UNH Healthcare Vitals: 988 and the Future of Geolocation Services

Did you know?

In July 2022, the 988 Suicide and Crisis Lifeline launched nationwide, providing an easy to remember number for individuals in mental health crises to anonymously call, text, or chat with a trained counselor from anywhere in the country. 988, which replaced the 10-digit Suicide Prevention Lifeline, is available for free 24/7/365 and connects individuals in crisis to counselors who can assess for risk and safety, provide de-escalation techniques, and connect callers to local follow-up resources and referrals. Individuals do not have to be suicidal to call 988; 988 is for anyone struggling with a mental health or substance use crisis. The 988 Lifeline has three subnetworks to connect individuals to more community-specific services: the Veterans Crisis Line, a Spanish speaking network, and the Trevor Project, which provides crisis support to LGBTQ+ youth and young adults. For individuals who do not select one of these three subnetworks, calls are automatically routed to call centers based on the area code of the caller. Across the country, there are approximately 200 call centers that answer 988 calls. Currently, 988 does not use geolocation services, which includes georouting; calls are routed based on area code, not physical location. For example, if a caller physically based in New Hampshire calls 988 from a phone with a Massachusetts area code, their call is routed to a crisis call center in Massachusetts.

Here is the latest

The Federal Communications Commission’s (FCC) April 2024 proposal to require georouting for calls to 988 follows a flurry of activity exploring geolocation services for the Lifeline.[1] Utilizing geolocation services for 988 requires not only considering privacy concerns, but also cost, legality, and policy implications, many of which were outlined in the FCC’s most recent proposal.
 
Georouting is distinct from geolocation: geolocation is used by 911 and provides the precise location of the caller. Georouting is a type of geolocation service. A switch to georouting would mean calls to 988 would be routed based on factors like the closest cell tower location, rather than the area code of the incoming call; georouting still would not disclose precise location data. While routing calls based on area code maintains location confidentiality for individuals in crisis who may not wish to be identified, it limits the ability for counselors to provide location-based resources and immediate in-person emergency response, when required. As reported by Route Fifty, 988’s current routing system can delay life-saving services to individuals in crisis.

The conversation about geolocation services for 988 does not only have technological and financial considerations; there are myths that engaging with 988 automatically dispatches a law enforcement response and/or disclose the caller’s location to authorities. Some communities are wary of 988 although 988 was in part developed to reduce law enforcement response to mental health crises. The idea of connecting location tracking services to 988 raises concerns in communities that have been disproportionately impacted by police violence and involuntary inpatient hospitalization, including but not limited to communities of color (including immigrants, refugees, and asylees) and individuals with mental illness, developmental or intellectual disabilities. Many of these communities are also at disproportionate risk for suicide health disparities. Communities that have faced systemic oppression and have been the subject of government sponsored activities, such as the U.S. Public Health Service Untreated Syphilis Study at Tuskegee, may question whether another initiative claiming to offer support may actually cause further harm.

What does this mean for New Hampshire?

NH’s Lifeline centers receive over 1,000 calls a month, as reported by Vibrant Emotional Health, the administrator of the Suicide and Crisis Lifeline for SAMHSA. Calls to 988 from a NH area code (603) are routed to Headrest, NH’s primary 988 Lifeline call center in Lebanon, NH. If Headrest crisis counselors are already on the line, the call is re-routed to Carelon, NH’s backup call center. With the movement toward georouting for 988, NH’s 988 system has a number of topics to consider. 

Call volume: It will be important for NH’s Lifeline centers to consider the impact of a shift on call volume and the potential need to adjust staffing to respond. Information has not been published to estimate a potential shift in call volume for Lifeline centers if the network shifts to georouting.

Connection to mobile crisis: Both of NH’s Lifeline centers have knowledge and understanding of local resources available to NH-based callers. In addition to connecting individuals to location-based therapists or groups that support their needs, georouting would ensure that all calls reaching a NH Lifeline center would be originating in NH and could be supported by a NH-based mobile crisis team, if needed. Currently, if a NH-based caller has a non-NH area code and reaches a call center outside of NH, the crisis counselor in that state may not know about NH’s mobile crisis response system through the NH Rapid Response Access Point.

Culturally responsive marketing: Given early unfounded fears about geolocation services connected to 988, a shift to georouting will undoubtably raise concerns within systemically marginalized communities across NH that a call to 988 may trigger a law enforcement response or involuntary hospital admission. This national shift would position NH to proactively communicate about 988 using culturally responsive language and content and trusted community messengers. In addition to utilizing the Action Alliance and SPRC’s 988 messaging toolkits, NH-specific marketing efforts should be grounded in systemic strengths and challenges that have been identified by those who both most need and are most hesitant to use 988.