This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

On July 16, the national 988 Suicide and Crisis Lifeline began operation nationwide – and Michigan joined the nation in implementing an ambitious, transformative vision for mental health crisis services.

Operated through the existing National Suicide Prevention Lifeline, 988 has been hailed by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) as a first step toward overhauling the U.S. crisis care system. 

"It's a pretty exciting time to have that easy three-digit number to remember," says Dr. Debra Pinals, Michigan Department of Health and Human Services (MDHHS) medical director for behavioral health and forensic programs. 

Suicide is among the leading causes of death for Americans ages 10-64, and in 2021 the National Suicide Prevention Lifeline received 3.6 million calls, chats, and texts. SAMHSA expects that number to more than double during the first full year after 988 goes live. The former National Suicide Prevention Lifeline number, (800) 273-TALK (8255), as well as the former Veterans Crisis Line number, will now route to 988. 

"When people are in crisis, we don't want them to be wondering where to call or who to call. Just like 911 has become a very well-known household number, 988 presumably will be the same," Pinals says. "I think it will help Michiganders having that additional line where there are trained counselors available to speak to people in distress."

Pinals notes that Michigan has been ahead of other states when it comes to funding mental health crisis services because the state had already established the Michigan Crisis and Access Line (MiCAL). To implement that system, the state contracted with a call center to respond to calls from across the state.

However, there's still ample work to do to implement the new service. The Biden administration has invested $432 million to scale mental health crisis centers' capacity, but individual states must enact their own legislation to change the way their communities respond to people experiencing mental health crisis and create funding for the call centers. Model state legislation is available for states to address the former. According to the National Alliance on Mental Illness (NAMI), in addition to enacting legislation that provides a total of $8 million to initially fund 988, pending Michigan legislation proposes a 55-cent monthly fee be added to residents' phone bills to cover ongoing costs. (Michiganders currently pay 25 cents a month for 911 service.)

Every call answered

988 calls throughout Michigan are fielded by two crisis services agencies: Oakland County-based Common Ground and Kalamazoo-based Gryphon Place. The only exceptions are Kent and Macomb counties, whose community mental health (CMH) agencies handle calls directly.
Kristin Spykerman.
"The reason that [Kent County's CMH] Network 180 was selected, as well as Macomb County CMH, is because we are the only two CMHs in the state that had already been answering calls for the National Suicide Prevention Lifeline," says Kristin Spykerman, chief clinical officer for Network 180. "We already had 24/7 call centers."

Network 180 also has a mobile crisis response unit that responds to mental health emergencies in Kent County.

"We have access to local resources and expertise about what locally is available for people if they need to get connected to any kind of behavioral health services," Spykerman says. "The mobile crisis response team serves adults, children, and families. It was created to be a diversion from having to call 911 or take an individual to the emergency department."

In Kent County, Arbor Circle will most likely be one of the agencies that 988 callers are referred to. Because connecting large numbers of callers to mental health resources is a huge task – and staffing shortages are already causing delays in mental health care – Arbor Circle President and CEO Kristin Gietzen has concerns that the initial 988 roll-out may encounter snags. But she encourages people to use the system, saying it's better to "take some action than not to take action."
Kristin Gietzen.
"Accessing the pathways into the mental health system is complicated. Hopefully, 988 will help streamline that in the same way that 911 helped streamline emergency calls with law enforcement," she says. "We forget that the rollout of 911 was complicated and took time to settle in. I think that that will be the same case with 988. Anything that we can do to help streamline access to the [mental health] system is important, worth the effort, and worth the bumps in the road."

With 988 available nationwide, it is up to states to ensure there are crisis services — 24/7 local crisis call centers, mobile crisis teams, and crisis stabilization options — so 988 callers receive the help they need. Michigan is already in the process of rolling out these crisis services. MiCAL was the first part of a three-part plan that also includes setting up mobile crisis first response as well as brick-and-mortar crisis stabilization units.

The crisis stabilization units will provide a location where people experiencing urgent mental health or substance abuse crises can go. Like a hospital emergency room, they will be open 24 hours a day, seven days a week. Unlike a hospital ER, the care will be trauma-focused and tailored to people with behavioral health needs.

Changing Michigan's mental health landscape

Kevin Fischer, executive director of NAMI's Michigan chapter, believes 988 will change Michigan's mental health and public safety landscape in a positive way, especially if people experiencing emotional distress or substance use disorders reach out before their issues reach a crisis level.

"I've always been a proponent of being more proactive rather than reactive to mental illness," Fischer says. "Let's not wait until a crisis to act. It's not just a crisis line. It makes behavioral health care resources available, proactively. That can improve the quality of lives and save lives."
Kevin Fischer.
Fischer notes that the line could also improve public safety by reducing the number of 911 calls and interactions with law enforcement. A Washington Post database of fatal U.S. shootings by on-duty police officers shows that more than one in five people fatally shot by police have mental illnesses.

NAMI has long offered its own help line, but Fischer expects that it will receive fewer calls as 988 gains momentum. That's a good thing because NAMI is a provider of education and support programs, not a direct care provider. 
 
"We have long been one of the leading resources for access to behavioral health care in Michigan," Fischer says. "Anybody who's aware of someone who is facing a behavioral health challenge, whether it's mental illness, substance use disorder, anything like that, please use 988 proactively. Don't wait until crisis. The earlier we intervene, the better."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Kevin Fischer photo by Doug Coombe. Kristin Gietzen photo by Bud Kibby. Kristina Spykerman and call center images courtesy of Network 180. Debra Pinals photo courtesy of MDHHS.