States can play a key role in helping local jurisdictions coordinate 911 call centers and the national 988 Suicide and Crisis Lifeline, according to a recent report from RAND, a nonprofit research organization. In examining interoperability, or how localities ensure formal processes and protocols are in place to transfer calls between the two systems, researchers also detail how states have been involved in this vital work.
The report explains that 911 is still “often the default option for individuals experiencing mental health emergencies,” even though the behavioral health clinicians who field calls to the 988 Lifeline are trained to help people in crisis and de-escalate emergencies. Policies and practices that help the two systems seamlessly move callers to the appropriate emergency line ensure that people receive the assistance they need. The report focuses on elements that support such coordination, including timely, accurate call transfers; collaboration and coordination across agencies; and community response services.
RAND, which received support from The Pew Charitable Trusts for the work, presented case studies from several localities, including two where state involvement was particularly helpful in 988/911 interoperability efforts: Virginia’s Fairfax County and South Dakota’s City of Sioux Falls and Minnehaha County.
In Fairfax, the county implemented related policies and procedures as part of a larger crisis response overhaul mandated by the state. In Minnehaha, meanwhile, county staff were members of a 988/911 coalition, with local call center directors and the state 911 coordinator working closely together to ensure that callers to either line are connected with the services they need.
In Virginia, state lawmakers enacted the Marcus-David Peters Act in 2020 in response to the 2018 death of Peters, a young Black teacher killed by police while experiencing a mental health crisis. The act established the Marcus Alert System, which provides emergency behavioral health response via coordination among 988 and 911 call centers and law enforcement. Currently, 10 cities and counties are using the system; statewide implementation is required by July 2028.
Both the state mandate and a state-provided framework for the Marcus Alert System shaped the alignment between the 988 and 911 systems in Fairfax County. Researchers learned through interviews with those who worked on the effort that the state tools were “not a substitute for the work of bringing together stakeholders.” Those people did the work to create procedures and policies aligned with the state framework. Still, the state guidance provided an important roadmap that helped drive the effort, providing clear guidelines for interoperability, including triage maps, training protocols, and timelines for implementation.
Those involved in the Fairfax work spent a year planning before implementing 988/911 interoperability in June 2023. The process included leveraging the county's crisis intervention processes, group planning sessions with regional stakeholders involved in emergency response, and “synergy sessions” between 988 and 911 staff to develop call transfer protocols.
In South Dakota’s Minnehaha County and the City of Sioux Falls, state involvement at two critical points aided 988/911 interoperability. Leveraging the statewide coalition working on the 988 launch allowed state and local stakeholders to work in tandem on 988/911 coordination. A strong relationship between the director of the state call center, located in Minnehaha County, and the state 911 coordinator also helped advance this work.
Planning was conducted as part of the state’s rollout of 988. In 2021, South Dakota convened the Behavioral Health Crisis Services Stakeholder Coalition planning group to focus on 988-related tasks, including steps to ensure interoperability. The group included various state and local agencies involved in crisis response plus Tribal organizations, community mental health providers, people with lived experience, and other stakeholders.
In the RAND researchers’ conversations with coalition members, many cited the importance of having both local 911 call center directors and the state 911 coordinator at the table during these meetings. This allowed the group to plan for the launch of 988 with all relevant parties in the room to share ideas, concerns, and identify opportunities for improvement.
After the July 2022 launch of 988, the task force split into small working groups addressing specific issues related to crisis response.
Although 988/911 interoperability is a local task, efforts in Fairfax and Minnehaha counties show that state-level involvement can be important to this work. Whether helping jurisdictions implement statewide mandates or being closely involved in local planning efforts, state officials can play a critical part in building emergency call response systems that help people in crisis.
Julie Wertheimer directs research and policy for The Pew Charitable Trusts’ mental health and justice partnerships project.