988 currently doesn't use geolocation services. Counties want to change that.

Federal agencies are working with the nation’s major wireless carriers to resolve an issue with the 988 Suicide and Crisis Lifeline that can lead to those seeking help being sent to call centers thousands of miles away from where they actually are.

The issue is over how callers to 988 are being routed to counselors. Currently, people dialing into the hotline are sent to a call center based on their area code, not on where they are physically calling from.

The Substance Abuse and Mental Health Services Administration, or SAMHSA, has been working with the Federal Communications Commission and cellphone carriers like Verizon to test routing calls based on where a person in crisis is generally located. To protect their privacy, their exact location is not being given to call centers. 

The timeline for implementing this change, which the nation’s counties are pressing for, is uncertain. But once the tests are completed, according to SAMSHA, the use of “geolocation” in routing calls will be phased in “gradually.”

In the meantime, the National Association of Counties is pushing for a bill in Congress that would require 988 calls to be routed based on location. It’s unknown if and when the legislation will be taken up, but if approved, it would go into effect within 90 days.

The issue, according to Rob MacDougall, director of emergency services for Johnson County, Kansas, is that a call center in Kansas isn’t equipped, for instance, to connect someone in Florida to the services and help they need.

His county’s call center received such a call from a woman who had moved to Gainesville, Florida, but still had a phone with the county’s 913 area code.

“She had had a pretty traumatic incident,” MacDougall recalled. “She was just really distraught, having some distorted thinking. She was very emotional on the phone, and so it took some time for a call taker to get an idea of what was going on and engage.”

The counselor considered transferring the woman to a call center in Gainesville, but that would have meant the woman would have had to describe her situation again. 

“It had taken some time to establish rapport with her, and she was pretty acute,” MacDougall said. “We were not feeling that the best thing to do was make her reiterate her story. That's not the best treatment for somebody who's struggling.”

What’s more, the call center in Johnson County couldn’t be certain the call would go through to someone in Florida. 988 hotlines in many states are still working out technical kinks or struggling with staffing, which can lead to wait times or not reaching a counselor at all. 

In Florida, the distraught caller would have likely sat on hold for an average of 32 seconds, according to SAMHSA data, although that is better than the national average of 39 seconds. 

But there is a chance that no one would have picked up her call. In January, 14% of calls to the Florida 988 hotline went unanswered, either because the caller decided to hang up or got cut off due to a technical issue. Only 8% of callers in Kansas did not get through, and 12%, or 1 in 8, nationally.

Ultimately, the Johnson County call taker started texting with another staffer, who began Googling what facilities were available in Gainesville. The staffer found a hospital near where the call was coming from, called the facility and said, “Hey, this is what we got. Is this an OK place for somebody to go to?”

Once it was confirmed the distraught woman could be sent there, the call taker asked to talk to her mother and told her where they could go.

“We were able to confirm with the mom an hour or two later that [her daughter] was in the hospital,” MacDougall said. “It was a really good outcome.”

The Johnson County call center keeps records of all the calls they receive, including where it has referred people and if a person sought treatment. So if someone that has called in the past, calls again and is routed to, say, Florida, a call center counselor there wouldn’t know anything about their past, including whether they a person seeking help has threatened to harm people in the past. 

“When somebody's calling from another community, and maybe they've lived there for a long time, we’re most likely going to be blind information-wise,” MacDougall said. “I’m sort of on a soapbox about this because I’m so frustrated.”

The issue is important to counties not only in Kansas but around the nation because they are on the front lines of providing mental health care, said Mark Ritacco, chief government affairs officer for the National Association of Counties. 

In addition, he said, county officials want to be seen as “trusted messengers to their communities. So they would be hesitant to market 988 as a place where you can get help if they aren't sure that you'll be connected with the things that can help you. If 988 isn't seen as a reliable thing to do, then that removes one of the tools from our toolbox.”

In September, FCC Commissioner Jessica Rosenworcel wrote to AT&T, T-Mobile, Verizon and the wireless trade association urging them to “take the necessary steps to identity and develop a 988 georouting solution.”

She noted in the letter that on average someone in the U.S. commits suicide every 11 minutes. “Last year, getting help got a lot easier when we implemented 988 as the easy-to-remember, 3-digit number for the 988 Suicide and Crisis Lifeline. But more can be done to ensure those in need can reach local resources for mental health support," she wrote.

Shortly after the letter was sent, three major carriers serving 95% of the nation’s customers had begun working with SAMHSA and the FCC to test changes in how the calls are routed based on geolocation.

“The goal is to help people in crisis reach support local to the state or territory they are calling from, regardless of their phone number’s area code, while taking into consideration the privacy and security of callers,” SAMHSA said in a statement to Route Fifty. 

The counties, meanwhile, are hoping Congress will go further. They are urging lawmakers to pass the bipartisan bill, sponsored by Rep. Tony Cardenas, a California Democrat, that would require calls be routed based on location.

“If I called 988 from Washington, D.C., I would be speaking to someone based in L.A. This is a huge problem if a call center needs to send a mental health response team to help a caller that might be thousands of miles away in another city,” Cardenas said in a press release.

Ritacco is hopeful that Congress would eventually pass the bill. “It’s not a red or blue issue,” he said. “I think more members of Congress will see that it's an issue in their community.”