What happens when someone calls 988?
What patients should know about speaking with a counselor, emergency services involvement, and inpatient admissions
Many people are apprehensive about calling 988 due to fears of emergency services involvement and/or inpatient admission. Continue reading to understand how counselors will engage the caller and under what circumstances they will initiate a non-consensual rescue, as well as how psychiatric inpatient admissions work in New York State.
What happens when someone calls 988?
1. The caller will hear an automated greeting with additional options while the call is routed to the nearest crisis center, based on area code
2. A trained crisis counselor at a local center will answer the phone and listen to the caller, work to understand what the caller is experiencing, provide support, and collaborate with on ways to feel better and connect the caller with any needed help or resources
3. The counselor will ask questions regarding safety, feelings, social situation, and any thoughts of suicide
4. If the crisis counselor feels the caller is in danger, they will speak with them about accessing emergency services and/or gather additional contact information to ensure their safety
5. The crisis counselor will also work with the caller to create a safety plan if necessary
What happens when someone chats with or texts the Lifeline?
Access the Lifeline chat at suicidepreventionlifeline.org/chat. For text support, simply text 988 and follow the below steps.
1. The user will begin by completing a short survey letting the crisis counselor know a little about the current situation
2. The user will see a wait-time message while they are connected to a counselor
3. A trained counselor will answer the chat, converse with the user to understand how their problem is affecting them, provide support, and share resources that may be helpful
4. The counselor will ask questions regarding safety, feelings, social situation, and any thoughts of suicide
5. If the counselor feels the user is in danger, they will speak with them about accessing emergency services and/or gather additional contact information to ensure their safety
6. The crisis counselor will also work with them to create a safety plan if necessary
Emergency Services Involvement
The Lifeline does not currently have geolocation capabilities like 911 providers do. The Lifeline uses the caller’s area code to route them to a local center.
In cases where crisis counselors deem the caller to be at imminent risk of serious or fatal injury, the counselor will seek the caller’s consent to involve local emergency services. If the caller is unwilling or unable to share their location information, Lifeline counselors must provide what information they have to 911 operators (phone number or IP address). Callers will never be required to provide identifying information to receive help from the Lifeline.
Less than two percent of Lifeline calls involve emergency services, and when emergency services are involved, over half of these dispatches occur with the caller’s consent. The Lifeline recognizes the potential trauma and danger of getting emergency services involved, and recommends alternative options whenever possible, such as a collaborative safety plan, mobile crisis team, involving the individual’s loved ones or professionals, or supporting the individual to get to a Crisis Stabilization Unit, emergency department, or urgent care. 911 contact is the last resort, and some crisis centers require supervisor approval before calling emergency services.
Of note, two additional community-based hotlines exist which discourage operators from initiating nonconsensual active rescue:
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BlackLine, a hotline dedicated to serving Black, Black LGTBQI, Brown, Native, and Muslim community members, provides immediate crisis counseling to callers
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Trans Lifeline provides direct emotional and financial support to trans people in crisis, and has been divested from the police since its inception
BlackLine and Trans Lifeline are alternative resources for individuals in crisis who may not feel safe calling the 988 Suicide and Crisis Lifeline.
Inpatient treatment
If the patient is at imminent risk to themselves or others, getting them to a safe environment is crucial. In some cases this may mean an inpatient admission.
In New York State, psychiatric admissions fall under one of three general categories:
Informal admission
The patient requests treatment and is admitted without a formal or written application
Patient must be periodically informed of their status and rights, including right to assistance from Mental Hygiene Legal Service
Patient is free to leave at any time
Voluntary admission
The patient, who is 16 or older, applies in writing for admission
If the patient is under 18, the parent, legal guardian, custodian, or next of kin may have the authority to apply on the individual’s behalf
Patient may make a written request for discharge at any time
Following the written request, the patient must be released unless the Director of the psychiatric center believes the individual meets the requirements for involuntary admission
If the Director believes the individual meets the criteria for involuntary admission, they must apply to a judge within 72 hours for authorization
Patient must be periodically informed of their status and rights, including right to assistance from Mental Hygiene Legal Service
Involuntary admission
Involuntary admissions can take place in one of three ways: medical certification, certification by a director of community services, or emergency admission
Medical certification requires two physicians examine the patient and certify they need involuntary psychiatric care
Patient may be kept in a psychiatric center for up to 60 days, after which time the Director of the psychiatric center must apply to a judge to extend the patient’s admission
Patient or another individual may apply for a court hearing to challenge the medical certificate
Should a director of community services or designated physician certify that the patient has a mental illness likely to result in serious harm to themselves or others, and for which immediate inpatient care is appropriate, a staff psychiatrist will examine the patient within 72 hours and determine if the patient meets the criteria for involuntary admission
Patient may be kept in a psychiatric center for up to 60 days, after which time the Director of the psychiatric center must apply to a judge to extend the patient’s admission
Patient or another individual may apply for a court hearing to challenge the medical certificate
An emergency admission may be made when there is a claim that the patient has a mental illness likely to result in serious harm to themselves or others, and for which immediate inpatient care is appropriate
A staff psychiatrist will examine the patient within 48 hours and confirm that the patient meets the criteria for emergency admission
Patient may be kept in the psychiatric center for up to 15 days
If the patient meets the requirements for medical certification, they may be involuntarily admitted beyond 15 days
Patient or another individual may apply for a court hearing to challenge the medical certificate
Regardless of the type of admission and length of stay, all inpatients have defined rights. Inpatients may also object to any form of care or treatment, and may appeal decisions with which they disagree. In the case of an objection, the treatment team must make every effort to provide an alternative treatment or procedure. Patients have the right to have proposed treatments and objections reviewed by Office of Mental Health physicians and by a court, and they have the right to representation in administrative and court procedures.
Restraints and seclusion are last-resort, emergency-use-only measures to prevent injury. Staff should use the least restrictive restraint which is appropriate and effective. Patients can only be restrained or secluded upon written order of a physician based on personal examination. Orders are valid for no more than one to two hours for adults, and another examination is required to issue a new order.
When it is time for the patient to be discharged, the psychiatric center will prepare a service plan. The patient must be given the opportunity to actively participate in the plan’s development. The plan will include:
A statement of need, if any, for supervision, medication, aftercare services, and help finding work
A recommendation for the type of residence in which the patient is to live, and a listing of the services available in such a residence
Staff will also consult with social services and process any applications for public assistance, Medicaid, and/or Supplementary Security Income (SSI) prior to the patient’s discharge.
To learn more about patient rights in New York State Office of Mental Health Psychiatric Centers, review this booklet from the New York State Office of Mental Health.