Comment The national mental health emergency hotline is switching to a single 988 number on Saturday, a transition expected to bring millions more calls, chats and texts to a system where readiness to deal with the surge varies from place to place. At the same time, advocates hope that the renewed focus on emergency aid and the spending that went with it, it will cause the expansion of other mental health services that are in desperate need in many communities. “I see 988 as a starting point where we can really rethink mental health care,” said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness. a national grassroots group. “We’re really looking at a fundamental change in how we respond to people in mental health crisis.” The network of more than 180 local call centers, drastically underfunded throughout its history, fielded 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 calls next year as the National Suicide Prevention Lifeline — 800-273-TALK (8255) — gives way to 988. The 800 number will remain active indefinitely. (The expected contact increase does not include a veterans hotline option.) Experts hope LGBTQ youth will call 988, a new suicide helpline The phone line at Tucson, for example, is is widely considered the gold standard for comprehensive care for people suffering from mental health crises. When someone calls this city’s hotline, trained counselors help resolve the emergency over the phone 80 percent of the time. If they can’t, one of 16 “mobile crisis teams” is sent to the caller’s door — or any other location — day or night. And those who need even more help can be taken to the city’s “stabilization center,” where psychologists, doctors, nurses and other specialized staff provide everything from emergency mental health care to drug medication. The regulation keeps people who may be thinking about suicide or have other acute mental health needs out of emergency rooms and jails, reduces police and EMT involvement in behavioral health cases, and speeds up getting help to people who need it. “We have the space. We have the staff. We have the training,” said Margie Balfour, chief of quality and clinical innovation at Connections Health Solutions, the company that operates the Tucson stabilization center. SAMHSA organized what had been a collection of individual 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 the Mental Health Association of New York City). Call centers are funded by local, state, and federal funds, creating wide variation in each center’s ability to handle its call volume. When local centers are overwhelmed or understaffed, central backup centers across the country respond. Now there are 14 and by August they will be operating 17. But local centers are preferable because staff there are more familiar with nearby mental health resources, officials said. Their ability to handle their capacity varies greatly by location. In the first quarter of 2022, for example, North Carolina was able to handle 90 percent of calls within the state, while Illinois responded to just 20 percent, according to Vibrant data. The total network capacity was able to handle 85 percent of calls, 56 percent of text messages and 30 percent of conversations, according to a government report, citing a December 2020 analysis. Already, increased hiring and spending have improved call centers’ ability to keep up with demand, said John Draper, Vibrant’s executive vice president. Xavier Becerra, secretary of the Department of Health and Human Services, said at a briefing for reporters this month: “988 will work if states commit to it. It won’t work well if it isn’t. There’s no reason, no excuse, that a person in one state can get a good answer and a person in another state will get a busy signal.” Lack of resources can be dangerous: The Wall Street Journal recently estimated that 1 in 6 callers hang up without getting through to anyone. Research has repeatedly confirmed that hotlines are highly effective in their mission. In the vast majority of cases, a trained counselor who listens and empathizes with a caller or texter can help them get through a short-term crisis over the phone. Staff and volunteers are also taught how to separate a person with suicidal thoughts from what can be used to do harm, send family or friends for help, arrange for follow-up or contact law enforcement law if necessary. “Suicide crisis callers report significant reductions in death intent, hopelessness, and psychological distress during their crisis,” Columbia University researchers Madelyn Gould and Alison Lake wrote in a September report on 988 and Suicide Prevention of suicide in the National Union of States. Mental Health Program Directors. They added that “crisis counselors are able to secure the caller’s cooperation in an intervention in over 75% of imminent danger calls.” SAMHSA has spent more than $280 million to strengthen the system, and Congress appropriated $150 million more. “Our goal is to make the 988 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’s the goal.” However, he made it clear that states, not the federal government, should 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 falling to 45,979 in 2020, according to the National Center for Health Statistics. In the wake of the coronavirus pandemic and other factors, government and health officials agree that the country is in a mental health crisis, especially among younger people, with rates of depression and anxiety skyrocketing. Equal mental health insurance coverage is elusive despite the legal guarantee Tucson’s continuum of services has grown over 20 years, a partnership of the state, county and private participants, Balfour said. Now officials across the country are pointing to his program as a model for other locations. Dispatchers for mobile crisis teams sit with 911 dispatchers and sometimes redirect calls for police to pairs of clinicians, Balfour said. Police are trained to bring people to the stabilization center instead of hospitals or jails when necessary. 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, he said. Available follow-up slots at mental health clinics are entered into the hotline’s computer, making it easier to access help. The hotline handles about 10,000 calls a month, Balfour said. The stabilization center handles about 1,000 adults a month as well as 200 to 300 children and teenagers, he said. It has an observation area with chairs for 34 adults and 10 younger people and a 15-bed adult inpatient unit where patients can stay three to five days, he said, even while they are withdrawing from drugs and starting medically assisted treatment. The beds help avoid hours and days of “boarding” in emergency rooms without treatment while hospital staff search for a bed in an appropriate facility. The center strives for “90 minutes door-to-doctor” and doesn’t turn anyone away, including pedestrians, Balfour said. Patients may be suicidal, violent, drunk, psychotic or detoxing. “Our model is we take everybody,” he said. “We want people who are usually denied in other places. We want these high-acid, potentially violent people.” If you or someone you know needs help, visit suicidepreventionlifeline.org.
