As we near the two-month anniversary of the 988 Suicide and Crisis Lifeline launch, it’s becoming increasingly apparent that state infrastructure readiness is a marathon, not a sprint. This means that no two states or geographies will prepare for the compliance with the behavioral health initiative on the same exact timeline or in the same exact manner. To address the infrastructure elements required to address the 988 Suicide and Crisis Lifeline most effectively, we sat down with Bamboo Health Senior Product Manager Carol Tsang to discuss the purpose-built tools and technologies that are available today to help states support their crisis management infrastructures.

Let’s start off by talking a little bit about your position at Bamboo Health and your journey to your current role.

I’ve been at Bamboo Health for about a year, but I’ve been building innovative tools and products to solve complex problems in a range of industries for about 15 years. My experience spans everything from finance to HR; the latter being a market where I’ve spent the most time. It’s in these types of product development positions where you are really afforded an opportunity to see the importance of what you are creating up front. This especially rings true in healthcare. The healthcare industry provides the opportunity to impact and change the lives of so many, which is the most exciting part of my work at Bamboo Health.

It’s been about two months since the 988 launch, and in terms of call volume, people are really beginning to utilize the offering to connect to behavioral health resources during their time in need. But at the state level, there is also the reality that not every geography has the same or is afforded the same resources to help support the demand right off the bat. Some are obviously a lot further ahead than others. What type of infrastructure or interoperability challenges do you feel some states might face at this stage of the roll-out?

To your point, different states are at various stages of maturity in terms of their crisis program preparedness. There are states who have never implemented statewide crisis management until now, and there are states who organically started the process by deploying crisis management tools even before  988 undertaking became a reality.

Because of these various degrees of maturity around the initiative, every state is depending on different tools and services to support their 988 efforts. These uniformity variations are often further exacerbated within each state, where organizations and agencies vary based upon region.

As states continue to move forward with their 988 rollouts, this means that the ability to consolidate and share patient information between these different technology platforms is going to be one of the biggest problems that we’ll continue to see. To effectively address this challenge, we will need greater interoperability and real-time care coordination between crisis management stakeholders to help individuals access expedited behavioral health crisis assessment and treatment.

Is there anything that you feel like all 50 states pretty much had covered in terms of preparedness?

At this stage, most states have an operator in place at crisis call centers to pick up the phone when the 988 call comes in. This is a promising first step, as a call center representative who’s available to talk with someone facing a behavioral health challenge is the key to success. In fact, it’s estimated that 75-80% of incoming calls can be deescalated by call center representatives.

For the rest of the incoming calls, however, operators should have access to additional resources such as the ability to dispatch mobile crisis teams and ensure callers get connected to the proper care when the need it most. Call center representatives should also be able to easily refer callers to inpatient and outpatient treatment facilities to get them the necessary care. Unfortunately, this back-end support varies greatly depending on each state’s crisis management infrastructure.

We’ve talked a lot about the behavioral health crisis at hand and infrastructure readiness at the state level. Let’s chat about Bamboo Health and the technology resources your team has purpose-built to support behavioral health initiatives.

At the core of our behavioral health IT portfolio is OpenBeds®, a solution which creates trusted, coordinated care treatment networks that can essentially act as a doorway into the referral system. To date, OpenBeds is in 14 states, and that number is growing. Bamboo Health’s footprint overall is large, and we really are the only healthcare organization offering a product of this caliber.

We also recently announced the launch of our Crisis Management System, which is built on OpenBeds and supports these crisis call centers at the regional level. This is accomplished by coordinating surges in 988 call volume when needed and expediting access to definitive assessment and treatment for those in crisis. It allows crisis call center staff to perform digital intake and assessment, as well as dispatch mobile crisis units, when necessary, to the individual in need. What I’m especially excited about is that through the Crisis Management System, state crisis response teams can now assess, follow, and manage an individual’s crisis journey from start to finish, and quickly iterate crisis care delivery using real-time data.

Why would you say Bamboo Health is an ideal technology partner?

For states looking for a 988 technology partner, Bamboo Health is an increasingly attractive option because we have people in the trenches who are already using our system today and they are successful. This means that states don’t need to wait months, or even years, to develop these capabilities. We have both the ability to jump in and start having an impact straight away and we also have a lot of experience working at the state-by-state level, with the ability to tailor our offerings to meet state-specific nuances and requirements.

You mentioned at the beginning of the call that working at Bamboo Health gives you the opportunity to make an impact. What are you most optimistic about when it comes to 988?

Let’s look at 911 for example. I don’t know if I’ve ever called 911, but it’s a number I know. It’s a number you don’t even have to think about, and you know exactly what that resource is when there’s an emergency. This is not currently the case with a behavioral health crisis.

As a result, when it comes to 988, I am most optimistic about its ability to shine a light on the crisis response in our country. Previously there were states who were more mature in the process, and they had hotline numbers and resources that you could call if you were facing a crisis. But it always seemed like a ‘nice to have resource’ versus a support system that should be front and center.

I’m looking forward to seeing elevated attention being paid to the crisis issue as well as awareness of resources to help. And, personally, I find myself being an ambassador for 988. While it’s not part of my formal job description, it’s exciting to be able to speak to it because now there is a place at the podium to talk about how our country addresses behavioral health needs.

Any advice you want to share for states looking to elevate how they are responding to the 988 mandate?

I think it’s important for states to remember that at the end of the day every government is going to approach 988 infrastructure readiness in their own way. They need to figure out what works best for their state from a financial as well as resource allocation perspective. As they look to navigate their behavioral health care coordination efforts in the months ahead, Bamboo Health is here to help!

For Additional Information

If you would like to learn more about 988 or how Bamboo Health can help support infrastructure development efforts for the national behavioral health lifeline, please check out our crisis management playbook.

Vatsala Kapur is the senior director of government affairs at Bamboo Health. In the latest installment of our 988 Q&A series, we sit down with her to discuss 988 preparedness at the state level and what needs to happen infrastructure-wise to make the initiative sustainable beyond the recent July 16^th launch.

Jump to:

• Previous experience with the government sector
• How often are conversations around 988 coming up?
• Where do you see states putting emphasis when supporting 988?
• Are there some states that simply have more fiscal resources to support the lifeline?
• Anything else keeping states up at night as it relates to lifeline preparedness?
• What’s the advice you would give to officials as they seek to navigate the 988 mandate?
• What does the initial 988 mandate look like? How has the federal government been helping?
• Are you having conversations with states that are forward-thinking about 988 sustainability?
• Are there any misconceptions about the 988 mandate that surprised you?
• Where does Bamboo Health fit when it comes to helping states comply with the 988 mandate?
• Anything else you want readers to know about 988 from a policy perspective?

Let’s talk a little bit about your journey to Bamboo Health. Can you tell us about your previous experience specific to the government sector?

I am passionate about improving health and healthcare, and more specifically, tackling care obstacles that are impacting underserved communities. The last decade of my career has reflected that mission. I’ve spent most of my professional life working in health and health IT policy, which included positions within two governor’s offices as well as with the U.S. Department of Health and Human Services.

I’ve found that when the industry is looking to overcome healthcare challenges, technology often is an afterthought. This is partly because health IT is not well understood. As a result, I developed an expertise in technology-related issues in the healthcare space, which ultimately led me to Bamboo Health. Today, I’m growing a team responsible for managing all government affairs work, supporting strategy with hospital associations and health information exchanges and working with state governments.

So, in your position you are often talking to healthcare policy leadership at the state level. How often are conversations around 988 coming up?

I’m hearing a lot about the 988 Suicide and Crisis Lifeline. I would say there is a spectrum of preparedness among states. Some states are meeting the letter of the law and others are focused on meeting the letter and the spirit of the law. This is often driven by the state funding environment, as states are considering how to find sustainability for their 988 systems.

Where do you currently see states putting the greatest emphasis when it comes to supporting 988?

Right now, a lot of states are focused on ensuring that the call centers are ready for additional call volume. Not many are thinking about creating an end-to-end system that helps to meet the holistic needs of this population, including dispatch and referral. A lot of states appear to be in wait-and-see mode right now because they’re trying to gauge what the call volume is going to look like.

My hypothesis is that over time – maybe over a few years – we’re going to see a diversion of calls from 911 to 988, and as a result, intake call volume will steadily increase. This should have a profound impact on how states invest in a system that supports these individuals over the lifecycle of their needs.

Let’s talk about 988 funding. Are there some states that simply have more fiscal resources to support the lifeline?

For starters, there is federal funding available to all states via the Substance Abuse and Mental Health Services Association (SAMHSA), but we are also seeing a lot of states exploring user fees to fund 988. It’s important to note that this isn’t a fee for calling into the hotline, rather it’s a small fee that’s added to cell phone subscriber bills. There are also some states that are exploring allocating funds from 911 and using them for 988 instead.

Anything else keeping states up at night as it relates to lifeline preparedness?

Besides call center staffing and lifeline funding, the biggest struggle states are starting to face is sustainability. States are wondering how they will get this initiative up and running, and then sustain it for years to come – just like 911.

It’s often difficult to recall that 911 only launched in 1968, and it’s taken decades to get the initiative where it is today. Given that, we can only expect the same with 988’s rollout. Luckily, it’s clear that the public supports 988. In fact, a recent poll conducted by the National Alliance on Mental Illness found that 89% agree that everyone, regardless of location or income, deserves access to quality mental health crisis responses and care. I think we’ll get there but we’ll need to have the funding in place and provide states with the time to determine how to best stand up their efforts.

What’s the advice you would give to officials as they seek to navigate the 988 mandate?

Anyone who’s had personal experiences with an individual in a behavioral health crisis knows that it is hard. We don’t have a holistic system for managing the needs of individuals with behavioral health conditions; rather, individuals and their caregivers oftentimes must cobble resources together.

My biggest suggestion to states is to take stock of their existing assets and infrastructure, both in terms of the call center capability as well as their referral network. Then, I’d urge them to think from a systems perspective about how to bring all the necessary infrastructure together in a patient-centric way.

More specifically, they should be looking at managing the patient referral process so it’s more streamlined and transparent. States can play an important role in helping create more systematization for when, where and how to get individuals the care they need when they need it.

I also think it’s important for states to tap individuals that have personally been in crisis and gain their perspective about what works and what doesn’t, so that whatever system is ultimately put in place is responsive to the needs of the individuals calling into 988, those staffing the call centers, and everyone else that touches that individual.

So what does the initial 988 mandate look like? How involved has the federal government been to help states prepare?

To date, the federal government has been giving states latitude in terms of implementation of 988 while also providing best practices, toolkits and other resources. That means every state from Alaska to Alabama is going to look different in terms of their 988 readiness. There are many states that have a lot of rural and frontier counties where access to behavioral health services was an issue even before 988 and those issues can’t be fixed overnight.

In your role at Bamboo Health are you having conversations with states today that are really forward-thinking about longer term 988 sustainability?

Bamboo Health recently partnered with two states to help them plan for their longer-term crisis responses. Further, all the states we have been partnering with are looking ahead. For example, many are determining how to sync 988 with their pre-existing 211 number, which helps people access social services in their area.

Are there any misconceptions about the 988 mandate that surprised you?

Leading up to July 16, some people thought that a switch would be flipped, and everything was going to operate seamlessly. Obviously, states have now learned that it’s not going to happen that fast, just as it didn’t with the implementation of 911.

Today, we take the 911 system for granted – when someone calls, dispatch happens quickly and expeditiously, but it took years for that to become the reality. From a government standpoint, I feel like there needs to be more of a policy construct or requirements tied to SAMHSA funding to really push states to think about all the infrastructure and be able to plan and pay for those needs holistically.

So where does Bamboo Health fit when it comes to helping states comply with the 988 mandate?

Bamboo Health can be part of the longer-term solution to help states stand up a successful 988 program and continue it for years to come. With Bamboo Health’s Crisis Management System, 988 call centers are able to quickly identify resources and mobile response teams, and help facilitate individuals receiving the care they need, at the right time.

As a technology provider, we have gained extensive experience. We’re currently working with 14 states, as they navigate the behavioral health resource delivery landscape. As a team, we’ve learned a lot about what works, what doesn’t and what challenges states consistently face. We are well-positioned to support states in their 988 response and be thought partners in optimizing existing and planned resources.

Anything else you want readers to know about 988 from a policy perspective?

From a policy perspective, 988 is momentous. It is a bipartisan issue, one of the few that cut across the current divide in Washington D.C. As an industry, I believe we have an opportunity to positively impact our nation’s growing behavioral health challenges. However, as a first step we need to offer more assistance to states as they try to navigate the best path forward, including funding. The federal government can play a role in that, and we can, too.

For Additional Information

If you would like to learn more about 988 or how Bamboo Health can help support infrastructure development efforts for the national behavioral health lifeline, please check out our crisis management playbook.