DOH prepares for new Hawaii CARES contract and 988 implementation


Nicole Pasia


The Behavioral Health Services Administration (BHA) under the Department of Health is working to update and improve its one-stop shop behavioral health crisis response system, Hawaii CARES. Improvements will help the administration prepare for the implementation of the nationwide 988 suicide prevention hotline later this year.


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Starting next month, the Adult Mental Health Division (AMHD) under BHA will begin a new contract with CARE Hawaiian outpatient mental health services providerto operate the state’s existing crisis line. CARE Hawaii will receive approximately $2 million to staff the program over the next year. The University of Hawaii, which is the current operator, will continue to staff the crisis line until its contract expires at the end of this month. 

AMHD Chief Administrator Amy Curtis, Ph.D., MPH, said there should be no interruption in services for callers during this transition period. While callers still only need to call one number, the new contract will allow the crisis line to better respond to the variation in callers’ needs, which can range from a general inquiry about available  services to being in crisis and in need of an immediate response. 

“The person who answers a phone and is helping someone who’s in crisis, that can be a different mode than taking very detailed information for an assessment to determine what level of care you might need,” Curtis said. “Those are two different tasks. We wanted to make sure and really highlight, with 988 coming out, the needs of those that are in crisis. But we also still want people to be able to call one line.” 

Curtis added that people in crisis may have difficulty reaching a responder if other calls in the queue involve longer behavioral health assessments. Under the new contract, crisis line operators can more seamlessly forward non-crisis calls to other resources to respond more quickly to those in immediate crisis.

Operating a crisis line that responds to such a wide range of behavioral health needs requires a well-organized technological and responder infrastructure. According to Curtis, part of the reason she expects a seamless transition for both the new contract and 988 implementation is because Hawaii’s crisis line has been in place for years. The state first established its call center in 2002 and began taking calls from the National Suicide Prevention Lifeline in 2007, before rebranding as Hawaii CARES in 2019. 

“We are actually, as a state, much ahead of other states. We’ve had crisis mobile outreach units available in all of the counties. We’ve had a 24/7 crisis line across the state for many years, but for some states, they’ve had to develop this [crisis line system].”

Call operators are required to have education in the human services field and work experience in the behavioral health field, with an emphasis on working with adults and youth with severe mental illness or emotional and behavioral issues. They also undergo extensive training prior to taking calls, which include crisis assessment intervention, suicide risk assessment, cooccurring treatment (of both substance use and mental illness) and trauma-informed care. 

Curtis said AMHD is also working to expand its crisis response, such as adding more crisis stabilization beds. Currently the program has these beds on the Big Island and Oahu, but plans to expand to up to 40 beds statewide. 

To reach Hawaii CARES, call (808) 832-3100 or 1 (800) 753-6879 (toll-free).