,” says Molly Candon, Assistant Professor of Psychiatry and Healthcare Management at Penn. In Philadelphia, the matter of follow through has been a concern of life or death.
In October 2020, two Philadelphia police officers fatally shot Walter Wallace Jr. while amid a mental health crisis. Though The Consortium Inc., a mental health response center located in West Philly, was familiar with Wallace, they were never contacted. Instead, Wallace’s family called 911 three times during his crisis episode. Wallace wasn’t the first person to be killed by police who weren’t equipped to handle someone in his mental state—a quarter of people shot and killed in Philly by police in recent years were experiencing some type of mental health crisis. Wallace’s death solidified the fact that Philly needed a more robust mental healthcare infrastructure. In June of 2021, Mayor Jim Kenney earmarked $13 million to beef up Philly’s crisis response system. Money went towards beefing up Philly's crisis response system by establishing 988 services and funding mobile crisis response teams, a program that partners mental health professionals with the police.
By investing in programs centered around mental health care, behavioral crises can be resolved without the usage of violence. According to Jill Bowen, Commissioner of Philly's Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), when someone dials 988, highly trained responders answer and assess for the best response. Most calls are resolved on the phone. If more help is necessary, community mobile crisis teams are then dispatched. Community is the focus of Philly’s mental health crisis response model. Furthermore, resolving behavioral crises non–coercively is a goal of DBHIDS, with the majority of crises addressed in the community or through voluntary evaluation.
There are four providers that operate these community mobile crisis response teams in different regions in the city. “The purpose of having a community mobile crisis response team is that it is a community response. It's not a police response. It doesn't come with a siren. It comes by the clinical team that is from the community that knows the community that has familiarity with the community,” Bowen says.
Another new reform is the Crisis Intervention Response Team program. This program comprises four CIRT teams that are first responders to any behavioral health crises identified by police radio. CIRT units are made up of police officers who have been trained in de–escalation tactics and mental health professionals contracted by DBHIDS. The goal of the program is ultimately for police to have better and more nuanced responses to mental health crises.
While remembering 988 is certainly easier than remembering 1–800–273–8255, it’s understandable that in the heat of the moment, people have an instinct to call 911 rather than decide whether their crisis might be better suited for 988. DBHIDS is prepared for those situations. If a call comes into 911 that does not require police intervention and is identified as a behavioral health call, it will get shifted over to 988. Furthermore, there are Philadelphia crisis line workers embedded in the 911 call center to assist with calls where the nature of the call is less clear. According to Bowen, from January 2022 to March 2023, 1,129 calls were shifted from 911 to 988.
Since the implementation of 988 in Philadelphia, the hotline has received an overall 14.5% increase in call volume, according to Bowen. A survey of people who had the mobile crisis team come to them found that about 75% rated the overall satisfaction at five out of five and 72% strongly agreed that it was helpful and informative. It's clear that people are utilizing 988 and are satisfied with their outcomes. But DBHIDS’s behavioral crisis response system reforms are not complete.
Looking ahead, Bowen says that DBHIDS is focusing on building up their website and exploring social media as another vehicle for getting the word out about 988. This summer, a fifth community crisis response team will open. DBHIDS is also looking to open the first adult behavioral health urgent care. They also have a newly formed crisis intervention support team, which follows up with individuals and their family for six weeks to ensure there is not a reemergence of crisis.
Clearly, awareness around 988 is necessary. As Candon points out, in the year after the release of artist Logic’s song, “1–800–273–8255,” the national suicide hotline saw a 26% increase in calls and there were as many as 245 fewer deaths. While DBHIDS hasn’t approached Logic to write a new song for 988, they have been running PSAs on various media outlets, such as news channels, radio stations during the traffic and weather, and on the backs of various newsstands throughout the city. They are also working on a specific neighborhood by neighborhood strategy to make sure that everyone receives information about 988 in the best communication style and language for them. As the DBHIDS Commissioner explains, “It's an all out effort to ensure that people know about [988] at the same level that they know about 911.”
While still in their infancy, these mental healthcare reforms are a step in the right direction in providing Philadelphia with a robust behavioral crisis response system and to prevent future tragedies like what happened to Walter Wallace Jr.
Bowen’s message is clear: “At the bottom of all of this is that if someone’s already experiencing behavioral health distress, you want to make sure that your system that responds doesn’t add any trauma—it must alleviate trauma.”
