988 is here: it’s time to respond

Healthcare Design for a Comprehensive Continuum of Care

By Sabah Mohammed

The national Suicide and Crisis Lifeline, 988, went live on July 16. We now have a new dedicated national telephone number that we can call or text anytime when a mental-health crisis arises for ourselves, our loved ones, or people in our communities.

A "crisis" is the most acute stage of distress for individuals with behavioral health needs.

Although the hotline connects callers directly to the National Suicide Prevention Lifeline, it is a resource for a broad spectrum of people experiencing crises related to “behavioral health,” a term that includes mental health disorders (MHD) and substance-use disorders (SUD) as well as the risk of suicide or self-harm.

Last week, my colleagues Marvina Williams and Lauren Neefe wrote about the launch of the hotline and the behavioral-health design solutions that Perkins&Will is implementing at our clients’ Emergency Departments (EDs). As an E. Todd Wheeler Health Fellow, I spent the past year researching the role of the built environment in responding to acute behavioral-health crises. With the launch of the hotline this week, I am paying close attention to how it impacts healthcare facilities.

Federal health officials estimate the hotline may receive up to 12 million calls and texts in its first year. Prior research has projected that 80% of this call volume can be resolved over the phone without dispatching mobile crisis teams, law enforcement, or emergency medical services. However, the remaining 20% represents a patient population that requires extremely high acuity care.

Even if the hotline is successful in shifting overreliance on law enforcement, it will overwhelm health systems, particularly emergency departments. Experts argue that demand for acute behavioral health services will outstrip supply as there are not enough beds at appropriate levels of care to respond to this surge in demand.

The new hotline will go a long way in diverting behavioral cases away from Emergency Departments.

Responders on the ground are bracing themselves. According to a Rand Corp. report, more than half of the public health officials charged with launching 988 said they felt unprepared without the necessary staffing or infrastructure resources to handle the rollout.

For many advocates and leaders, the hotline launch serves as an inflection point. They are seizing this opportunity to reimagine our “crisis care continuum” and get to better, safer crisis care, starting at the front door.

The ideal crisis care continuum will require the infrastructure investment our public health officials and care providers are calling for in order to increase our collective capacity to respond. Ultimately, crisis services must be designed to serve anyone, anywhere, at any time. This translates into better care, better health outcomes, and lower costs for the community. To achieve this ideal, our health systems need support to address the following priorities:

  • expanding mobile crisis units
  • ensuring collaboration with other emergency response systems
  • integrating flexible, adaptable, care-appropriate ED spaces
  • strengthening community-based care, residential crisis options, and inpatient care
  • building post-ED aftercare, such as wraparound clinics

The new hotline is a victory, but the United States needs a thoughtful comprehensive response to behavioral-health and crisis-care infrastructure across the comprehensive care continuum. Technology, process improvement, training, and operational policies are all critical leverage points in the care we provide to people in crisis. Changes to the built environment are a critical leverage point, too.

Perkins&Will has deep expertise working with healthcare clients who integrate behavioral health in their services and have designed for behavioral health at a range of scales. We also partner with our clients to understand their organization and implement process improvement and operational planning. In other words, we design for behavioral health across the whole continuum of care. The spaces at left are a window into what our healthcare future could look like.

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