After the Webinar: 988 and the Future of Crisis Response. Q&A with the Presenters

Webinar presenters John Snook and Shannon Scully answered a number of your questions after their presentation, 988 and the Future of Crisis Response: What Criminal Justice Professionals Need to Know. Here are just a few of their responses.

Audience Question: Can you talk more about the funding opportunities related to 988. Where can we find out more about them, and can we find out about what local and state agencies have already received funding?

Shannon Scully: Yeah, and John, actually, if you don’t mind, I’m going to leave this off because I’m going to steal this idea that someone gave me the other day. John and I spent a lot of time having conversations with folks about this topic, and a lot of the funding that is happening right now. A lot of, it’s in the mental health space, right? So, there’s something called the Mental Health Block Grant, and every state gets a chunk of money every year or two, to provide services and support around mental health. And there was a bump this past year that states are going to be seeing to specifically address crisis services. And so that’s one of the funding areas, and there’s some other funding that is coming through the large funding bills being passed through Congress. And so, one of the things that I would recommend, in terms of how that money’s going to get spent. It’s going to go through your state’s mental health systems. And one of the ways that we can kind of make sure that we’re breaking down those silos is maybe encouraging your governor’s office or your state’s criminal justice coordinator. The people who are involved in administering the Byrne JAG grants. Encourage them all to get involved in deciding how this money is going to get spent. Because that is a decision that is going to be made at the state level. And I, you know, was in conversation with someone the other day, and the thought was, well, how do we kind of get those criminal justice coordinating representatives, kind of involved at the state level, and really, I think that is kind of through the Governor’s office. Because I think both, that’s where there’s going to be some decisions made about how that money gets spent and gets distributed. And so, that’s kind of one of the immediate. I think the way John mentioned it, that we’re working on some more sustained funding opportunities, and we’ll definitely continue to bring those as they get introduced, as they move through, and if they get signed into law. What I’ll just mention is that we’re advocating for something called S1902, it is a federal bill that has been introduced in the Senate and is supported by Senator Cortez Masto and Senator Cornyn. But it basically provides long-term funding streams through health insurance to cover crisis response services. So that’s some of what we’re doing. John, I don’t know if you have other thoughts or ideas, or ways to, kind of point folks in the direction of the money and how to get involved.

John Snook: Yeah, that was a very good answer, and I think it sort of depends on which piece you’re talking about. So, there’s significant funding going to the 988 portion, there are planning grants that are going to help coordinate at the state level. There are these new, long-term funding streams that are still sort of coming down the pipe. And then, as Shannon mentioned, there’s this sort of deluge, flood of mental health resources that are coming to states. Honestly, in quiet conversations, we’ve had a lot of communities and state providers just say, “We’re not sure exactly how we’re going to be able to spend it all. Because it’s so much money coming so quickly, and we want to do a good job with it.” So, I think there are some real opportunities to open new doors and to have new conversations about how to spend some of these resources. So, it’s less of sort of the typical well, there’s a new widget coming down for a grant program. There are some of those. But there’s also a bunch of new ways that this is happening. So, I have less of those, go to this page, and look at this grant funding opportunity than I would normally. But, again, the DOJ is going to be talking about a number of ways that they’re coordinating some of their resources as well at that next meeting. So, stay, you basically keep paying attention and look to see what your state is taking on as well.

Audience Question: How will 988 calls be routed to local centers? Is that going to be based on the area code latitude, longitude, information from a phone? And, of course, not everyone’s going to be calling from a mobile phone. Do you have any idea, technically, how they’re planning on doing that?

Shannon Scully: So, as I kind of mentioned earlier, that, you know, what 988 is today, it’s not going to be what it is two weeks from now. So, we have been working very closely with the FCC, the Federal Communications Commission to make sure that geolocation technology is, in fact, applied to 988. And so, currently, the way the lifeline works is based on area code, but obviously, we know that’s not how people make phone calls anymore. Right? You know, I mean, I’m originally from Minnesota. I’ve lived in Chicago, I now live in DC, the DC area, but my area code on my cell phone, if I dial 988, they will route me to a Minnesota Call Center. So, one of the things that we’ve been working with the FCC to do is to make sure that geolocation technology is implemented in order to make sure that when we call, we’re able to route those calls at least, to the same state where someone is located. The FCC works at a different timeline than the rest of us. We are encouraging them to release these guidelines as soon as possible. But I currently do not have any specifics on that except that they are working as quickly as they possibly can to get guidance out on this. So that the technology will be in place as soon as possible. And that is the best answer I can provide to you. But we are pushing on them as hard as possible, to make sure, yes, that we’re able to route these calls to a call center that is as close to the person as it could possibly be.

Audience Question: Do you envision, can a 911 call be transferred back to 988, and then vice versa? And then how will those information share information so, the caller doesn’t have to repeat everything that they just told that to the last call taker?

John Snook: So, we’ve seen a number of really interesting innovations already, even prior to 988 coming online. Communities where they’re able to basically set up what amounts to three-way calls that bring on a clinician or specific kind of just having somebody sitting in the same room. That you have a mental health clinician. Austin, Texas does this. You have a mental health clinician who sits in for 911 calls and is able to redirect them. So, that’s the sort of thing that we expect and anticipate the folks at Vibrant and the 988 line we’ll be doing. You know, I think a lot of those conversations are happening right now, but I’m waiting for the FCC to pull out that some of this information. And then some of it is going to be sort of at that local and state level, how are you planning to co-ordinate this process? Do you have an existing crisis system that this is just going to sort of attach on top of? Or is this basically going to be 988 goes to 911, they take all the calls. You know, I think there’s going to be different versions all across the country. For any number of reasons, whether it’s resources, what the community looks like, you know, the only one crisis team in Wyoming, you’re not going to probably have the same process, as you’ll see in Downtown Los Angeles.

Shannon Scully: And John, I would just add on to that. So, for those of you who run 911 call centers, Atco has just released a call for folks to engage in a working group to develop kind of standards for 911 Call Centers to engage with what they’re referring to is as alternative hotline numbers or call centers, so 988 essentially. For those of you who might be interested, I’m going to drop that opportunity kind of into the chat so you can take a look at that. We know that NENA is also the National Emergency Number Association. So, these two organizations that you know, are really involved in setting up standards for 911 call centers. They are thinking about this. They are starting to engage in the process so that they can come up with guidance and standards for how 911 call centers can interact with 988 call centers, which I think is going to address some of these concerns. So, I dropped that into the chat for everyone. If you are someone who is an expert in this area, I encourage people all the time to get involved in this because I think it’s a really robust process. And the more people that I think can get involved to try to inform some of these guidances that are kind of come up from the professional associations. That’s really going to just help. Everyone has solid guidance on that. So that’s another thing that’s coming out and is happening as we kind of barrel towards this July 2020 to date.

Audience Question: Many jurisdictions that have established or are in the process of establishing multi-disciplinary 911 response units, such as a fire EMT paired with a crisis worker, and so on. Do you see this has been counter-productive to the 998 efforts?

John Snook: No. I think that is exactly what we were talking about. I think there is a tendency to sort of think of it as competition, but I do think that there is a significant opportunity. I’m very familiar with the Right Care model out of Dallas. Meadows worked on that, and it’s a multi-disciplinary response team that includes paramedics, law enforcement. On paper that could be, in competition with 988, that crisis team could somehow be taking resources, either competing for populations. But the reality is, we can build out a system that provides all of these resources, and it’s going to look different in different communities in Texas, because of the requirements for law enforcement to do emergency detentions. That process is going to look a little different than it will in another state. But what we’re talking about is potentially using 988. For those responses that don’t require that level, that multi-disciplinary response team level. I think every crisis is urgent, so it’s hard to say, non-urgent, but sort of those situations that don’t rise to the level, that these teams can go out and address these populations in other ways. And I think we’re seeing that in a number of communities, that have sort of coordinated both, a response, using these sorts of teams, and have also allowed for a community response, a sort of a version of 988, sort of cahoots style model, where you send teams out, to address people prior to crisis, and before you need an MDR team, but I do think it’s going to look different in community, depending on what your specific situation.

Audience Question: How are other jurisdictions addressing the issue of lack of access to ER and acute beds, which have been the bottleneck that causes people to get sicker because there are no long-term residential treatment beds available in most jurisdictions?

John Snook: I think that has come up in a number of communities, even communities that have adopted really effective crisis response teams. We know that you can’t just solve for crisis. It would be like if we just had really good teams to respond and someone had a heart attack, we wonder why there were so many people struggling with cardiac conditions. That’s what we’re talking about here, what we want, and what we’re seeing with the significant amount of funding that’s coming from SAMHSA. And, again, these real expectations that we’re going to have certain levels of care as a baseline, is that we’re going to invest more in crisis stabilization units that we’re going to have places that we can take people. That they don’t need to end up in jails or they don’t need to end up in emergency rooms. And I think it makes both the funding that’s already coming out and then just the opportunity to see other communities doing it makes the advocacy easier in your community, because you aren’t having to re-invent the wheel. You could say, we want to do what is happening just across the border in that state, or what is happening in that city over there. And I think that’s the real opportunity because we know that having a good crisis response team and a good hotline doesn’t work if there’s nowhere to go. And we’ve done a number of sessions with this group, talking about divert to what. And that’s really what we’re talking about is really pressuring both SAMHSA, your state agencies, and your legislators to say you’re not done if you’ve created the 988. Now, you need to have answered that divert to what question.

Shannon Scully: Yeah, and John I just. You’re still on the spot right there and just kind of speaking from NAMI, obviously shares that perspective of individuals with mental health conditions in their families. 988 and building out crisis response is just an opportunity to get to people earlier. I mean, crises don’t just happen. When you all are running into a crisis, you’re seeing it at its most acute point. But, you know, when I talk to families, they frequently share and I’m sure you’ve heard this. Like, they knew the crisis was coming days or weeks before anyone came out and responded. And when they sought help, someone asked them, are they a danger to self or others? And if they couldn’t answer yes, well, nobody was able to help them. And so, I think, you know, what we’ve seen with some of these models of crisis response services is that we don’t necessarily have to wait for the most acute point in order to help someone. And I think if we start looking at how we can get to people sooner, we can think about how to engage them in Community Services. We can think about how to prevent them from getting to the point in which, we can really only serve them in a hospital setting. Serving everyone over the phone is not going to be for everyone, but I think we can start looking at how we can peel back and serve certain groups of people in a different way so that the most acute services and that are most acute support only needs to be given to people who need it. And so, it’s just almost like the distribution of the cases across the different types of supportive services. And so, we’re serving them more appropriately, instead of allowing everyone to get to that point where they all need acute inpatient services. Again, which is not appropriate for everyone. And we can get to people earlier. And I think people who are really leaning into this idea of kind of serving everyone are really finding that it does kind of help with that, redistribution of where we’re serving people in.

Audience Question: If you’re one of those on this webinar, 90% of agencies that are just now learning about 988, or just barely familiar with what’s going on. What would you recommend, just the next 2 or 3 steps that they take?

John Snook: I felt like I was jumping in on all of them. Goes back to my law school days. I was feeling bad. So, I’m happy to go so much better than mine. Anyway.

Shannon Scully: My always easy one is, is to contact your state or local NAMI. We have been talking to our NAMI field about this for years, if not months. You know, there’s a lot of this work, in terms of the legislation started happening a few years back and so our nominees are pretty familiar with it. So maybe starting off with your local/state NAMI. I’d also take a look at that legislative map that we put up. You can probably see a lot of states that have taken action, there’s probably a coordinating committee somewhere in there. Some states got planning grants to start thinking about the build-out of 988. And so, I’m going to look for that list, so I can drop it in the chat while John responds. If I don’t find it right away, I’ll make sure it gets sent out. But like I said, start with your local NAMI. A good place to find out information about what might be happening already in your state. And then just start figuring out, see if your state has a planning grant, see if your state has taken action on any of this legislation because that might be a really good point about how to get involved, or who’s already involved, and how to kind of get your voice there. Then, if you cannot find anything, and nothing has been happening, start having conversations. You guys are all leaders. This should not be information that is new to any leader because I know it’s been talked about for years. CIT first started in the 1980s. People know that there are alternatives to crisis response. They may just not know what the opportunity is right now. And so, take some of these resources that we’re providing to you, and maybe even, I mean, heck, take this PowerPoint and show up to some of your leadership. Or if you are a leader, start convening other leaders to start talking about how you or your community can kind of organize that. I’m going to look for that list. John, do you have any thoughts about what they might do?

John Snook: Well, a couple of the shortcuts that I have talked to a number of communities about is some of the things that you all have already done, the hard work to get set up. So, if you have CIT teams, you basically already had a lot of these conversations. If you’ve done sequential intercept mapping in your community. If you’ve just sort of engaged with the mental health system to talk about, what do we do in these crisis situations? And if I can be a little cynical, the reality is, we know too often, these systems get set up without this sort of responsibility. And what happens is the difficult patients, the patients that folks don’t want to see, fall through the cracks, and end up with law enforcement. And I think having law enforcement at the table in these conversations makes this much easier because you can ensure that there is accountability in the system. I think one of the reasons that we’ve seen Tucson become such a national model is because the Tucson community braided all of their various funding from state and from their various Medicaid, Medicare and really tied that to accountability, that you weren’t able to drop people off the roles, because they missed an appointment, or they know that their crisis was somehow not something that the crisis teams could respond to. Or they didn’t have the right insurance, which we’ve seen in a lot of states that you don’t get into the crisis team or the hospital, because you have the wrong insurance. So, one of the nice things is that Tucson has been so generous in their materials, and Margie Balfour if you don’t know her, happy to add some of their materials into the resources we share. They’ve proven the model for how this works, and if you’ve got Stepping Up in your community, if you have CIT in your community, you already know the folks to talk to you, you’ve got a shortcut here. So, it’s just bringing those resources together, bringing those models that we know work, and saying, here’s how it’s going to happen.