Since the 988 Suicide and Crisis Lifeline—the national mental health emergency hotline—launched in 2022, an area of focus has been 988/911 interoperability: the existence of formal protocols and procedures that allow the transfer of calls from 988 to 911 and vice versa. This report presents case studies from three jurisdictions that have established models of 988/911 interoperability, including lessons learned from planning and implementation.

The Road to 988/911 Interoperability

Three Case Studies on Call Transfer, Colocation, and Community Response

Stephanie Brooks Holliday, Samantha Matthews, Wendy Hawkins, Jonathan H. Cantor, Ryan K. McBain

ResearchPublished Mar 20, 2024

The 988 Suicide and Crisis Lifeline—known more simply as 988—holds promise for significantly improving the mental health of Americans and accelerating the decriminalization of mental illness. However, the rapid transition to 988 has left many gaps as communities scramble to prepare—not the least of which includes determining how 988 will interface with local 911 response systems and law enforcement. 911 is often the default option for individuals experiencing mental health emergencies, despite the fact that 911 call centers have limited resources to address behavioral health crises. Since 988 launched in 2022, one key area of focus has been ways that jurisdictions approach 988/911 interoperability: the existence of formal protocols, procedures, or agreements that allow for the transfer of calls from 988 to 911 and vice versa. This report presents case studies from three jurisdictions that have established models of 988/911 interoperability. It provides details related to interoperability in each model, including the role of each agency, points of interagency communication, and decision points that can affect the way a call flows through the local system. It also identifies facilitators, barriers, and equity-related considerations of each jurisdiction's approach, as well as lessons learned from implementation. This report should be of interest to jurisdictions that are looking to implement 988/911 interoperability, including those that are spearheading local initiatives and those that are responding to state-level legislation. Its findings are relevant to 988 call centers, public safety answering points, mobile crisis units, law enforcement, and local and state decisionmakers.

Key Findings

  • In two of the three sites, the 988 call center was located separately from the 911 call center or public safety answering point. The third site had 988 and 911 call centers colocated in the same facility.
  • Each site described the key decision points that governed the transfer of calls from 988 to 911 and vice versa. These decisions centered around the likelihood of risk of harm to the caller or other people.
  • When behavioral health calls are handled by 988, the majority are able to be resolved by phone; for example, one site reported that 97 percent of calls were resolved by phone. However, some cases require an in-person response, and jurisdictions had a variety of in-person options, including mobile crisis units, traditional law enforcement officers, Crisis Intervention Team–trained law enforcement officers, co-response teams, and peer support teams.
  • Although sites varied with respect to their specific resources and models of 988/911 interoperability, there were some cross-site findings related to effective planning and implementation. For example, planning and implementation should be collaborative, engaging a variety of contributors. Entities involved in planning should focus on developing shared language and mutual respect, even when their cultures differ.
  • Having a local champion for 988/911 interoperability is an important facilitator for planning and implementation, though the background of the champion may vary across jurisdictions.
  • 988/911 interoperability requires more than protocols for transferring calls between 988 and 911. It also must be considered within the larger continuum of crisis services available in the community.

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RAND Style Manual

Holliday, Stephanie Brooks, Samantha Matthews, Wendy Hawkins, Jonathan H. Cantor, and Ryan K. McBain, The Road to 988/911 Interoperability: Three Case Studies on Call Transfer, Colocation, and Community Response, RAND Corporation, RR-A3112-1, 2024. As of May 1, 2025: https://www.rand.org/pubs/research_reports/RRA3112-1.html

Chicago Manual of Style

Holliday, Stephanie Brooks, Samantha Matthews, Wendy Hawkins, Jonathan H. Cantor, and Ryan K. McBain, The Road to 988/911 Interoperability: Three Case Studies on Call Transfer, Colocation, and Community Response. Santa Monica, CA: RAND Corporation, 2024. https://www.rand.org/pubs/research_reports/RRA3112-1.html.
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This research was sponsored by The Pew Charitable Trusts and conducted in the Justice Policy Program within RAND Social and Economic Well-Being.

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