Washington State

Washington State 988 Implementation Support

Practice Area: Behavioral Health Scope: State Location: WA Status: Closed

Project Overview

In preparation for 988 hotline implementation as required by the National Suicide Hotline Designation Act of 2020, Washington State partnered with Third Sector to perform a landscape assessment exploring the features of a successful, culturally, and linguistically competent crisis response and management system.


In America, we have not been able to successfully address the various behavioral health challenges we are all grappling with. As a result, we have not yet built a sufficiently robust service delivery system to support our greater social, mental, and emotional well-being. In the fall of 2020, the federal government passed legislation to address one component of this crucial service gap, the National Suicide Hotline Designation Act of 2020, requiring all state telecommunications services to implement 988 for mental health emergencies, including suicide. This new hotline is intended to provide people in crisis with the live support they need. However, setting up systems is only one part of the equation. States had to think holistically about creating processes and procedures to coordinate 988 calls with local services and ensure that callers with the most severe mental health needs didn't fall through the cracks. 

Washington State has a diverse population and wanted to take the hotline mandate a step further by passing H.B. 1477. In Washington, suicide rates are higher among American Indians/Alaska Natives than among the general population, while criminal justice involvement and interactions with law enforcement is disproportionately higher within BIPOC communities due to systemic injustices, including violent responses by police to those experiencing a mental health crisis. H.B. 1477 takes a community-first approach, envisioning a statewide crisis response system that provides culturally and linguistically competent services to save lives and stabilize individuals in crisis in the community using the least restrictive means possible.


In preparation for 988 implementation in Washington State, Third Sector partnered with the state to explore the features of a successful crisis response and management system that would allow the state to meet the requirements of the National Suicide Hotline Designation Act of 2020 and H.B. 1477. To develop this landscape assessment, Third Sector staff conducted a literature review, as well as desk research about the current crisis response systems in Washington and other key states, including systems that have developed culturally and linguistically competent services aimed at especially serving BIPOC populations. Third Sector staff also interviewed key informants within the current behavioral health and crisis responses systems in Washington and other states, as well as software vendors currently providing services or able to provide services to crisis response systems.


The report provided Washington State with a landscape assessment for the current state of its crisis call center systems, exemplars in 988 and crisis call centers nationwide, and technology vendors with software that could meet the requirements of HB 1477 and provide other benefits to the state’s crisis call systems. Additionally, Third Sector developed the following recommendations based on our research: 

  • Outcomes Measurement: Adequately measuring outcomes can help ensure that any changes to an existing behavioral health system lead to improved suicide prevention and mental health crisis response.
  •  Integration with Existing Crisis Response Systems: Crisis line providers, first responders, and behavioral health care providers should all be consulted when designing and launching a statewide crisis response line so that existing referral pathways and local expertise are effectively leveraged.
  • Equity & Cultural Competency: States should consider how to best address existing disparities based on race, ethnicity, geography, and gender when designing 988 crisis response systems. In particular, the state should consider how to best work with tribal communities, which may have fewer resources and experience disproportionate suicide rates nationwide, and support their existing crisis response teams. 
Practice area:

Behavioral Health

Third Sector works with communities and our government agencies to transform how we deliver mental and behavioral health services to support people’s recovery and well-being.
Project NameScopeLocationStatus
Incorporating Consumer Voice in Outcomes Design & System ImprovementsCountyCAActive
Sutter-Yuba’s iCARE Innovation Project seeks to increase access to behavioral health care for underserved groups not currently engaged in traditional behavioral health services. Third Sector is supporting outcomes framework design and outcomes impact assessment for iCARE by soliciting and integrating input from consumers to both inform continuous improvement efforts and contribute to consumer-defined recovery metrics.
Designing Outcomes-Focused Mental Health Services in Los Angeles CountyCountyCAClosed
Third Sector partnered with the Los Angeles County Department of Mental Health (LACDMH) to transform approximately $300 million in service provider contracts, creating the nation's largest system of outcomes-focused mental health provider contracts. This multiyear, data-driven process focused on LACDMH's Full Service Partnership program, which supports a "whatever it takes" approach to caring for individuals with the most challenging mental health needs. As a result, LACDMH was able to deliver better outcomes for the more than 15,000 clients they serve each day.
Practice Area Managing Director of Behavioral Health