What mental health experts are saying about the 988 crisis line and its future

On June 5, 2017, Zachary Bear Heels died in police custody in Omaha, Nebraska.

Bear Heels, 29, had bipolar disorder and schizophrenia. He was  arrested, tased 12 times, and punched in the head after allegedly refusing to leave a gas station during a delusional episode.

Bear Heels died of excited delirium, physical struggle, physical restraint and use of a stun gun, according to officials cited by the Associated Press. There was no video recording of the police response.

If the national mental health crisis hotline, 988, had been up and running when Bear Heels was in crisis, said psychologist Anitra Warrior, the outcome may have been very different.

“There was no interaction, no real opportunity of visiting with this individual,” said Warrior, who is based in Nebraska with Morningstar Counseling, which specializes in serving the Native American community. “We’ve had such horrible interactions with police in general for our population specifically that having more things like this happen creates even more of a barrier for our people.”

Warrior and half a dozen other experts on the effort to decriminalize mental illness spoke to student reporters from Youthcast Media Group (YMG) at the 3rd Annual Sozosei Foundation Summit in December about incidents like the death of Bear Heels and the national and local rollout of the 988 crisis line. Their responses have been lightly edited for length and clarity.

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988 launched nationally in July. How do you think the rollout has gone so far?

"We're slowly getting more people aware of what 988 is and then what it's not. For our community, we're trying our best to let people know that yes, it is ... a true one-for-one replacement for the Suicide Lifeline and it will become even more of a true mobile crisis response for those in mental health emergencies." – Tansy McNulty, CEO of 1M4 (1 Million Madly Motivated Moms)

"Some positives have been that 988 has brought about more visibility of mental and behavioral disorders and helped destigmatize them. However, getting more awareness of 988 and optimizing its widespread use is a long process that will take time." – Jonah Cunningham, CEO of National Association of County Behavioral Health and Developmental Disabilities/National Association for Rural Mental Health

What about 988 is working best and why?

988 "is easily memorizable and has quick responses. It has cut down on wait times and more people are being served as soon as they reach out. It also helps that the responses are culturally competent and so the circumstances of the people being called are understood, this is in no doubt a result of the community organization partnerships 988 has fostered." – McNulty 

"988 has had a lot of success in the early adopter states like Utah. It is hard to compare them to other states because the goals of the states are different and so success cannot be measured by just one metric." – Cunningham 

What has been the biggest challenge in making 988 successful?

"There has been a recent workforce shortage, which has also impacted call centers and the number of people answering calls and the time it takes them to answer those calls. Lack of sustainable funding also plays a factor. There needs to be constant resources going toward 988 in order to maintain it." – Cunningham

"A lot of the issues that we see around mental health services is the stigma that's associated with receiving them. African Americans have the highest number of mental health conditions in the United States of America, but they are the least likely to get service, mainly because of the stigma that's associated. ... 

"And so when you are in communities that are marginalized and under-resourced, it's really difficult to get someone to come in to services, when the person they want to talk to does not look like them." – Tiffany Russell, chief officer of Crisis and Justice Partnerships, Substance Abuse and Mental Health Services Administration (SAMHSA) 988 and Crisis Behavioral Health Coordinating Office

What major change would you like to see to improve access to mental health crisis services?

"I would like to see more regional services being offered that are specific to our tribal communities as well as more of our clinics. I often talk about decolonizing behavioral health — what this means is we’re going to remove all the institutional pieces of what health care looks like and really focus on the community and who we’re serving. This means we’ll come out of our offices, this means we’ll be part of the community, this means you’ll have increased access to us, and the relationship will be more of a relative than a healthcare provider.

"This does not have to be Native-specific, because of the intimate relationship between the health care provider and those they’re serving, this could be put in place across the country." – Warrior

"There needs to be more brick and mortar associated with 988. Without supportive housing it will be difficult for any progress made to stick. Supportive housing provides the base and structure to heal and grow, with possessions of your own making a huge difference. This is especially important as people with mental disabilities have a harder time maintaining housing. – Nancy McGraw, chief development officer of the Corporation for Supportive Housing

"Our crisis response and treatments and our resources should reflect the fact that it's not an individual by themselves that is in the crisis. It's a family, it's a community, maybe a school ... everyone that is connected to that individual is impacted by that individual's crisis."  – H. Jean Wright, deputy commissioner, city of Philadelphia's Department of Behavioral Health and Intellectual disAbility Services

What gives you hope for the future of mental health crisis care?

"The young Gen Zers — y'all are so dope. You don't have any problem telling us about ourselves. You're very honest, you're very open, very transparent (and) direct. So honestly, that gives me the most hope for the next generation." – McNulty

"When I first started, no one wanted to talk about behavioral health. It was underfunded and they didn't want to talk about it. Policymakers didn't see it as a winning issue. That's changed over the last, let's say, two to five years." – Cunningham  

"During COVID many people experienced struggles with their own mental health, something that changed the previous widespread narrative of mental health. There is now a new awareness of the importance of mental health services and funding is being put into the field, which is particularly encouraging as funding drives these operations. Overall, there is now more mainstream national discussion about mental health and structural racism, which is helping destigmatize mental illness, especially in communities of color." – Dr. Sosunmolu Shoyinka, chief medical officer of Philadelphia’s DBHIDS:

Oyewumi Oyeniyi is a junior at Cristo Rey Philadelphia High School and attended the Sozosei Foundation Summit as a student reporter with Youthcast Media Group, a nonprofit that trains high school students from under-resourced communities in journalism. YMG’s content and programs director, former (Cleveland) Plain Dealer health reporter Brie Zeltner, contributed to this report.