Sarah calls 988 from Casper on a Tuesday evening, overwhelmed by suicidal thoughts. The counselor at Central Wyoming Counseling Center uses a structured suicide risk assessment, creates a detailed safety plan with specific coping strategies, and connects her with the partner organization for a wellness check within two hours.
Three weeks later, Sarah’s brother calls 988 from Laramie in a similar crisis. Wyoming Lifeline answers. He receives the same compassionate, evidence-based support and a comprehensive safety plan. Still, the counselor connects him with a local therapist for a next-day appointment and provides information about a peer support group that meets weekly.
Both received excellent, life-saving help. Both counselors were skilled and caring. But should the pathway to recovery and the resources offered depend on which center happens to answer?
This scenario illustrates the challenge facing Wyoming and 31 other states operating multiple 988 crisis centers. While different resource connections aren’t necessarily problematic, the lack of standardization makes it impossible to ensure equitable access to the whole network of crisis services statewide or to measure and improve quality consistently.
In a significant step toward improving mental health crisis services, the Wyoming Department of Health, Behavioral Health Division (WDH BHD), has partnered with Behavioral Health Link (BHL) to develop a comprehensive 988 Standard Operations Manual. This collaboration addresses Wyoming’s pressing mental health needs while establishing consistent, evidence-based crisis response services across the state’s two 988 crisis centers: Central Wyoming Counseling Center and Wyoming Lifeline.
Whether you’re a state mental health commissioner, crisis system leader, or 988 center director, this case study offers a proven roadmap for ensuring every person in crisis receives consistent, high-quality care.
The 988 Consistency Challenge Facing States Nationwide
The national 988 Suicide & Crisis Lifeline represents a historic commitment to mental health crisis response, but its implementation reveals a critical challenge that few states want to acknowledge: consistency. Every 988 center (more than 200 nationally) has its own crisis protocols, procedures, training, organization structure, and local challenges. This fragmentation makes consistency in crisis response across the country difficult to achieve.
While research shows the 988 Lifeline to be effective1, reports2 and individual 988 experiences3 describe situations which, at best, are not helpful, and at worst cause harm. These anecdotes impact people’s comfort and confidence with using 988, and the more centers deviate from best practices, the further users may be negatively affected.
The National Consistency Gap
The 988 Lifeline faces several challenges with consistency, including:
- Individualized system design: each center determines how to structure and fund its 988 response. This means the scope of services, staffing models, and coordination with local resources can vary widely.
- Multiple call centers with different practices: differences in policies, staff training, technology platforms, and call handling protocols can lead to uneven experiences for users.
- Workforce and staffing challenges: high turnover, staff shortages, and the need for specialized training make it hard to maintain the same level of service quality across centers.
- Rural vs. urban challenges: rural communities often lack behavioral health providers and crisis response infrastructure, making it harder to connect people with local resources compared to urban areas.
- Integration with broader crisis systems: some states have strong linkages between 988, mobile crisis teams, and crisis stabilization units, while others are still building those connections. The level of integration significantly affects how consistent the caller’s experience is.
Why Wyoming Couldn’t Ignore This Challenge
Wyoming faces mental health challenges that exceed national averages, particularly concerning suicide rates. The state has successfully implemented 24/7 in-state 988 crisis coverage, with its two centers, Central Wyoming Counseling Center and Wyoming Lifeline, answering over 90% of Wyoming’s in-state crisis calls. This is a remarkable achievement that many states have yet to accomplish.
However, having two independent centers serving the same population presented a consistency problem. Without standardized operational procedures, Wyoming residents could receive different service levels, intervention approaches, and resource connections depending on which call center answered the call.
This inconsistency wasn’t just an operational inefficiency for Wyoming’s small population spread across the nation’s 10th largest state by area. It was a potential life-or-death issue. The state’s Behavioral Health Division recognized that maintaining quality and consistency across both facilities required a proactive solution.
A Comprehensive Framework for Crisis Response
Recognizing that standardization requires both national best practices and local expertise, Wyoming partnered with BHL to create a comprehensive 988 standard operations manual. The Wyoming 988 Standard Operations Manual, developed collaboratively by BHL, WDH BHD, and over 20 key stakeholders, including both 988 centers in Wyoming, provides a detailed operational framework organized into six essential chapters which addressed the foundation for quality crisis center care, key policies and procedures to meet accreditation requirements, training and supervision standards, workforce support, technology, and data. In addition, the manual’s key resource is its appendix list, which includes draft Memorandums of Understanding (MOUs), job descriptions, training and data resources, and policies and procedures to help reduce administrative burden on the 988 centers and increase consistency.
Using the 988 Standard Operating Manual
BHL, a national leader in behavioral health crisis systems, has partnered with states across the country to design, strengthen, and align crisis operations. In collaboration with the WDH BHD, this project focuses on developing tools and procedures that enable both crisis centers to operate seamlessly, share resources efficiently, and ensure equitable access to care statewide. Creating a 988 Standard Operating Manual demands a deep understanding of the dynamic crisis response landscape. To build a guide that promotes consistency and quality across centers, BHL combined local stakeholder interviews and surveys with a thorough review of materials from current 988 providers. This was further informed by an extensive analysis of national best practices, standards, and operational models. The resulting framework integrates evidence-based approaches with the unique needs and strengths of Wyoming’s centers, and offers clear, practical guidance to help ensure every help seeker receives the same high standard of compassionate, effective care, no matter where they call from.
The Lifeline Program Coordinator, Katrina Ferrell from CWCC, shared, “I think it is great that processes have been streamlined for consistency. It will also be very advantageous to have consistent and compliant documentation.” Other feedback also received was how advantageous this manual is for helping with accreditation requirements. Alicia Johnson at WDH BHD is most excited about how it will impact the state. She shared, “The project will allow Wyoming to provide consistent services and build local trust and support for the 988 network.”
The Future of Crisis Coordination
The development of this comprehensive operations manual represents more than just standardized procedures; it reflects Wyoming’s commitment to evidence-based, trauma-informed crisis response that meets the unique needs of its residents. Wyoming is positioning its 988 centers to provide consistent, high-quality crisis intervention services by establishing clear operational guidelines, training requirements, and community partnership frameworks.
As both crisis centers implement the standards outlined in the manual, Wyoming residents experiencing mental health crises will benefit from coordinated, professional support regardless of which center they reach. The manual’s emphasis on continuous quality improvement ensures that services will evolve based on data, feedback, and emerging best practices.
The Wyoming 988 Standard Operations Manual stands as a model for states seeking to establish robust crisis response infrastructure while maintaining the flexibility needed to serve geographically dispersed and diverse populations.
Key Considerations for Multi-Center States
If your state operates multiple 988 crisis centers, a standardized 988 operations manual may benefit your system if you’re experiencing:
- Inconsistent caller experiences based on which center answers
- Difficulty measuring system-wide performance due to different data collection methods
- Accreditation challenges with centers at different compliance levels
- Inefficient resource allocation because centers aren’t sharing best practices
- Staff training inconsistencies that impact service quality
The Wyoming model demonstrates that standardization doesn’t mean losing local flexibility, it means ensuring all centers have access to the same evidence-based tools while adapting to community-specific needs.
Ready to Improve 988 Consistency in your State?
People in crisis who use 988 in your state deserve consistent, high-quality care, regardless of which center is answering. Don’t let lack of consistency cost lives, waste resources, and frustrate users of the 988 service.
Get A Free Consultation to see if this resource may be beneficial to you.
Continue Your Crisis Coordination Education
📖 1: National Suicide Prevention Lifeline (Now 988 Suicide and Crisis Lifeline): Evaluation of Crisis Call Outcomes for Suicidal Callers
📖 2: The Problem With 988 Report November 2024 Text
📖 3: “I Secret Shopped #988 and Three Cop Cars Showed Up Outside My House – Mad In America”
About the Author
Dr. Helen Littrell is a Crisis Intervention Subject Matter Expert and has worked for 12+ years in the crisis field. She has answered local, national, and international crisis lines, provided mobile crisis, crisis stabilization, and residential services. She has led death by suicide loss survivor and suicide attempt survivor groups. She was the lead writer for Wyoming’s 988 Standard Operating Manual.