DBHDD Webinar: 988 Rollout Update First 45 Days, September 8, 2022

Georgia's DBHDD Commissioner Judy Fitzgerald and leaders of Georgia's 988 Steering Committee reviewed the data and updates from the First 45 Days of the 988 Rollout in Georgia. 

*Slides and data from the presentation are available here.

Transcript:

Commissioner Judy Fitzgerald 0:04

Hello, and welcome.

This event is actually a re recording of an event that we held on September 8 of 2022. Thank you for joining us today, as we provide an update on the early days of the rollout of 988. you all well know that just over 50 days ago, we took our first steps down a long road of transforming Georgia's crisis system, and making it easier for those experiencing a behavioral health crisis, to know who to call in an emergency. That's what brings us here today. We made a commitment to transparency early in the planning process for 988. We promised that we would keep you informed on the impact of the rollout on the people that we serve. So we're here today to tell you what we've seen so far, and let you know what we're watching, because of the impact that we anticipate that 988 will have on our overall behavioral health delivery system. So I've got a really important caveat that we want to be sure that you understand, because it's so early in this transformation process. Much of the data that we will share today is preliminary. But we wanted to release what we could, as soon as we could to begin to tell the story of how 988 is redefining Georgia's crisis needs, and how we see this three digit dialing phone number, to be making it possible to support many people who have traditionally been underserved, underserved to seek support. So I'm proud to say we believe we're one of the first states to release this much data on the impact of 988. So far, we're going to continue to watch this information, and know that it provides insight for us and for our state on who is seeking help where we're successful, and where we need to prioritize our efforts to improve and build capacity. As I've said before, 988 as an easy to remember number for those seeking help for substance abuse and mental health crises is both this first and incredible opportunity to reduce stigma for those who need help. And second, it's also an intimidating challenge for states, as we begin to build capacity to meet these growing needs. You might recall that early projections for Georgia's crisis system told us to anticipate that demand might double with the rollout of 988. Now initially, those projections were the first for the first year of the rollout. But several factors have changed since then, especially this, there is no mass marketing of 988 until July of 2023. So to be clear, it's too early to say how soon projections may become reality in Georgia. But we do have a good story to tell about the early days of 988. First, Georgia is answering the call at rates above the national standard. We're really proud of that. And we have early evidence that people we know need help, or who have been traditionally underserved, are finding their way to support through the 988 line. We are really proud of these early successes. But we know that it's early. I want you to hear me clearly when I say this is just the beginning. And there is a long road of capacity building ahead for all of us. So I'm excited to share more. I have here with me today, members of our in house planning team for 988 and our Director of Behavioral Health Monica Johnson. Over the next half hour, these members of the planning team will provide you with an update on what's happening in Georgia in the early days of 988, highlighting some of the themes of what we're seeing, and also talking about common misperceptions about 988 that we are especially seeing on social media. We are excited to share this information with you. So now I'm pleased to turn it over to Monica Johnson, who will set the stage with some reminders of what were our goals for 988 and our partnership with the federal government here. And, as I said, a preview of our early observations. Thank you for joining us, Monica.

Monica Johnson 5:02

Thank you, Commissioner. Good afternoon, I'm happy to be here to provide like the commissioner already referenced some early information related to 988 what we're seeing, but before I get there, I want to do a little table setting. Next slide, please.

So if you will recall, there are three components to 988. The federal law requires that these three things will happen. The first is someone to call. So for us, that means calling into either via 988, or our 1-800-GCAL number, which is still active, so both numbers will get you to the same place, in that someone is available to speak to someone that is experiencing a mental health crisis. Our call center obviously, for those not maybe familiar, it is 24/7, it remains in place that is available for calls, as well as text. And as well for chat. We also operate peer peer run warm lines, peers for us are individuals with lived experience. And sometimes that is the right intervention that is needed on the other side of the phone call. And so someone's to call, someone to call that's priority area number one, after someone calls and the intervention is more than what can happen over that telephone call. The second component of the 988 framework is someone to respond. For Georgia, what that looks like could be mobile crisis. Georgia has had statewide mobile crisis services prior to the go live date of 988, we will continue to look at capacity as it relates for those mobile crisis services over time. It may also look like coordination between our call center so our 988 Call Center GCAL number call center, it may also look like those individuals can connect with 911 or EMS as appropriate depending on the situation. Or that someone to respond could also look like a connection for the individual that placed the call it the connection may be to an outpatient behavioral health provider, the third component of the 988 system would be a safe place for individuals to go that are experiencing a level of crisis that requires a place to go for stabilization of those services of those needs. So that can look like in Georgia crisis stabilization units, which are community based facilities that individuals can go for around proximately, five to seven days for the support services that they need. It can also look like some of our walk in centers where individuals can walk in for an assessment when they're experiencing a crisis, or for a shorter period of observation. Other examples can be detox facilities, it can be referrals to an inpatient bed setting that is a little bit longer than perhaps the short term crisis stabilization programs. It can also look like peer wellness RESPA centers, we have a few of these across the state. These are places that are run and operated by our peer leadership. And sometimes these are places for the appropriate level of intervention to happen for an individual at this level in a crisis. It can also look like again, outpatient crisis services connection. So again, someone to call someone to respond and then a safe place for individuals to go as warranted based on the individual's needs. Next slide. So taking each of those components SAMSA has set forward a five year vision for how you get to making sure all of these things are achievable within each state system. So of course here in Georgia, we are following the same framework. So kind of thinking back to the three steps I took you through these are now the aims or the goals that are in place that we are also mimicking here in Georgia. So for the first arm of 988, the someone to call, the expectation is that 90% or more of all 988 contacts answered in state by 2023.

The second aim or goal here would be 80% or more of individuals have access to rapid crisis response by 2025. And then lastly, by 2027 80% or more of the individuals will have access to community based crisis care. So wow, we have our areas of things that we're working on. on. And we're taking them and, you know, gradual approaches, looking at each part of the system as we continue to roll out and experience the implementation of 988 in our state. Next slide, please. So I want to end my part of the presentation talking a little bit about some kind of highlighted data points that we wanted to take the time to share with you of things that we're seeing in the first 45 days of the 988 rollout. So you're gonna get a lot more data that's going to be discussed with you today. But again, for critical ones that we want to point to kind of from the start, 988 calls are being answered in a little over nine, I mean, excuse me, seven seconds, on average, and 97% are being answered within the state. We're very proud of that initial finding. One of the things that stood out for us is that we did notice that Georgia's rural counties have had the highest prevalence for crisis calls in the first 30 days of 988. There are many questions probably percolating in your mind right now, like why what's driving that we're continuing to try to understand what's behind the data. And we'll be able to monitor that over more time as more time goes forward. The third point I want to raise here is in the first 45 days of the 988 rollout, we have 476 calls that resulted in active rescues of individuals who lives were believed to be in danger. So that's that collaboration between 988 and 911. And then lastly, approximately 10% of calls that came in, were for youth under age 18. Again, what's the driver for that? We do not know that yet. But we will be continuing to monitor these trends. In these early findings. As we begin to receive more data and have more time to understand the meaning behind some of the data that's presenting pretty early in this process. I would like to turn it over to my colleague Anna Bourque.

Anna Bourque 12:11

Thank you, Monica. Hi, my name is Anna Bork. And I'm the Director of the Office of provider relations and ASO coordination. And I'm going to share with you some data that we've collected. This is all preliminary data. Next slide please.

So really just wanted to share with you this slide shows from 2019 through the end of August of 2022, what we expect to see in our in our volume increases. So you'll see that there is some trending patterns that we can call out and we know they're there. This is sort of to let you know that we have natural spikes, and we have natural valleys within our what we'd expect to see in the call volume. And then some of the things that have over time impacted our call volume, our celebrity suicides, you could track back and find there's been a celebrity suicide or natural disaster also, we'll send those trends a little bit different. But overall, you see our year over year within the call center, as well as the trending patterns that we've been working toward. Next slide, please. So what's happened in the first 45 days of the rollout? We have been answering our 988 calls within seven 7.4 seconds as Monica said, we're speed to answer not only are we answering them our overall George crisis access line speed to answer is 14.8 seconds. So we're getting to the nine eight calls about twice as fast as we're getting to the other calls at this time. Our answer rate for 988 is 96.9. So those that means 100% of the calls that were sent 96.9 were answered in the state of Georgia, our overall answer rate is 97.72. So we've been able to meet or beat those performance standards that were set out by the federal government in the first 45 days. Again, very preliminary data. And we are very closely monitoring this performance to ensure that we are making sure that we have the response rate we bought it response rates we want as volume increases. Next slide please. So the first 45 days impact you can see that we have the July 16 to August 29 of 2021 versus July 16 August to August 29 2022. And that we've received an increase in calls over that time period, with a significant increase in calls from the 988 line. The majority of our calls are still coming from the people in Georgia who tell the Georgia crisis and access line But we are seeing that the 988 calls are increasing. We had seen this trend begin before July 16, I just want to let you know that we have seen a trend and increased call volume from988 starting as early as April. So, this, this is a trend we're going to continue to watch as we do year over year data analysis. Next slide, please.

So, what happens when somebody calls, so when someone calls, and they're they need crisis services, we have what we call an episode. And that's where a person didn't call and just ask for basic information, or phone number or some some times there's more than one call for one episode. So I might call somebody else might call and somebody else might call about the same person having a crisis episode, because we all see what's happening and are very concerned. So just to let you know, we're now be talking about things in terms of an episode instead of a call. So 30% of the people who called in who had an episode 30% of episodes, needed someone to call, they needed to have a warm call, they needed an outpatient referral, they just needed information. They just needed to talk to somebody. And so that was 30% of our calls. 24% needed somebody to come out. And that's whether that somebody would come out was our mobile crisis team, or whether that somebody to come out was the an act of rescue, somebody needed to physically be where that person was to support them in their time of crisis. And then 46% of our episodes ended in a referral to a place to go, whether that was a behavioral health crisis center, a crisis stabilization unit, or some other kind of inpatient referral, maybe they had Medicaid, so they went to a private hospital or maybe had private insurance, and we did a referral connection to an inpatient referral. Next slide, please. So when you look at the total volume by county, you'll see that the of course the more populated counties have the higher end of calls coming into the Georgia crisis and access line within the first 30 days of the 988 rollout. This would be to expected because you have higher populations, you would have higher call volume, we have two counties, Quitman and Echols that have no calls coming in during that 30 day period. So, again, not anything you would expect the higher volume counties to have, the higher the higher volume calls, the higher the higher the number of people who live in the county, the higher the cost. The interesting thing when we looked at this data was really when we got to the prevalence map. Next slide, please. When we looked at the crisis episodes by county, by population of 10,000 residents per county, we noticed that our largest call by prevalence really was in South Georgia, you'll see that the top seven counties are all in by collar all in South Georgia. Next slide, please. Well, it's too early for us to draw conclusions because we don't have enough data to say what all this means. We do know that the suicide rates in George's rural areas have increased since the pandemic. And we do know that in 2020, rural suicide rates increased by 8.3%, while they decreased in some of the urban areas. So we can see that we have some work to do in terms of unpacking our preliminary data to understand exactly what this means and what we need to do to support people who are in those rural counties. Next slide, please. So as we were looking at the data, we wanted to look at it in terms of gender. Also, we do need more data to dig into this to be more definitive and draw any conclusions. However, we know that nationally, males make up 49% of the population, but almost 80% of the suicides. So this is again, we're seeing for our call center, based on census a little more calls by females than males, but we know that this is another area that we have to work at. We know that men are less inclined than women to seek help through traditional venues. And it could be noted that men maybe using the crisis line more than women due to the anonymous nature of the call. So they feel less vulnerable stepping out to ask for those help. Again, this is all work we have yet to do in terms of ensuring that we know what this means in terms of the additional call volume by gender. Next slide please. Our episodes by age we know that nationally young people are going to the emergency room more for mental health reasons. In 2020 emergency department visits for mental health related related reasons grew by 24% for youth who were aged 5 to 11. And the emergency department visits for mental health reasons related grew by 31%. For youth who were 12 to 17. Those are CDC. So we know that we have an increased need within our, for our youth.

Right now a little under 10% of all of our episodes are for youth who are under age 18. That just one more note on that is that is age at the end of the age of the person. So someone may be calling for a youth, or it may be the youth themselves reaching out, it could be either one. Next slide, please. Since 2020, suicide attempts and deaths and deaths by suicide for the African American population has risen. So this is our crisis episodes by race. In 2019 Suicide was the second leading cause for death for African Americans aged 15 to 24. So again, we know that we have a lot more work to do in terms of looking at race, reaching out and doing a deeper dive into the data to include ethnicity and race data, so that we can be sure that we are providing the services needed, where they're needed. Next slide, please. So the key trends to watch. An active rescue is when we have dial 911. For whatever reason, the Georgia crisis and access line has had to reach out to seek immediate support through either police fire or EMS. So that is what we would call an active rescue. You'll note that in the first 45 days of data we have received we have moved from an average of 8.5 active rescues, to 10.5 active rescues per day. So we'll be watching this data very carefully. I do want to reflect back to the growing percentage of calls coming from the National line. It's really just again too early for us to tell. But 988 may route more people to us who need a more urgent or truly in crisis and need a connection immediately. We're going to watch this closely we have seen a slight rise in our CSU bhcc utilizations, we've seen a slight rise in the active rescue. So again, as we continue to look at this preliminary data continue to monitor we will be looking for these kinds of trends. And want to take this opportunity to introduce Dawn Peel. So she can talk some more about some other trends we're seeing.

Dawn Peel 22:48

Thank you, Anna. And hello, everyone. My name is Dawn Peel. And I'm the director for the Office of crisis coordination for DVHDV. Next slide, please. So I'd like to take a few moments and talk about the impact on our mobile crisis teams within the first 30 days of of the rollout. So as you can see hear overall, our number of mobile crisis dispatches increased by 37% since fiscal year 20. And we expect the demand to continue to increase as we move forward with the 988 rollout. And particularly once mass marketing begins next year. Federal projections suggest that we could have as much as 176% increase in mobile crisis dispatches once mass marketing begins. I'll give you a little bit of context about why mobile crisis teams might be dispatched. So when a person calls into the Georgia crisis and access line, if the call taker is not able to deescalate the person or appropriately linked them up in a safe way to outpatient services, they might identify the need for a mobile crisis team to be dispatched. What happens when a team comes out is they will quickly do an assessment, determine what's going on with the individual and their situation, and then make appropriate determinations about next step. So the appropriate next step might be an a referral for outpatient services. Or it might be a referral for a higher level of care at one of our community crisis beds. Next slide, please. So in terms of our community crisis referrals, the number of referrals that happened in the first 30 days of the 988 rollout was just over 4100 referrals and so Once again, this is preliminary preliminary data, we will continue to monitor this as time goes on, to watch for trends. Again, when we talk about projections based on the impact of mass marketing, we expect that our community crisis bed admissions could increase by as much as 105% After the first year of implementation. And we're struggling a little bit with staffing now, particularly in the area of nursing. So we're working closely with our partners to identify ways to maximize our workforce, and to improve the pipeline for people entering the nursing and other behavioral health workforce to support the demand that will be needed as the 988 rollout continues. Georgia relies on a network of public and private providers to support our short term inpatient psychiatric deeds of people who do need that higher level of care that Monica had referenced earlier, people who might need some psychiatric stabilization for five to seven days, or those that also need substance use detox. And although we work really hard to serve people in the lowest appropriate level of care, we do understand that we will need to double our capacity for community crisis beds in the future. Next slide, please. So now we're going to shift gears away from the data and talk about some of the common misconceptions and commonly asked questions. The first one focuses on the difference between 988 and 911. So when a person calls 911, the dispatcher talks with a person and very quickly assesses the need, and usually that the next step from there is dispatching fire, EMS or law enforcement. When a person calls 988. The call is taken by a trained counselor who assesses the person and their situation, de escalates whenever possible, and determines the appropriate next step. In many cases, that appropriate next step is a referral to outpatient services. And so the main difference is that with 988, the call is the intervention in many cases. And And if needed, the person can be referred to a higher level of care as well. But oftentimes, it is resolved by the call taker itself. Another main difference is the difference. In response time,

EMS average response is seven minutes nationwide. And when a person calls 988, the phone call takes on average about 20 minutes. When a mobile crisis team needs to be dispatched, it's important to remember that they are not immediate responders. The goal is for our mobile crisis teams to arrive on site in 59 minutes. But it's important to remember that there's a big difference between the amount of time that a response would happen if fire EMS was dispatched, or if a mobile crisis team was dispatched. And we provide this information to make sure that people have appropriate expectations about what happens when they call 988. The second question that frequently comes up is will law enforcement still be dispatched? If I call 988? And there's a lot of misinformation out there on social media about this question. So I want to give you all information about what really happens. So again, as I said earlier, our goal here is that the least restrictive intervention is put into place. crisis counselors only engage 911 and a supportive law enforcement in situations where a person's life is at imminent risk, whether it's the person that needs assistance themselves, or if that if they're a danger to someone else. It's done as a last resort, and the only information that the 988 off counselors shares with 911 is what's absolutely needed to save that person's life. And as Anna mentioned earlier, on average 10.5 active rescue calls are made each day. To give you some context, the Georgia crisis and access line receives approximately 800 calls a day. So as you can see, the number of active rescues that are dispatched is very, very low in terms of the overall number of calls. The next question that we frequently get, is will individuals be involuntarily committed? If someone dials 988 So, again, there's a great deal of misinformation out there, both locally and at the national level, about what happens when people call 988. So the fact is, is that 1% of all of the calls that come in through the Georgia crisis, Nexus line, be it from 988, or people that call the 1-800 Number themselves, result in a 10-13, or 20-13 being written by our mobile crisis teams. So 1% of those calls are resulting in an order for an involuntary evaluation. And what I can tell you is that those numbers are on par with what's happening nationally, the national data is about one to 2%. So very small proportion of the event individuals that call in to 988, result in a 10-13 or 20-13 order. Again, as I mentioned, all possible efforts are made to divert the person to a lower level of care, whether that's an outpatient appointment, have a mobile crisis, team respond, and deescalate the person or if it's absolutely necessary that they need invasion stabilization. In many cases, most often, in fact, our mobile crisis teams will talk with the person and encourage them to go voluntarily to treatment. Because we know that that usually leads to better treatment outcomes when a person seeks treatment voluntarily. Another question that frequently comes up is can I text 988? And the answer is yes. Anyone nationwide can text 988 today and get assistance. In Georgia, right now, we don't have the technology available to have 988 texts answered by clinicians in Georgia. But we're working on that. We're working very closely with our providers, and federal partners to identify the mechanism to make that happen as soon as possible. If you would like to reach out or know somebody that would like to reach out in crisis via text and get linked up to a clinician in Georgia, they can use the myGCAL app, because that goes directly to Georgia clinicians to be answered.

The last question that frequently comes up is does 988 have geolocation capability. And again, a lot of misinformation out there in the media and social media about this. So right now 988 does not have geolocation capability. And what they can do is identify the area code the person is calling from, but that's the the most technology that they have to identify where the person is calling from. But again, as we talked earlier about active rescues, if a person is at high risk of harm, in the immediate future, our call center, clinicians will link them back to a 911 center so that dispatch can be made. And 911 centers do have geolocation capabilities. So if you're interested in learning more about 988, you can reach out to enter 988 website at 988ga.org. And at this point, I will turn it back over to the commissioner.

Commissioner Judy Fitzgerald 33:44

Next slide, please. And here's our final slide. First, I want to thank you for joining us to get more informed about what's happening in Georgia around this vital and transformative resource of 988. What you see before you here on this slide, is information about how to stay connected with what's happening in Georgia. Many of you are familiar with our website, 988ga.org, you see it right there. We will continue to use that website as a place where we post additional information and where questions come to us. We keep updating that website, again, with the intention of being a resource for Georgians to know what's happening, to get the facts straight and to have a consistent place that they can go back to. We are really excited about the progress to date. We do want to acknowledge our many partners in this work, which includes our crisis providers, and of course, our partners at the Georgia crisis and access line who have been a A key part of this early success and certainly will be essential along with our community provider provider network, to providing crisis services to meet the demand that we're seeing in Georgia. And I want to thank our steering committee and planning committee members in the community. You continue to guide and inform this work as we go forward. And we're grateful for the opportunity to work in partnership with fellow Georgians, and certainly our elected officials who have been interested and been supporters, and have really lifted up and enhanced our ability to be responsive in Georgia. So we invite you to come back to this website. And we maintain our commitment to ongoing transparency about this transformative opportunity to really reduce stigma around behavioral health crisis and for Georgians to be ready in the coming months and years to meet the demand. So again, thank you for joining us today. We look forward to seeing you again. Thank you.