Report suggests special efforts needed to allow 988 and 911 systems to work in concert

Getting the 988 and 911 emergency telephone systems to work in concert requires detailed planning and close cooperation, and such efforts may benefit from having one or two people at the local level who act as champions for interoperability, according to a new RAND report titled "The Road to 988/911 Interoperability: Three Case Studies on Call Transfer, Colocation, and Community Response."

In order to make sure callers are routed to the appropriate system, efforts need to involve representatives from both 988 and 911 call centers, law enforcement, mobile crisis teams, peer support specialists, behavioral health specialists, and people who have lived experience with crisis services, researchers say.

Local champions can aid such efforts by establishing priorities, convening local stakeholders, brokering difficult conversations and charting an effective path toward interoperability.

"The 911 system essentially remains as the default people call when there is an emergency, even if there is a mental health component to the crisis," said Stephanie Holliday, lead author of the report and a senior behavior scientist at RAND, a nonprofit research organization. "It's critical that the 911 and 988 systems work together so that each call is handled appropriately."

In the summer of 2022, the 988 national mental health emergency hotline launched, replacing what was known as the National Suicide Prevention Lifeline. The shift to 988 was intended to create an easy-to-market and easy-to-remember number that could be used by people experiencing any type of a mental health crises, in addition to suicide.

Although use of the 988 mental health hotline has risen sharply since its debut, several surveys show that many people are unaware of the service and are uncertain when to use it.

Without knowledge of 988, it is likely that many people will call 911 when faced with a mental health emergency. In addition, although about 95% of the calls to many 988 call centers are resolved over the telephone, there are situations that may require a public safety response, researchers say.

"For the system to work to its full potential, the two systems need to be interoperable—to work together to make sure the proper resources are used, regardless of which number a caller uses," Holliday said.

Some states have begun to adopt legislation to require coordination between 911 and 988 call centers. But there are many hurdles to overcome, including differences in culture and in organizational structure (911 often is organized at the local level, while 988 tends to be regional).

In order to learn how to best develop interoperability between 911 and 988 systems, RAND researchers examined efforts in three jurisdictions that have been early adopters of efforts to get the two systems to work together seamlessly.

They studied efforts in City of Sioux Falls and Minnehaha County in South Dakota, Orange County in New York, and Fairfax County in Virginia. The jurisdictions were chosen because they have worked to establish different models of 988/911 interoperability

Although sites varied with respect to their specific resources and models of 988/911 interoperability, there were some cross-site findings related to effective planning and implementation.

For example, planning and implementation should be collaborative, engaging a variety of contributors. Entities involved in planning should focus on developing shared language and mutual respect, even when their cultures differ.

"Interoperability requires more than protocols for transferring calls between 988 and 911—it also must be considered within the larger continuum of crisis services available in a community," Holliday said.

The process of assessing a caller's needs and deploying the right resource—be it phone counseling, emergency medical services, police or fire response—requires procedures tailored to every jurisdiction's governmental, geographic and population characteristics, researchers say.