Cleveland behavioral care providers determine role after 988 hotline launch

Everyone knows how to call 911 in an emergency. However, not all crises are created equal, particularly when an individual’s mental health is at stake.

Bridging the Response Gap is the first national mental health crisis hotline. Launched in July, the new 988 system is designed to connect callers to trained local counsellors, ideally offering them precision behavioral services not always available through standard emergency care.

Cuyahoga County hospital systems and service coordinators are still determining their roles in this new care environment. Findings reported by FrontLine Service — a nonprofit behavioral health organization — demonstrate that 988 is at least in its early stages.

During the first Saturday the system was in operation, 51 of 188 calls to the FrontLine Service crisis center came from the 988 line. The center received an average of about 20 calls from the national line on a typical Saturday. In its first two weeks, 988 doubled the weekly average of inbound calls previously made to the National Suicide Prevention Hotline.

The 988 effort relies on the National Suicide Hotline, a network of 200 crisis centers located across the country. Locally, FrontLine Service operates a 24-hour suicide prevention, addiction crisis, and mental health number (216-623-6888) where those in need are referred to emergency or treatment options.

Current Cuyahoga County services include a mobile crisis team or behavioral specialist who accompanies police on calls. The program, funded by the county’s Alcohol, Drug and Mental Health Services (ADAMHS) board, is part of a fragmented system that too often leads to poor outcomes, noted Dr. Patrick Runnels, psychiatrist for university hospitals.

Typical emergency departments, for example, may refer someone with schizophrenia to an emergency room ill-equipped to handle such a delicate issue. Such a siled approach is why a more comprehensive mental health crisis management system is needed.

“Emergency rooms are designed for a physical health crisis,” Runnels said. “These environments are rigid, noisy and cluttered, and not linked to high-level behavioral services. You won’t get psychotherapy in the ER, because that’s not what it’s intended to do.”

MetroHealth child psychiatrist Dr. Raman Marwaha said Ohio’s 19 crisis agencies could send a first-response or behavioral health team to an emergency. As availability may vary by location, it is crucial to connect people in difficulty with a suitable response as quickly as possible.

In the future, the 988 system can be to mental health what 911 is to serious medical conditions or other life-threatening situations, Marwaha said.

“The overall goal of 988 is to have a crisis care response connecting people to community providers,” he said. “Do we need a stabilization center or a behavioral specialist coming with paramedics who have no other expertise to defuse someone in a mental health crisis?”

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