In a new report, experts weigh in on how 988 and 911 can better work together to ensure that people in crisis get the help they need.
As the 988 Suicide and Crisis Lifeline approaches its fourth anniversary this July, it is in a precarious situation — trying to balance cuts made by the Trump administration to the funding and staff of the federal department that runs it at the same that calls to the hotline continue to grow.
The 988 hotline was created as an alternative to 911 to provide a service for people needing help in a mental health crisis that didn’t require a police response.
Last month, in a new report, experts in crisis response weighed in with their advice on how 988 and 911 can interact better to ensure that no matter which number is dialed, people in crisis get the help they need.
The key is communication, said researchers at the University of Chicago Health Lab, which released the report, “Voices from the Field: A Report on 911 and 988 Interoperability.”
“The 988 and 911 systems and their respective leaders and staff need to be in communication to understand community needs, build trust across hotlines as well as with communities, and provide the best service possible for those in need,” Sarah Scaffidi, senior research manager at the Health Lab, told MindSite News. “Trust is also absolutely critical, and communication goes a long way towards building it.”
The report broke down the problems into three main categories: human, systemic and technological. The authors offer insights and suggestions for improvements based on the experiences of a panel of crisis-response experts they interviewed.
“Despite being a valuable resource, there is a lack of public education about 988 and how it is differentiated from 911 in the minds of many members of the public,” Jessica Gimeno, a mental health policy analyst at Access Living, a Chicago-based nonprofit focused on disability and civil rights, told the researchers. “There is confusion about the distinctions between hotlines: which handle acute crises, which are warm lines and which provide general support. Clarifying these can significantly impact how people seek help and trust these services.”
The experts stress the importance of building trust not just between the two hotlines, but also the communities they are attempting to serve. Many people in different communities including Black, Native American and LGBTQIA people, don’t trust either 988 or 911 in a crisis.
Adding another challenge, 911 and 988 dispatchers may not trust each other and fear liability if they transfer the call to the other and something bad happens. Staff at 988 are reluctant to transfer calls to 911, fearing an armed response may lead to injury or arrest, the experts said.
Tiffany Patton-Burnside was the senior director of crisis services at the Chicago Department of Public Health in September 2021 when mobile crisis teams began heading out in vans to the scene of mental health emergencies as part of the new CARE program. It took time and effort to build trust between the multiple agencies involved, she said.
“It has taken a long time to indoctrinate our program into the call center, even with the clinicians there every day to facilitate trust in the work we’re doing as an outside entity and to give us more information,” she says in the report.
In Washington state, Valley Communications 911 and Crisis Connections, a crisis support network, negotiated a pilot program that embeds 988 professionals in the 911 communications center. Members from both organizations told researchers they built a strong relationship through commitment to the goal and frequent meetings.
“It takes time to build relationships and trust. Go slow and smart and be intentional. Meet in different forums, build camaraderie and shared vision,” says Lora Ueland, former executive director of Valley Communications 911, in the report.
On the systemic level, the report’s authors stress the need for improved staffing and training for both workforces to avoid burnout. Many 911 call centers already operate at less than 50% of optimal staffing levels, according to data collected by the Health Lab.
While there were fears that the 988 hotline would draw dispatchers from the 911 workforce, that wasn’t the experience of those working in the industry.
One point of consensus was the need to address inconsistent training for 988 phone counselors. Some are hired without educational prerequisites. Some centers run their counselors through real 988 calls or extensive role play. Others receive no training before their first call.
“Crisis counselors are often recruited straight out of school or as volunteers and provided inadequate training to deal with life or death using zero physical cues,” one counselor told Crisis Crowd Founder Dan Fichter, who released a survey of 988 crisis counselors in 2024. “Throwing them to the sharks in crisis is unfair, not trauma-informed and downright dangerous.”
Burnout is especially high among 911 dispatchers, who are routinely exposed to primary and secondary trauma. A 2022 survey found that 911 dispatchers have significantly higher rates of depression, anxiety, PTSD, and suicidal ideation than law enforcement and firefighters, all of whom have higher rates of distress than the general public.
High levels of distress were also expressed by 988 phone counselors who responded to Fichter’s survey in 2023. Unlike 911 professionals, they are often answering calls exclusively from people experiencing a mental health crisis or those trying to help people in crisis.
“Most of the co-workers I started with left well before I did, and a number of crisis counselors I worked with experienced PTSD or severe burnout,” one counselor told Fichter.
The technology also presents challenges, including locating 988 callers when necessary; an inability to transfer some calls from 988 to 911 and vice versa; and privacy and statutory issues with data sharing.
Unlike people who call 911, callers to 988 aren’t tracked to a specific location to protect their privacy and to enable the service to roll out more quickly. With their location unknown, callers may feel more comfortable being open and asking for help.
Also, building a geolocation system like the 911 system, which was built to support landlines, not cell phones, is complex, expensive and time-consuming, according to the report.
Initially, this meant 988 calls were routed to call centers based on the area code of the phone, even if the caller was in a different state. In October 2024, the Federal Communications Commission created a rule requiring 988 calls to instead be georouted to the closest call center. In theory, this should improve access to local services for those calling, but more research is needed, according to the report.
While some systems can seamlessly transfer calls between 911 and 988, others require the caller to hang up and dial the other hotline. Some call centers offer their own unique solutions to this problem.
In Tucson, Arizona, fire, police and 988 all operate out of the same center. Call takers are also equipped with a speed dial to smoothly initiate a call transfer to others on staff. In Colorado, 911 operators can press a button to alert 988 calltakers that a transfer is being initiated.
To learn more about how the two systems can better collaborate, MindSite News reached out to the report authors with a few questions.
How do the various players involved in these systems — 911 and 988 dispatchers, police responders and mental health crisis responders — differ from each other? And how do the experts you consulted, the Inform988 Community of Practice, view the question of having callers’ phones be trackable via geolocation technology?
A common misconception is that 911 and law enforcement are interchangeable, when in reality they are two distinct functions. 911 professionals are tasked with gathering information to determine if an incident can be resolved over the phone, or if a police, fire, medical, or alternative response is needed.
One key difference between 911 and 988 is that the former hotline tracks the caller’s precise location while the latter does not, meaning that an in-person response to a 988 call cannot be as readily dispatched without the caller sharing their location.
The vast majority of calls to 988 are handled over the phone, but for the less than 2% that do involve deploying emergency services (often police), the (experts in the) Inform988 Community of Practice agreed that consent is key.
There is not a universal policy on gaining caller consent, but COPE members agreed that 988 call takers should clearly explain why they want to transfer the call. If the caller declines, then the call taker would not make the transfer unless they are required to by policy (i.e., if the caller is at imminent risk of harm to self or others.)
This is another area where communication and trust come into play – if 988 and 911 trust one another, and if community members trust that practitioners at both hotlines have their safety and well-being at heart, that provides the groundwork for both systems to function most effectively.
The report notes the importance of state advisory boards for crisis response systems. Why are these advisory boards so important and what can be done to ensure more states have them in place?
Each 988 and 911 center operates within its own local context, and state advisory boards can offer guidance, share information and resources, and develop standards for, among other things, coordination between 911 and 988, as has been done in California and Utah.
Gathering the relevant information can have a steep up-front cost, so having a statewide office tasked with that and disseminating it throughout the state can be very helpful in allowing each center to function at its best.
State level governing bodies can look at the existing advisory boards to learn how they came to be, what they have accomplished, and how they might be adapted to new states.
What can be done to ensure 988 can survive as long as 911 has?
As the crisis response landscape shifts and expands, the entities that provide the most needed services to people seeking relief from distress should be the ones to survive. More concretely, coordination between 988 and 911 can go a long way in ensuring the longevity of both.
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