National suicide hotline switches to 988 from Saturday
“I see 988 as a starting point where we can truly reinvent mental health care,” said Hannah Wesolowski, advocacy manager for the National Alliance on Mental Illness, a grassroots national group. “We’re really looking at a fundamental tidal shift in how we respond to people in mental health crisis.”
The network of more than 180 local call centers, significantly underfunded throughout its history, answered 3.6 million calls, chats and texts in fiscal year 2021, according to the Federal Substance Abuse and Mental Health Services Administration (SAMHSA). Officials expect that to grow to 7.6 million contacts in the coming year, as the National Suicide Prevention Lifeline – 800-273-TALK (8255) – gives way to 988. The 800 number will remain active indefinitely. (The expected increase in contacts does not include a veterans-only hotline option.)
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The hotline in Tucson, for example, is widely regarded as the gold standard for comprehensive care for people with mental health crises. When someone calls the city’s hotline, trained counselors help resolve the emergency over the phone 80% of the time. If they can’t, one of 16 “mobile crisis teams” is dispatched to the caller’s door — or wherever — day or night.
And those who need even more assistance can be taken to the town’s “stabilization center”, where psychologists, doctors, nurses and other specialist staff provide everything from urgent mental health care to drug treatment drugs.
The arrangement keeps people who are contemplating suicide or have other acute mental health needs out of emergency rooms and jails, reduces police and EMT involvement in cases of behavioral health and expedites help to those in need.
“We have the space. We have the staff. We have the training,” said Margie Balfour, chief clinical quality and innovation officer at Connections Health Solutions, the company that operates the Tucson Stabilization Center.
SAMHSA organized what had been a collection of one-to-one call centers into a national network in 2004, awarding the contract to operate and develop the system to the nonprofit Vibrant Emotional Health (then known as of Mental Health Association of New York City).
Call centers are funded by local, state, and federal resources, which creates wide variation in each center’s ability to handle its call volume. When local centers are overwhelmed or unstaffed, centralized rescue centers across the country respond. There are 14 now and up to 17 will be operational by August.
But local centers are preferable because staff there are more familiar with nearby mental health resources, officials said. Their ability to handle capacity varies greatly by location.
In the first quarter of 2022, for example, North Carolina was able to answer 90% of its calls in the state, while Illinois only answered 20%, according to data from Vibrant.
The overall network capacity was able to answer 85% of calls, 56% of texts and 30% of chats, according to a government report, citing a December 2020 analysis. Already, increased hiring and spending have improved call centers’ ability to meet demand, said John Draper, executive vice president of Vibrant.
Xavier Becerra, secretary of the Department of Health and Human Services, said in a briefing for reporters this month, “988 will work if the states have committed to it. It won’t work well if they aren’t. There is no reason, no excuse, that a person in one state can get a good answer and a person in another state can get a busy signal.
A lack of resources can be dangerous: The Wall Street Journal recently calculated that 1 in 6 callers hang up without reaching anyone.
Research has repeatedly confirmed that hotlines are very effective in their mission. A trained counselor who listens and empathizes with a caller or texter can help them navigate a short-term crisis over the phone in the vast majority of cases.
Staff and volunteers also learn how to separate a person with suicidal thoughts from anything that could be used to do harm, send family or friends to help, arrange for follow-up care or contact the forces of the order if necessary.
“Suicidal crisis callers report significant reductions in intention to die, hopelessness, and psychological pain during their crisis call,” Columbia University researchers Madelyn Gould and Alison Lake wrote in a September report on 988 and suicide prevention to the National Association of State. Mental health program directors.
They added that “crisis counselors are able to obtain the caller’s cooperation during an intervention on more than 75% of imminent risk calls”.
SAMHSA has spent more than $280 million strengthening the system, and Congress has allocated another $150 million.
“Our goal is to make the 988 look like the 911,” Becerra said. “If you are willing to turn to someone in your moment of crisis, someone will be there. 988 will not be a busy signal. 988 will help you. That is the goal. But he made it clear that states, and not the federal government, will have to fund call centers on an ongoing basis.
The number of suicides in the United States rose steadily from 29,350 in 2000 to 48,344 in 2018, before dropping to 45,979 in 2020, according to the National Center on Health Statistics. As a result of the coronavirus pandemic and other factors, government and health officials agree the country is in the throes of a mental health crisis, especially among young people, with a sharp rise in depression rates and anxiety.
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Tucson’s continuum of services has developed over 20 years, a collaboration of state, county and private participants, Balfour said. Today, officials across the country point to his program as a model for other localities.
Mobile crisis team dispatchers sit with 911 dispatchers and sometimes redirect police calls to pairs of clinicians instead, Balfour said. The police are trained to bring people to the stabilization center instead of hospitals or prisons, if any. They can be in and out in minutes, rather than spending hours with patients in an emergency room. There is a dedicated entrance to the facility for law enforcement so officers don’t have to remove and store their weapons, she said.
Slots available for follow-up care at mental health clinics are entered into the helpline’s computer, making it easier to access help. The hotline handles about 10,000 calls per month, Balfour said. The stabilization center handles around 1,000 adults per month as well as 200 to 300 children and adolescents, she said.
It has an observation area with chairs for 34 adults and 10 youths and an adult inpatient unit with 15 beds, where patients can stay for three to five days, she said, including while they withdraw from drugs and begin medically assisted treatment. The beds save hours and days of “boarding off” to emergency rooms without treatment while hospital staff search for a bed in an appropriate facility.
The center strives for “90 minutes door-to-doc” and does not turn anyone away, including walk-ins, Balfour said. Patients may be suicidal, violent, intoxicated, psychotic, or detoxifying.
“Our model is that we take everyone,” she said. “We want people who are usually turned away in other places. We want these high-acuity, potentially violent people.
If you or someone you know needs help, visit suicidepreventionlifeline.org.