988 crisis line implementation (HB 1477)

Overview

In Washington, the legislature passed HB 1477 (E2SHB 1477), the Crisis Call Center Hubs and Crisis Services Act, to enhance and expand behavioral health crisis response and suicide prevention services for all people in Washington State. This bill established the Crisis Response improvement Strategy (CRIS) committee, which will develop recommendations to support implementation of the work in the bill.

As of July 16, 2022, the 988 dialing code became available nationally for call, text, or chat. Increased collaboration between crisis service providers aims to reduce the use of emergency room and police departments, while increasing options for those in crisis and improving system coordination around access to care.

On September 17, 2024, T-Mobile and Verizon enabled georouting for 988 Lifeline calls. Calls from these phone service providers will be routed to a 988 Lifeline crisis center based on the caller’s geographic location. Georouting uses only general location information to protect privacy and confidentiality for all callers. AT&T will enable georouting later in fall 2024, with smaller carriers to follow in the future. Until a carrier enables georouting, calls will still route by area code.

988 fast facts

• 988 is confidential, free, and available 24/7/365, connecting those experiencing a mental health, substance use, or suicidal crisis with trained crisis counselors. Those who are worried about a loved one who may need crisis support can also dial 988.
• Access to the 988 Lifeline crisis centers is available through every land line, cell phone, and voice-over internet devices in the United States.
• Live 988 services are available in English and Spanish and use Language Line Solutions to provide translation services in over 250 additional languages.
• Text and chat functions are currently available in English only.
• The 988 dialing code is available for call, text, and chat as of July 16, 2022. The original ten-digit number, 1-800-273-TALK (8255), is still active along with 988.
• The nationwide implementation of the 988 three-digit call, text, and chat line is just the first important step in re-imagining crisis support in the U.S.
• Washington’s Native and Strong Lifeline is now live –the first program of its kind in the nation dedicated to serving American Indian and Alaska Native people. Operated by Volunteers of America Western Washington (VOA), one of our state’s three 988 crisis centers, this line is available for people who call the 988 Suicide & Crisis Lifeline and is specifically for Washington’s American Indian and Alaska Native communities. Calls are answered by Native crisis counselors who are tribal members and descendants closely tied to their communities. Read the Department of Health (DOH) press release.
• For additional resources, please see NativeAndStrong.org and the National Suicide Prevention Lifeline.

What happens when you dial 988?

• When you dial 988, you will be connected to a 988 Lifeline crisis call center.
• You can call, text, or chat 988 on your cell phone, land line, or voice-over internet devices.
• The original 10-digit number is still active. You can dial either 1-800-273-TALK (8255) or 988.
• People contacting 988 are not required to provide any personal data to receive services. Calls may be monitored or recorded for quality assurance or training purposes. The network system has several safeguards to address concerns about privacy.
• There are no changes to dispatch for Designated Crisis Responders and mobile crisis response teams or the functions of any other regional crisis service.
• The 988 Lifeline crisis centers will continue to operate according to national standards and will connect with 911 services and regional crisis services as usual.
• Learn more about calling 988.

988 resources

• Georouting of calls to 988
• Georouting of calls to 988 for tribal partners
• 988 fast facts
• 988 fast facts (Spanish)
• What happens when you dial 988
• What happens when you dial 988 (Spanish)
• Native and Strong Lifeline
• Native and Strong Lifeline (Spanish)
• 988 for First responders

Crisis call centers

Washington has three 988 Lifeline crisis centers that answer calls from around the state.

• Volunteers of America of Western Washington
• Frontier Behavioral Health
• Crisis Connections

Your call will be directed to one of these crisis call centers based on your location. Calls are routed by area code. Crisis centers are currently hiring. If you are interested in a career helping people in crisis, apply for a job with an 988 Lifeline crisis center.

Additional legislation

E2SHB 1688 (Chap. 263, Laws of 2022) protects consumers from charges for out-of-network emergencies by addressing coverage of emergency services, including behavioral health emergencies. The law also aligns with the Washington State Balance Billing Protection Act and the federal No Surprises Act.

• View the behavioral health provider briefing document.

In 2023, the Washington Legislature passed House Bill (HB) 1134 to help implement the 988 Suicide & Crisis Lifeline. This bill expands crisis services in Washington by creating an endorsement for rapid response crisis teams, funding, and training for responders. Other key parts of the bill include working toward co-location to improve the transfer of mental health crisis calls made to 911. This allows 988 crisis counselors located at 911 dispatch sites to answer calls and provide support.

Mobile crisis response

Goals and overview: "Someone to respond"

A behavioral health crisis can be devastating, and even traumatic, for individuals, families, and communities. Although we cannot know when a crisis may occur, we can create a system that is agile and responsive when the need arises. We imagine a crisis system in Washington State that minimizes delays, reduces the use of law enforcement and emergency departments, and only looks to the most restrictive responses when no other safe resolution exists. A key component of our state’s crisis system must include mobile crisis response (MCR) teams that can be rapidly deployed to the location of the crisis and provide crisis assessment and stabilization services to anyone, anywhere, and at any time.

Program guide

The Mobile Crisis Response program guide was developed using SAMHSA’s best practice toolkit. The guide was created to standardize mobile crisis response programs while still giving regions the ability to make teams work for their unique areas and serves as the first step in standardizing mobile crisis response in the state. It serves as a clinical and operational guide for new and existing teams. Best practices direct teams to improving services and moving practices toward implementing SAMHSA’s best practices in Washington’s crisis system enhancements.

View the program guide.

Mobile crisis teams: future work and expansion

HCA is working to expand the crisis system to respond to an increase in calls to 988 in alignment with SAMSHA's best practices for crisis response. SAMHSA’s vision for comprehensive crisis care that is for anyone, anytime, anywhere and comprised of three key components; someone to call, someone to respond, and somewhere to go.

HCA continues to work with Behavioral health administrative service organizations (BH-ASOs), managed care organizations (MCOs), the Crisis Response Improvement (CRIS) committee and subcommittees, providers and stakeholders on the crisis system expansion to ensure adequate coverage for an equitable response statewide as calls to 988 increase. Building mobile crisis response teams to capacity in alignment with SAMHSA’s vision will reduce response times, reduce the likelihood of unnecessary contact with law enforcement or continued reliance on emergency responders like fire and EMS for behavioral health needs.

Adult mobile crisis response

Mobile crisis response (MCR) services offer voluntary community-based interventions to individuals in need wherever they are including at home, work, school, courts, or anywhere else in the community where the person is experiencing a crisis. The caller, not the provider, defines the crisis. These services are provided by two-person teams that include a behavioral health clinician and a certified peer counselor.

Key components of quality MCR services include:

• Triage/screening, including explicit screening for suicidality and risk of harm to others
• Responding without law enforcement accompaniment, unless special circumstances warrant inclusion, to support true justice system diversion
• Reducing the use of emergency departments
• Assessing for risk and opportunities to resolve the crisis in the least restrictive setting
• Developmentally appropriate de-escalation/resolution
• Peer support; including family peers or youth peers
• Coordination with medical and behavioral health services
• Crisis planning and follow up

Mobile response and stabilization services (MRSS) for youth and families

MRSS is a child and family specific intervention that recognizes the unique developmental needs of youth. Caregivers and youth are interconnected so when a youth is in crisis, the caregiver’s ability to respond to the crisis can be impacted. Supporting the caregiver’s response to the behavioral health need decreases the likelihood of calling 911, juvenile justice or child welfare involvement.

MRSS removes the word crisis, because in this comprehensive crisis continuum, youth can be screened during a crisis event and stabilized and connected to resources and supports after stabilization. This reduces barriers to ongoing clinical care, prevents return to the crisis phase, and improves outcomes.

In addition to the goals for all MCR services, MRSS is unique in the following areas:

• There is an initial response for 72 hours, and a separate stabilization phase for up to 14 days
• The crisis is defined by the youth, young adult, parent, or caregiver
• The team responds in person with peers within two hours and without law enforcement
• The team works with the youth and caregivers to reduce admissions to emergency departments (EDs) or adolescent inpatient units, and prevent unnecessary contact with law enforcement or child welfare
• Support and maintain youth in their living and community environment, reducing out of home placements
• Promote and support safe behavior in the home, schools, and community
• Ensure staff are trained in culturally responsive, developmentally appropriate trauma-informed care, de-escalation, safety planning for youth and families, and harm reduction
• Assist youth and families in identifying, accessing, and linking to natural and clinical supports
• Teams should provide robust outreach and engagement with youth system of care partners

HCA's crisis systems team (CST) is working to expand dedicated youth teams statewide and implement MRSS expansion through the ongoing work of HB 1477 and the CRIS committees.

Washington 988 Lifeline Crisis Center best practice guidelines

HCA and the Washington State Department of Health (DOH) collaborated to create these best practice guidelines as directed by HB 1477. The contact hubs will assist people who contact the 988 Lifeline by minimizing the use of emergency room services or law enforcement for people in crisis. We received feedback from both community partners and recommendations from the Crisis Response Improvement Strategy (CRIS) Committee to create the guidelines.

As of the publication date of this 988 Lifeline Crisis Center Best Practice Guidelines (December 2023), 988 contact hubs have not yet been designated. These guidelines serve to provide best practices to Washington’s current crisis centers (both 988 and Regional Crisis Lines) and will do the same for 988 contact hubs when they are designated in 2026. We are committed to implementing nationwide best practices for crisis care in alignment with SAMHSA’s National Guidelines for Behavioral Health crisis care.

*These best practice guidelines do not override any statutes or rules and are not meant to override any agency policies or clinical judgment. These best practice guidelines apply only to 988 Lifeline crisis centers contracted by the Department of Health (DOH) and Regional Crisis Lines contracted by Behavioral Health Administrative Service Organizations (BH-ASOs). The best practices are meant to be adopted by crisis centers and the future 988 contact hubs as training and infrastructure support and allow.

View the Washington 988 Lifeline Crisis Center best practice guidelines.

Additional resources

• SAMHSA 988 key messages
• SAMHSA 988 Partner Toolkit
• FCC resources
• Action Alliance messaging framework
• 988 next day appointment referral tool

News

• Washington to Invest More in 988 mental health crisis line
• One Year Later: 988 Answers over 65K calls in Washington
• The Washington Mental Health lifeline made for and by Native People
• Nation's first Native and Strong Lifeline Launches as part of 988
• HHS Awards Nearly $105 Million to States and Territories to Strengthen 988