Q&A: Hawaii DOH Community Programs Supervisor discusses state’s transition to 988 crisis line, increased call volume


Shane Ersland


Hawaii implemented its 988 crisis response line in July to provide more efficient access to those in need of assistance during mental health or suicide crises. Individuals with an 808 area code can now call 988 to connect to the Hawaii Department of Health’s (DOH) Hawaii CARES crisis line to access crisis support services.

The three-digit number provides a quicker process for those in need of crisis services than the state’s 808-832-3100 and 800-753-6879 options, which residents can continue to use. Hawaii CARES received 101,151 calls in 2021. DOH Community Programs Supervisor Belinda Danielson discusses the state’s transition to the 988 line in this Q&A.


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State of Reform: Could you discuss some of the benefits the new service has offered Hawaii residents since it was rolled out? 

Belinda Danielson: “The immediate and obvious benefit is the simpler number to remember, from 10 digits to 3 digits. For the state, this allowed for chat and text services where previously only text was available via a partnership with the Crisis Text Line. Now, chat and texts are both responded to by the local call center.  

These modes of communication are a tremendous benefit to the youth and young adults who may prefer these methods as opposed to calling, and more importantly for our hearing and speech impaired residents to reach out for help.  

The conversion to 988 has signified how much suicide prevention, mental health, and substance use concerns have been prioritized across the country. This has highlighted the national effort for awareness, training, and access to a broader array of crisis services to include someone to talk to (the crisis call center), someone to respond (crisis mobile outreach), and a safe place for help (stabilization services), which Hawaii has had in place for more than a decade.”

SOR: Have there been any notable challenges in implementing the 988 initiative? 

BD: “There have not been any noticeable challenges for the state because of the simple fact that there was an existing partnership with the National Suicide Prevention Lifeline. The [conversion] to 988 was seamless.”

SOR: How has the implementation of 988 affected the DOH? 

BD: “For the DOH, it has provided funding opportunities through federal grants for workforce and infrastructure development, staff training, and formalized partnerships. There has been tremendous national resources and technical assistance [available] for clinical best practices, policies and procedures, and data collection to include key performance indicators.”

SOR: Could you provide a brief overview from an operational perspective, including how many call centers operate the line and the size of the staff? What type of training do staffers receive? 

BD: “For Hawaii, there is one statewide call center, Hawaii CARES, that handles both calls that are routed through 988 and the local crisis call center numbers [808-832-3100 and 800-753-6879]. The center has a staff of over 30 crisis counselors.  

The crisis counselors are required to receive extensive training that includes, but is not limited to, topics such as crisis assessment and intervention, suicidal risk assessment, suicide facts, suicide prevention and intervention, homicidal assessment, integrated co-occurring mental health and substance abuse treatment, mental health facts, serious mental illness diagnoses, commonly used psychotropic medications, motivational interviewing, effects of trauma on emotional and psychological development, and trauma-informed care.  

Training is also required regarding special considerations for specific sub-populations such as children and adolescents, LGBTQIA-plus, service members, veterans, and family members.”

SOR: Has the state seen an increase in callers needing help with crises since 988 was implemented? If so, do you think that is related to the new number being easier for residents to remember? 

BD: “For 988, there has been a 43% increase in call volume in comparison to last year at the same time. We do believe the ease of the number, as well as national media campaigns about the 988 line, most likely account for the increase in calls to 988. 

Overall, calls to Hawaii CARES for all behavioral health needs, including behavioral health crises, have only increased slightly during the same time period, consistent with more individuals in behavioral health crisis in Hawaii using the three-digit number versus the 10-digit line.”

This Q&A was edited for clarity and length.