CCBHCs: A Cornerstone of 988 Implementation

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988: A New Crisis Hotline

In July 2022, 988 – the new national 3-digit crisis hotline – will go live. 988 will provide easy access to mental health and substance use crisis support for all Americans. It offers states an opportunity – and an imperative – to bolster high-quality community crisis response systems that are expected to see a surge in demand when 988 is launched. Through their standardized crisis response capabilities, their broad range of required crisis care, and their role in serving all individuals regardless of location or ability to pay, CCBHCs are uniquely positioned to serve as a cornerstone in our nation’s new crisis response system, decreasing the burden on 911 operators, law enforcement officials, and emergency departments.

CCBHCs as a Cornerstone for Crisis Response and Ongoing Care Coordination

The ideal crisis system provides communities with a continuum of services that address increasing intensity of needs and connect individuals to care beyond the moment of crisis. CCBHCs’ required services span this continuum, making them an essential component of a crisis response system.

At a minimum, CCBHCs provide...

1) Prevention

  • Early engagement in care
  • Crisis prevention planning
  • Outreach & support outside the clinic

2) Crisis Response

  • 24/7 mobile teams
  • Crisis stabilization
  • Suicide prevention
  • Detoxification
  • Coordination with law enforcement & hospitals

3) Post-crisis Care

  • Discharge/release planning, support & coordination
  • Comprehensive outpatient MH & SUD care

Many CCBHCs are going above and beyond these requirements with additional high-impact services and partnerships.

In areas where other organizations are delivering some or all elements of the ideal crisis response system, CCBHCs can play an important role in filling any gaps and in serving as a referral source for 988 call centers so that individuals are connected to a source of ongoing treatment designed to prevent future crises.

Three Roles for CCBHCs in 988 Implementation

CCBHCs can serve as 988 call centers

  • 75% of CCBHCs already operate a crisis call line, with 21% reporting they participate in the National Suicide Prevention Lifeline Network.

CCBHCs can serve as partners to 988 call centers for services the call centers do not directly provide (e.g., mobile crisis response, crisis stabilization)

  • 100% of CCBHCs deliver the required services described above

CCBHCs can serve as referral partners to 988 call centers and other crisis responders for post-crisis or non-urgent needs

  • CCBHCs serve all clients regardless of ability to pay.
  • CCBHCs are eliminating waitlists that pose a barrier to care in other settings: 50% of CCBHCs can offer same-day access to care, with 93% offering access within 10 days or less.

Learn more about CCBHCs’ role in 988 implementation.

Accommodating an Unprecedented Surge in Demand

The adoption of 988 as the national crisis care hotline for mental health and substance use needs is expected to cause a surge in demand for crisis services. Vibrant Emotional Health estimates a 150-240% increase in call volume in the first year of implementation alone, with call volume rising to 325-455% over baseline within 5 years. As states and providers grapple with how to ensure sufficient workforce capacity amid a nationwide workforce shortage, the CCBHC model holds promise. When implemented with a prospective payment system in Medicaid, CCBHCs’ flexible funding offers flexibility in adapting to increased demand while improving clinics’ ability to recruit and retain qualified staff.

Action Needed to Expand, Sustain CCBHCs

But to ensure a sustainable crisis response system, the CCBHC program must be expanded to allow mental health and substance use organizations in every state the chance to adopt the model.

  • Congress can extend the option to join the CCBHC program to every state in the nation through the bipartisan Excellence in Mental Health and Addiction Treatment Act. Ask for your legislators’ support.
  • States can implement the CCBHC model through Medicaid without waiting for Congressional action. Contact us to connect to efforts in your state or learn how to get started.
  • Current CCBHCs can sign up today to participate in the National Suicide Prevention Lifeline (which will transition to 988).

“In just the first 72 days of [CCBHC] operations, our team did 50 hospital diversions, six arrest diversions, had direct contact with 95 people and reached out to 89 more. Hospital emergency department visits are estimated at $500 per visit and an admission at $10,000 so we estimate we saved at least $372,500 for just the hospital diversions if approximately 70% were admitted. Annually that would work out to approximately $1.8 million in savings. Additional savings to the system were realized from the six arrest diversions as well in the first few weeks of the program and measurement period.”

Endeavor Health Services (New York)

“Since becoming a CCBHC we’ve been able to get many mobile devices, iPads, into the communities. Law enforcement officers are able to reach out to us seven days a week, 24 hours a day. Through these partnerships, we have been able to save law enforcement officers in Northern Oklahoma 275 days of continuous driving — the equivalent of 15 trips around the world — because we can identify the best, most appropriate level of care.”

Josh Cantwell, Chief Clinical Officer of Special Programs, Grand Lake Mental Health Center (Oklahoma)

“We have more than 20 care coordination agreements in place, which has led to greater than 50% diversion rate from jail when mobile response happens.”

Seasons Center (Iowa)