Michigan Crisis Services System Implementation and Rollout

Logo Description automatically generated Last revised: February 2023 Michigan 988 Implementation & Rollout

Michigan Department of Health and Human Services (MDHHS) is in the process of developing a crisis services system for all Michiganders. This system will have three primary components: Michigan needs a *Crisis System in place for ALL Michiganders Michigan Crisis and Access Line ( Michigan Crisis and Access Line (MiCAL MiCAL)/988 Center (Call) )/988 Center (Call) Someone to talk to: 24/7 crisis call center staffed with crisis specialists and clinical staff who provide crisis intervention and support (phone, chat, and text), meet National Suicide Prevention Line (NSPL) standards, and provide Air Traffic Control quality coordination, with real time data management. MiCAL will answer 988 calls, texts, chats statewide. Goal: 80% of calls, chats, texts resolved on the phone. for anyone, anywhere, anytime. Mobile Teams Mobile Teams Someone to respond: Mobile crisis teams services offer community-based interventions to individuals in need whenever and wherever they are, including at home, work, or anywhere else in the community where the person is experiencing a crisis. Community Mental Health Service Providers (CMHSPs), Certified Community Behavioral Health Clinis (CCBHCs), and a few private agencies currently provide this service but there are variations in this service in terms of population served, hours, and location. Goal: 70% are resolved in the field. Safe place to go Someone to respond Crisis Stabilization Unit (CSU) Crisis Stabilization Unit (CSU) Somewhere to go: a pre-screening unit or a facility that provides unscheduled clinical services designated to prevent or ameliorate a behavioral health crisis or reduce acute symptoms on an immediate intensive and time-limited basis in response to a crisis. MDHHS and stakeholders are developing a CSU model and certification standards. Goal: 70% discharged to the community. Someone to call *Crisis is defined by the individual who needs help.

In July 2020, the Federal Communications Commission (FCC) designated 988 as the new three-digit number for the National Suicide Prevention Lifeline (NSPL). Federal Federal Direction Direction SAMHSA & SAMHSA & 988 Facts 988 Facts The 988 Suicide & Crisis Lifeline launched on July 16, 2022. The previous NSPL phone number (1-800-273-8255) is not going away. Dialing either number will route callers to the same services, no matter which number they use. 988 moves the NSPL from a standalone call line to part of a crisis system. 988 is not only for suicide prevention, 988 is for all mental health and substance use crises. The objective of 988 is to expand and broaden the purpose of services. States/territories are charged with implementing 988 and ensuring 988 centers meet NSPL requirements.

988 Builds Directly on the Existing National Suicide Prevention Lifeline 988 2001 2007 Congress appropriates funding for suicide prevention hotline; SAMHSA awards competitive grant to establish a network of local crisis centers 2021 2015 SAMHSA and VA partner to establish 1-800-273-TALK as access point for the Veterans Crisis Line (VCL) 2022 2020 SAMHSA/VA/FCC are responsible for submitting multiple 988 reports to Congress Disaster Distress Helpline was incorporated into Lifeline cooperative agreement Lifeline began incorporating texting service capability in select centers 988 transition complete July 16, 2022 2005 2013 2020 2020 2021 Lifeline began incorporating chat service capability in select centers National Suicide Prevention Lifeline (Lifeline) was launched with number 1-800-273-TALK FCC designates 988 as new three-digit number for suicide prevention and mental health crises National Hotline Designation Act signed into law, incorporating 988 as the new Lifeline and VCL number State 988 funding opportunity released, andstates are responsible for submitting planning grants to Vibrant 4

MiCAL MiCAL & 988: & 988: What is the difference? What is the difference?

988 & MiCAL Facts MDHHS led a 988-planning process which involved cross sector group of stakeholders to develop a 988-implementation plan. Michigan s Official Draft 988 Plan was submitted to Vibrant/SAMHSA January 21, 2022. MiCAL is primary for answering 988 calls in Michigan and will be secondary for answering calls where there is a regional 988 center; calls are routed by area code, not by location. MiCAL will be primary for answering 988 texts and chats statewide but Michigan is still in the development stage for a text and chat rollout plan and process. Michigan Received a 2-year SAMHSA 988 Implementation Grant in April 2022. Since June 1, 2022, Michigan has had statewide 988 call coverage.

Michigan's Crisis and Access Line (MiCAL) is the central crisis line accepting the 988 calls and will accept texts and chats originating from Michigan. oMichigan is still in the development stage for answering chat and texts. o988 National Backup Centers are providing call overflow in Michigan and all text and chat coverage for Michigan. MiCAL is primarily responsible for answering 988 calls statewide except in Calhoun, Cass, Kalamazoo, Kent, Macomb, St. Joseph, & Van Buren counties where, three regional call centers provide primary coverage and, MiCAL provides backup call coverage to the existing 988 call centers. 988 988 in in Michigan Michigan

Michigan 988 Call Center Coverage* Michigan 988 Call Center Coverage* *Calls are routed by area code and exchange.

Michigan Crisis and Access Line (MiCAL) for all Michiganders Michigan Crisis and Access Line (MiCAL) for all Michiganders MiCAL.Michigan.gov Trained Crisis Call Specialists Support Michiganders via phone 24/7 Crisis Intervention including Safe-T Assessments and Safety Plans for at-risk Persons Activate face to face crisis services when necessary Provide Referrals for mental health and substance use disorder services Make Provide follow up calls to ensure people are connected to services Care Coordination with Community Mental Health & CCBHCs through crisis alerts and follow up notes Up to date behavioral health service information from 211, MiCARE, and CMHSPs Customer Relationship Management System to safely house caller data and produce reports for population health management warm transfers whenever possible

Michigan is still in the development stage for answering chat and texts. Texts and chats are routed to Lifeline network crisis centers and answered by trained crisis specialists, regardless of location.

988 went live nationally on July 16, 2022. For the remainder of 2022, Michigan focused efforts on: Maintaining and ensuring a solid infrastructure be built first. Coordination with 911. Adequate staffing capabilities to handle call volume. Michigan has statewide staffing in place for calls. Michigan s Michigan s 988 Roll Out 988 Roll Out Michigan gradually rolled out 988 to the state to ensure that there was a flawless transition and avoid potentially overburdening the call centers all at once. Marketing efforts for 988 began at the start of 2023. We are more than happy to provide our stakeholders and community partners more information on 988, its implementation, and how they can get involved.

Michigan 988 Implementation Statewide Coverage for calls with less than 10% being answered NSPL back up centers. Develop chat and text implementation plan. Common Practices across all 988 Lines: crisis assessments, referrals, follow-ups, and training. 988 Funding as a Public Good. Care Coordination with other crisis services (mobile crisis, preadmission screening, behavioral health urgent care centers, and crisis stabilization units). Coordination with 911: (1) active rescues, (2) public education on calling 911 vs 988 development. Development of 988 Marketing plan in partnership with stakeholders. Calendar Year 2022 Calendar Year 2022 Developing Infrastructure

Michigan 988 Implementation Michigan 988 Chat and Text Implementation. Coordination with 911: (2) implement public education on calling 911 vs 988, and (3) 911 Diversion to 988 Best Practice development. 988 Funding as a Public Good. Targeted Outreach and support for high-risk callers: follow ups and marketing. Listening Sessions with people from typically underserved groups. General Marketing Campaign implementation through use of trusted community partners/communication channels. Calendar Year 2023 Calendar Year 2023 Engaging Stakeholders and Marketing

Michigan Statewide 988 Call Metrics Michigan Statewide 988 Call Metrics Goals: 90% of calls are answered by a Michigan 988 Center 95% of calls will be answered within 20 seconds 988 December 2022 Metrics: Call Volume: June 2022 Call Volume: 5,240 December Call Volume: 6,466 Average Speed of Answer: 25 seconds In-State Answer Rate: 90% While we have identified what data will be collected, we are still working on the data collection process at a state and national level to ensure accuracy and consistency. Total Calls Received & Average Speed of Answer were pulled from Vibrant s State Report The Answer Rate was calculated using the Total Calls Answered as reported by the centers divided by the Total Calls Received as reported by the center. Due to the data discrepancies between Vibrant sand centers data, Michigan will rely on the 988 Center s total calls received when reporting the answer rate.

Metrics for Imminent Risk Metrics for Imminent Risk September 2022 August 2022 November 2022 December 2022 October 2022 Total 20 25 26 39 22 132 Contacts that resulted in emergency rescue (11 Involuntary) (9 Voluntary) (13 Involuntary) (12 Voluntary) (14 Involuntary) (12 Voluntary) (27 Involuntary) (12 Voluntary) (15 Involuntary) (7 Voluntary) (80 Involuntary) (52 Voluntary) Contacts that included suicide attempts in progress 13 19 26 38 28 124 Disclaimer: We would like to note that we are still actively in the process, at both the state and the federal level, of working towards developing consistent and accurate data reporting.

The Michigan Suicide Prevention Commission's 2022 Annual Report identified several groups at a heightened risk for suicide and suicidal behaviors. Despite a strong demand for Mental Health Services, common barriers and inequities remain, especially among high-risk and underserved populations. Some barriers to behavioral health care include but are not limited to lack of awareness of available resources, stigma, unequal access to evidence-based practices, mental health workforce shortages, geographical maldistribution of providers. "While most Americans do try to seek out treatment, there also is a large portion of the population who have wanted to but did not seek treatment for themselves or loved ones (29%) in part due to not knowing where to go if they needed this service." Overview of Michigan's 988 Marketing Approach

Michigan's Marketing Approach Focus: Ensuring health equity among high-risk and underserved populations. Research has indicated that: High-risk and underserved populations face gaps and barriers that cause further mental health disparities. People with higher trust in the health ecosystem were more likely to receive preventive care. In the United States, 81% of respondents with high trust had a checkup in the last year compared with 58% of those with low trust. Our Strategy: Embedding and focusing on the importance of trust within these high-risk communities. Our strategy is to emphasize and utilize our established trusted partners and their networks to support and encourage underserved communities to use 988.

Marketing 988 in Marketing 988 in Michigan is LIVE! Michigan is LIVE! Starting January 1st, 2023, marketing 988 in Michigan has officially gone live! Please feel free to now openly publish, share, advertise, and market 988 and 988 relevant information through your communication channels. We are asking stakeholders to: Continue replacing the former NSPL number (the 800 number) with 988. Notify us of any places that they may see the former 800 number still being posted specifically if it is in a location that the stakeholder cannot replace themselves.

Advisory Group People with lived experience Law enforcement and fire service representatives Other stakeholders Michigan Michigan Stakeholder Stakeholder Engagemen Engagement Marketing Channels Michigan s initial public awareness approach targets people most at risk for behavioral health crisis through communication channels via trusted community partners such as community groups, advocacy organizations, and allied professionals. Develop a public awareness/ marketing plan which will identify existing channels such as newsletters, websites, and conferences. Tailoring 988 Support to all Michiganders Two listening sessions were held with people who have experienced suicidal thoughts or behaviors, accessed crisis services, contacted a crisis line, or lost a loved one to suicide. MDHHS will host listening sessions with underserved groups and high-risk individuals. We are working with Federally Recognized Tribal Nations around 988.

Priority Focus areas Social Connectedness Community Linkages Michigan Stakeholders Environment Our Approach Gain insight on the communities that have the most need. Utilizing our stakeholder's network to: Identify gaps and barriers in previous marketing efforts. Encourage Stakeholders to connect 988 services within their already trusted channels to encourage groups to utilize 988.

Information for Stakeholders Information for Stakeholders CONTACT US If you are interested in being added to our stakeholder list serve or have feedback, questions, or concerns related to Michigan 988, email us at MPCIP-support@mphi.org *Please do not include any private health information in emails to this address. MARKETING MATERIALS For marketing materials, visit: 988 Partner Toolkit | SAMHSA

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