In 2020, Congress passed the National Suicide Hotline Designation Act designating 9-8-8 as the new dialing code for behavioral health emergencies, to be operated through the existing National Suicide Prevention Lifeline (NSPL) network of local centers, to be effective July 2022. 988 calls in Illinois will be answered by Lifeline Call Centers (LCC) that must be staffed, trained, and monitored to assure compliance with federal standards and state contractual requirements. Federal guidance for 988 implementation includes consideration for public messaging for 988, funding mechanisms for sustainability of the service, standards of care and operation and linkages necessary to fully address the needs of the crisis caller. The Division of Mental Health (DMH) has been charged with implementing this law in Illinois.
The call centers are intended to be part of a system of emergency response and a continuum of “crisis care for anyone, anywhere and anytime.” These services are characterized by the U. S. Substance Abuse and Mental Health Services Administration (SAMHSA) as “someone to talk to” (crisis lines accepting all calls, texts and chats, and dispatching support if required, based on the assessed need of the caller), “someone to respond” (mobile crisis teams dispatched to wherever the need is in the community), and “somewhere to go,” (crisis receiving and stabilization facilities that serve everyone that comes through their doors from all referral sources).
Someone to call
In Illinois, “someone to talk to” refers to the six existing Lifeline calls centers (LCCs). These LCCs have been contracted with the NSPL to provide suicide prevention and response. Under the 988 implementation, they will respond to a wider variety of mental and behavioral health crisis situations. With DMH funding (Program 400), PATH Inc of Bloomington has been designated to provide 24/7 NSPL hotline service to areas of Illinois not currently covered by a local LCC, as well as backup service and text and chat, an increasingly important way to connect to young people especially vulnerable to mental health crises. With recently announced support from SAMHSA (DHM Program 401), Illinois LCCs will expand to full 24/7 local service.
Someone to respond
For the last year, 68 providers across Illinois have been building their capacity to provide emergency mobile crisis response (MCR). Many of these local agencies already provide crisis lines, assessment and stabilization, and referral services. With funding from DMH (Program 590), they are expanding their mobile crisis response services, including two-person teams comprised of a crisis counselor and an engagement specialist -- a trained person with lived experience of recovery.
Somewhere to go
The state has acknowledged that expansion of 988 and mobile crisis response coverage are just the first major initiatives in a larger vision to strengthen the crisis safety net for persons experiencing behavioral health crises. To that end, DMH is funding 21 “Living Rooms” to break the cycle of psychiatric hospitalization and 11 Crisis Residential Programs to provide a transition from specialized to community care. These programs are currently limited in scope and availability, but represent the initial effort to provide this crucial, stabilizing element of the crisis care continuum.
An alternative response
These components of the crisis care system are being developed within a larger understanding that many mental health crises require an alternative to a response by law enforcement. In 2021, Governor J.B. Pritzker signed into law the Community Emergency Services and Support Act (CESSA). CESSA's goal is to allow mental health providers to serve as initial responders in situations where an individual presents with a behavioral health crisis, whenever capacity exists, and is legally and medically appropriate. The work of CESSA is to determine, with significant input from stakeholders, the appropriate responders -- behavioral health mobile crisis teams, emergency medical technicians (EMT) or law enforcement -- given the specific circumstances associated with the crisis call. The primary entry points into this “behavioral health first response” will be 911, managed by 180 Public Safety Answering Points (PSAPS) in the state, and eventually 988. The behavioral health responders for these crises will be the 68 Mobile Crisis Response providers (MCR) across the state.
In Illinois, CESSA requires coordination of these efforts across three different systems in state government: Mental Health (IDHS-DMH), Public Health (IDPH) and Law Enforcement (the 911 Administrator, through the Illinois State Police (ISP)). Both 988 and CESSA require the involvement of significant stakeholder input via statewide advisory committees, multiple subject matter subcommittees and in the case of CESSA, no less than 11 regional advisory committees. The CESSA Statewide Advisory Committee is set to convene in May, with the regional sub-committees to follow. Recommendations from the CESSA process are due in January 2023.
For more information:
DMH Contact: Lee Ann Reinert, Deputy Director of Policy, Planning and Innovation lee.reinert@illlinois.gov