Implementation of 988 line, community-based programs helping Texas address behavioral health crises

This article was published by State of Reform on March 18, 2024. Read the full article on State of Reform’s website. 

Behavioral health experts and community leaders met at the 2024 Texas State of Reform Health Policy Conference last month to discuss the state’s work to bolster its crisis response system.

After the Federal Trade Commission adopted rules mandating use of the 988 suicide crisis line, which launched in July 2022, states had to find ways to implement it into their behavioral health crisis continuums.

Reilly Webb, associate commissioner of mental health and substance abuse programs at the Texas Health and Human Services Commission (HHSC), said Texas’ line operators answer the third-highest number of 988 calls in the country, and its utilization has increased by about 70 percent since the 2022 fiscal year.

The premise of 988 is that everyone has somewhere to call, someone to talk to, and someplace to go when they are in crisis, Webb said.

“Our goal is to answer as many calls in the state of Texas as possible so that we prevent those calls from rolling over to a national backup center that may be outside of Texas,” Webb said. “Really, the point being that Texans can talk to Texans and make sure that they’re getting referrals, information, and services that are as close to their community as possible.”

Texas’ 988 line has an 86 percent answer rate, Webb said.

The majority of 988 calls are resolved over the phone, Webb said. And for those that aren’t, callers are connected to a crisis team. He also noted that many people call 911 while having a mental health emergency, so HHSC is trying to provide wraparound 911 services in order to best serve people in crisis.

When a law enforcement response is necessary, we have mental health deputies. They are trained in mental health first aid and crisis intervention… Last fiscal year alone we had 2,400 people served through mental health deputies, and only nine arrests.
— Webb

Josette Saxton, co-chair of the Texas Suicide Prevention Council, said community involvement is vital in the success of the 988 line, as the crisis continuum includes more than just a call center and referral. People need a place to go when necessary.

Saxton said the state needs to identify where the gaps are in these services, and find ways to fill them.

“How are we going to expand the resources that are available in the community to then turn into services?” Saxton said.

HHSC formed a 988 stakeholder coalition in order to provide feedback on 988 implementation, Saxton said. The coalition includes people from all aspects of the crisis continuum, including community organizations, and those who have been personally affected by suicide, she added.

Before the implementation of 988, various organizations were considering ways to improve Texas’ behavioral health crisis response, and they continue to serve the crisis continuum going forward.

Meadows Mental Health Policy Institute (MMHPI), for example, developed a program called the Rapid Integrated Behavioral Healthcare Team (RIGHT Care), which began in Dallas 2018.

“[RIGHT Care] was our state’s first true public safety alternative response program,” said B.J. Wagner, senior vice president of health and public safety at MMHPI.

RIGHT Care is a crisis response model that sends a specially-trained police officer, a paramedic, and a licensed mental health clinician to a behavioral health emergency call site.

Jon Fortune, deputy city manager of Dallas, said the program is a way for the city to provide its officers with specialized training on how to handle an emergency situation for someone experiencing a mental health crisis.

We have seen a dramatic decrease in the level of instances in which officers are having to use force in these particular situations and these call types, but also fewer arrests and fewer hospitalizations as a result.
— Fortune 

Wagner said that if law enforcement is needed during a crisis call because there is a risk to public safety, the situation still requires a compassionate response.

“Everybody, no matter how acute or how loud and big their mental health emergency may be, everybody can have an alternative response,” Wagner said.

Saxton also noted that law enforcement is not needed at every crisis call.

It shouldn’t become the default that suicide equals a law enforcement or critical emergency response. We need to do better, and we need to think about suicide prevention more comprehensively using a true public health approach.
— Saxton

The Centers for Disease Control and Prevention provides guidelines on how to use a public health approach for suicide prevention, which includes creating protective environments, promoting healthy peer connections, teaching coping and problem-solving skills, identifying at-risk individuals, and more.

Wagner also highlighted the need to continue the inclusion of mental health workers in crisis response. She added that Texas is one of the top-ranking states for loss of community workers to suicide.

Fortune said Dallas is considering different ways to support the city’s first responder personnel.

“We now have on-staff psychologists,” Fortune said. “We have emotional support dogs that go to the scene of a critical incident just to be there to give the members of our public safety team some level of support they’ve never had before.”

During the 87th legislative session, Texas lawmakers passed Senate Bill 64, which created the Texas Law Enforcement Peer Network (TLEPN), Wagner said.

TLEPN is an anonymous application that helps Texas police officers find peer support and alternative resources when they are experiencing a crisis of their own.

When we don’t have a healthy workforce, we can’t provide really solid community services.
— Wagner

Moving forward, Webb said Texas needs to work on implementing programs approved by the legislature, and collect data on those programs so lawmakers know what is working. He noted that more people need help than ever before.

“We know that there are gaps in our services across the state,” Webb said. “We know that we need to continue to support our behavioral health workforce who’ve got caseloads that are higher than they ever have been before.”