National 988 Crisis Line Goes Live, NJ Works toward a Comprehensive 988 Crisis Response System

Beginning Saturday, July 16^th, everyone across the country, regardless of where they are located, will be able to simply dial three numbers, 988, to reach the 988 Suicide and Crisis Lifeline (Lifeline), previously operating as the National Suicide Prevention Lifeline. (The existing Lifeline number, 1-800-273-8255, will continue to be available.)

To reach the Lifeline, people can call or text 988 or chat at 988lifeline.org

The 988 Lifeline is there for those experiencing mental health-related or suicidal crises, and those looking to help loved ones through crises.

Background: Federal and State Legislation and Funding
The federal law to establish the three-digit crisis line number was passed in 2020. On June 30, 2022, Governor Murphy signed into law P.L.2022, c.35, which establishes the 988 line in New Jersey and goes further to provide requirements for building a comprehensive crisis response system with mobile crisis teams and crisis stabilization services across the state.

In the FY2023 budget that began on July 1^st, $12.8 million in state funds is included to support hotline call centers in New Jersey. New Jersey recently received $2.5 million in federal funding for the same purpose. As of early June, the Division of Mental Health and Addiction Services (DMHAS) had distributed $3.2 million to three of New Jersey's five call centers.

Additionally, the Legislature added $16 million to the FY2023 budget to fund mobile crisis teams throughout the state. Last year, DMHAS stated that portions of the supplemental increases to both the Mental Health Block Grant and Substance Abuse Prevention and Treatment Block Grant (in both the December 2020 federal Omnibus bill and American Rescue Plan) would be used to establish crisis stabilization centers across New Jersey. Current expectations are for nine centers, some with specialty services for individuals with intellectual and developmental disabilities. Crisis stabilization centers will be places where individuals can walk in or be brought voluntarily by mobile crisis teams, law enforcement or loved ones. They will include medical staff and provide on-site crisis de-escalation services for up to 23 hours, will engage people with follow-up care and connect them to services.

A Comprehensive Crisis Continuum of Care
The building of a comprehensive crisis system in New Jersey and full implementation of 988 interoperability among call centers, stabilization centers, mobile crisis teams, screening centers, community-based providers, law enforcement and other entities will take several years. It will build upon the many well-established, life-saving services already operating in New Jersey such as Early Intervention Support Services (EISS) programs, Psychiatric Emergency Screening Services (PESS, aka Screening Centers) and Children's' Mobile Response and Stabilization Services, all of which are present in every New Jersey county. EISS programs are the equivalent of urgent care centers for mental health. The crisis continuum will also rely on Certified Community Behavioral Health Clinics (CCBHCs) (comprehensive integrated care programs that provide crisis response services to their clients), respite programs, and other community-based mental health and substance use treatment models, including a multitude of innovative programs developed locally that connect mental health professionals to local law enforcement.

New mobile crisis teams and stabilization centers, as well as growing relationships and systems interoperability among all new and existing components of the crisis continuum of care, will help to keep individuals in the community and out of hospitals and the criminal justice system, and to connect and engage individuals in timely, appropriate behavioral health services.

Research shows that approximately 80% of crisis calls are resolved on the phone and 14% are resolved in the field - meeting each person where they are. The remaining 6% are served by stabilization centers, hospital screening centers and other types of acute care.

Crisis Assessment Response and Enhanced Services (CARES) for Individuals with IDD
1-888-393-3007, 24 hours a day, 7 days a week

In addition to the new 988 number discussed above, there is an important resource that is specific to helping individuals with intellectual and developmental disabilities (IDD) who experience a mental health or behavioral health crisis. It is called the Crisis Assessment Response and Enhanced Services program (CARES). This program provides crisis response and stabilization services for a period of up to 120 days for adults (age 21 and older) with IDD, and there is no fee for these services.

CARES staff are located in regional offices and will respond anywhere in New Jersey to assist individuals with IDD who experience mental health or behavioral crises. CARES can prevent unnecessary hospitalizations by helping manage behavioral crises in place, and assisting individuals, family members and professional staff to obtain needed expertise to support people in crisis.

CARES works with individuals, their families, staff and providers by offering:

· Direct response at the time of crisis in family homes, residential placements, day programs and emergency rooms

· Consultations at psychiatric inpatient units

· Training and technical support to families, guardians, and both IDD and mental health service provider

· Connection with ongoing support resources

988 Marketing Resources and Additional Information

In June, DMHAS provided its vision for 988, along with its history and a status report inthis presentation. The New Jersey Department of Human Services has created this988 tool kitwith promotional materials to help spread the word about 988. The tool kit includes in English and Spanish: social media posts and graphics, flyers, a brochure and a wallet card. We hope you will share these materials to help raise public awareness about 988.

The Substance Abuse and Mental Health Services Administration's (SAMHSA's) resource page, designed to help states, territories, Tribes, and mental health and substance use disorder professionals understand the background, history, funding opportunities, and implementation resources for strengthening suicide prevention and mental health crisis services, also includes a marketing toolkit with social media shareables and other materials. SAMHSA and the national 988 Lifeline administrator, Vibrant Emotional Health, also have this page with 988 background information, mental health resources for specific populations and situations, a section on "What Happens When You Call the Lifeline", a link to the 988 chat, and more.

Ongoing Advocacy Is Needed

It is critical that all components of New Jersey's 988 crisis response system are fully funded and operational, as we work to build a comprehensive system of voluntary behavioral health crisis care in our state. It is anticipated that the volume of calls after 988 goes live will increase significantly, putting pressure on a system that has historically been unable to answer all calls. Given the current workforce shortage, ever-increasing demand for services during COVID and the planned expansion of not only the various crisis system components mentioned herein, but also other mental health and substance use treatment services, maintaining adequate response capacity is both an immediate and long-term challenge.

We encourage all NJAMHAA members and other stakeholders to join us in contributing their voices to shaping New Jersey's crisis response system and advocating to ensure its full implementation and sustainability!

Click here or here to read more about the 988 Crisis Response System in articles for which Mary Abrams, NJAMHAA's Senior Health Policy Analyst, was interviewed.