New Report Examines How 911 and 988 Can Better Coordinate to Deliver Crisis Care

The University of Chicago Harris School of Public Policy today announced the release of a new report from the UChicago Health Lab, “Inform988 Voices from the Field: A Report on 911 and 988 Interoperability,” examining how the two hotlines can better work together to provide relief from distress, with key systemic and training recommendations for reform.

“This report reflects what we have heard consistently from practitioners: while 988 represents a critical investment in mental and behavioral health crisis care, its success depends on how well it works alongside 911,” said Rebecca Neusteter, executive director of the UChicago Health Lab. “Working together, 911 and 988 can ensure that people in crisis can access appropriate, effective, and safe care no matter which number they call.”

The report is grounded in the work of the Inform988 Community of Practice and Engagement (COPE), a multidisciplinary group of 911 and 988 practitioners, government representatives, researchers, and advocates who met regularly from 2023 to 2024 to identify challenges and opportunities at the intersection of the two systems.

Each year, at least 240 million calls are made to 911 in the United States. While 911 serves as the primary gateway to emergency response, the report notes that many calls involve needs for care such as mental and behavioral health crises that fall outside traditional emergency response categories.

In response to these needs, 988 was launched nationwide in July 2022 as a dedicated mental health crisis hotline. The report emphasizes that “the future success of 988 hinges…on understanding the ways in which 988, 911, and other hotlines work together.”

Public awareness of 988 remains limited, with about 1.2 million calls from 2022 to 2025, but utilization is increasing, creating both an opportunity and a challenge for systems tasked with responding to growing demand.

Based on extensive discussions and analysis, the report identifies three primary categories of challenges to effective coordination between 911 and 988:

• Human-level challenges, including lack of trust between agencies and communities, fear of liability among call takers, and limited collaboration
• System-level challenges, including staffing shortages, accessibility gaps, and inconsistent standards and protocols
• Technology-level challenges, including difficulties with geolocation, call transfer systems, and data sharing across different regulatory frameworks

The report finds that these challenges are rooted in the fact that “911 and 988 systems were designed to operate largely independently,” creating barriers to seamless coordination.

“The barriers to coordination between 911 and 988 are not just technical,” said Sarah Scaffidi, senior research manager at Health Lab. “From staffing and training to trust and clear protocols, the details of how these systems interact matter enormously. This report offers practical lessons that agencies can use right now to strengthen how they respond to people in crisis.”

In addition to identifying challenges, the report highlights emerging practices and strategies that can improve coordination between systems. These include:

• Developing clear protocols for transferring calls between 911 and 988
• Investing in workforce training and support to prepare staff for collaboration
• Strengthening relationships and trust between agencies through ongoing engagement
• Improving technology to enable more seamless call transfers and appropriate data sharing

The report also advances a shared goal, adapted from prior Health Lab work, of ensuring that “any person in crisis has around-the-clock access to appropriate care…regardless of where the call was received.”

The report is intended as a resource for 911 emergency communications centers, 988 call centers, policymakers, and others working to improve crisis response systems. It outlines how agencies can use its findings to assess their current practices, guide interoperability efforts, and inform future policymaking at the local, state, and national levels.

It also identifies key questions for future research, including how to increase appropriate call transfers, improve data sharing, support workforce capacity, and build trust in crisis systems.