During the oversight hearing with the Guam Behavioral Health and Wellness Center on Wednesday, officials from the 988 Lifeline and Mobile Crisis Response Team shared a couple of stories of real-life calls they have responded to, stressing that they are examples of how their services have helped reduce the load on other first responders.
In the first case, a person called 988 and disclosed that they were “standing on a cliff.” Within minutes, MCRT was on the scene and de-escalated the situation. The second call involved a person at the edge of a high-rise apartment, 17 stories up.
“While on the line with 988, they were able to talk to them while MCRT was en route to meet them where they were at and able to de-escalate the situation, contact the on-call consultation for the doctors, (and) then transport them to GBWHC,” Joshua Pangelinan, care coordinator with MCRT, said.
According to Jesse Libby, 988 project director, neither call involved the Guam Fire Department or the Guam Police Department, which before 988 absorbed all calls.
“In fact, we diverted those individuals from the emergency rooms,” he said.
Part of the reason, the response is executed quickly is that the 988 Lifeline and MCRT are co-located. It’s a model that Libby said has drawn national attention.
“My colleagues and I recently were interviewed by the National Mobile Crisis Network, and they were talking to us about the design of how we have our 988 and MCRT co-located,” Libby said. “We are so ahead of the game. Other states and jurisdictions have completely different models of how they operate their crisis interventions.”
Libby shared that the co-location model allows 988 lifeline specialists to pivot quickly and call in MCRT professionals into the center for a live three-way call with the help seeker when a call can’t be de-escalated.
“Having a person respond on the ground and directly have consultations with the doctor, we were able to bypass a lengthy, lengthy medical screening process from an already overburdened emergency room,” Libby said, noting their effectiveness.
GBWHC Deputy Director James Cooper-Nurse estimated the crisis diversion to be saving hundreds of thousands in ER costs to the patient.
“We’re estimating roughly $4,000 for an emergency room visit to include mobile medical transport. So if we take that figure times the 162 resolutions, we’re looking at mobile crisis 988 … saving roughly $668,000 from emergency room visit costs alone,” Cooper-Nurse said. “The community is starting to already learn that this is a valuable service to them. We wanted to highlight that there are actual dollar figures connected to what diversion attributes to.”
Joshua Pangelinan, care coordinator, shared that from June 2024 to the end of that fiscal year, the MCRT has had a total of 213 activations; 162 of those activations led to “safe resolutions,” while 51 activations required GPD or GFD intervention.
“76% of our responses are considered diversions from GPD or arrest. And in the past two fiscal years, we have estimated 141 activations,” Pangelinan said. “Just for this fiscal year, we surpassed the amount of activations at 167 … compared within three quarters of this fiscal year, compared to our previous two fiscal years.”
As of June 3, he reported a total of about 308 activations.
“75% of responses are considered diversions and 232 safe resolutions and 76 needed higher intervention,” he said.
Libby said 988 is 100% federally funded through two Substance Abuse and Mental Health Services Administration, or SAMHSA, grants, which will sunset at the end of this fiscal year.
“However we are anticipating the release of the funding announcements from SAMHSA so we can reapply for the next cohort,” Jesse Libby, project director of the 988 lifeline, said, characterizing it as a normal process.
The 24/7 service offers free, confidential access to trained lifeline specialists who help people experiencing mental health-related distress like suicide ideation, mental health or substance misuse crisis, or emotional distress.
“The scope of 988 services: we offer safety screening, suicide screening, (and) wellness planning. We also offer de-escalation, safety planning, (and) referrals to community services depending on the needs at the moment, and we serve as the activation point for MCRT and also referrals and warm transfers to GFD and GPD,” Libby said.
He stressed that Guam consistently exceeds Vibrant/SAMHSA’s 90% in-state answer rate benchmark.
“Guam ranks among the top ten states and territories for the highest in-state answer rate,” Libby said.
Not only are more calls being answered locally, but GBHWC also reports a high effectiveness rate for the Lifeline.
Approximately 97% of incoming calls to the 988 lifeline are successfully de-escalated at the call center level, without requiring transfer to MCRT or emergency services such as GPD or GFD.
“We’re reducing system utilization because if 988 wasn’t in existence, the calls would traditionally be answered by (the) police department or Guam Fire Department, so we’re happy to be at the table and take those calls for them,” he said.
In total, 3,865 calls were received as of May; he said this puts the 988 lifeline on a track to exceed fiscal year 2025, which was reported as 5,627 calls for the year.
“If you see in the total calls, we receive quite a number of calls to our crisis hotline, and the intensity of the calls from my time as project director of 988 has increased, and I can attest to that,” Libby said.
For 988 lifeline chat and text, which are other 988 access points, Libby said, “What’s interesting about this (is that) nationally, text is the second (most) popular method of reaching out, and for Guam we are currently in reverse. Individuals like to reach out through chat and text and simply because chat offers anonymity to help seekers.”
Libby reported that the chat and text line received 1,020 messages in less than six months, which points to a strong uptake trend.