cALL 800-273-8255 or
text "sos" to 741741
FLASH The data shows that in
August, a total of 361,140 calls, chats and texts
were routed to a 988 lifeline call center. Among
them, 84% of calls, 97% of chats and 98% of texts
were answered and engaged by a counselor --
representing a total of about 88% of people who
reached out to the lifelines. The remaining 12%
were disconnected before being engaged by a
counselor, according to the data. On average, it took about 42
seconds for calls, chats or texts to be answered
after an automated greeting, and the average amount
of time counselors spent talking, chatting or
texting with contacts was about 18 minutes and 49
- 9/9/22 From June 2021 to June 2022,
the Lifeline has seen a 13% increase in calls, a
148% increase in chats, and a 77% increase in
7/15/22 We are currently recommending
caution on the use of the 988 crisis line system,
and particularly texting to 988. We encourage
everyone to read some of the 18 articles
immediately below. We will continue to support the
National Crisis Lifeline 800-273-8255 and the
Crisis Text Line text SOS to 741741. We are
following the Mental Health Amerca's lead as they,
too, recommend the Crisis Text Line only for
texting in crisis. It is also the only crisis text
service we are aware of that knows and understand
to level of lethality of some of the emojs that are
used by youth today.
The data shows that in August, a total of 361,140 calls, chats and texts were routed to a 988 lifeline call center. Among them, 84% of calls, 97% of chats and 98% of texts were answered and engaged by a counselor -- representing a total of about 88% of people who reached out to the lifelines. The remaining 12% were disconnected before being engaged by a counselor, according to the data.
On average, it took about 42 seconds for calls, chats or texts to be answered after an automated greeting, and the average amount of time counselors spent talking, chatting or texting with contacts was about 18 minutes and 49 seconds. CNN - 9/9/22
From June 2021 to June 2022, the Lifeline has seen a 13% increase in calls, a 148% increase in chats, and a 77% increase in texts. Fortune Well - 7/15/22
We are currently recommending caution on the use of the 988 crisis line system, and particularly texting to 988. We encourage everyone to read some of the 18 articles immediately below. We will continue to support the National Crisis Lifeline 800-273-8255 and the Crisis Text Line text SOS to 741741. We are following the Mental Health Amerca's lead as they, too, recommend the Crisis Text Line only for texting in crisis. It is also the only crisis text service we are aware of that knows and understand to level of lethality of some of the emojs that are used by youth today.
What states have
implemented 988? So far, thirteen states,
Alabama, Colorado, Idaho, Indiana, Kentucky,
Minnesota, Nebraska, Nevada, New York, Oregon,
Texas, Virginia and Washington, have passed
legislation to fund the project. -
What states have implemented 988?
So far, thirteen states, Alabama, Colorado, Idaho, Indiana, Kentucky, Minnesota, Nebraska, Nevada, New York, Oregon, Texas, Virginia and Washington, have passed legislation to fund the project. - 6/10/22
NEW Calls to suicide prevention lifeline rose 45% after changeover to 988 number - CNN - 9/9/22
Determining When to Start Widescale Promotion of 988
Partnership for Suicide Prevention Announces Private Sector
Behavioral Health Treatment Services Locator
Available as of July 16, 2022
prevention hotline to have three-digit number for mental
FCC Vote happened July 16, 2020
If adopted, would require all telecommunications carriers and interconnected Voice over Internet Protocol (VoIP) service providers to begin directing all 988 calls to the existing National Suicide Prevention Lifeline (1-800-273-TALK) and complete that transition within the next two years, by July 16, 2022.
Rejects a call from phone providers for a longer transition period while acknowledges the real challenges of such a nationwide effort including the need for widespread network changes and providing time for Congress, other federal agencies, and local call centers to prepare for the expected increase in the volume of calls
Stresses that, during the two-year
transition period, Americans in crisis should continue to
contact the Lifeline by calling 1-800-273-TALK and through
prevention hotline to have three-digit number for mental
health emergencies: 988
When the months-long process is completed, U.S. residents will be able to call 988 for help in a mental health emergency, just as 911 connects people in need to first-responders for other emergencies.
Currently, the National Suicide Prevention Lifeline uses a 10-digit number, 800-273-TALK (8255). That number routes callers to one of 163 crisis centers, where counselors answered 2.2 million calls last year.
The three-digit number is really
going to be a breakthrough in terms of reaching people in a
crisis, said Dwight Holton, CEO of Lines for Life, a
suicide prevention nonprofit. No one is embarrassed to
call 911 for a fire or an emergency. No one should be
embarrassed to call 988 for a mental health emergency."
not about embarrassment for youth. It's that they just don't
talk on the cell phones and they don't call a crisis phone
line when they are in crisis. They text. 988 is also the
text line and this fact needs to be publicized, especially
to youth. There also the well established Crisis Text Line
741741 for them and anyone else who prefers texting to
talking. The Crisis Tent Line is there to help anyone at any
level of crisis, 24/7, with free, confidential counseling. -
not a hotline,
it's a 'warmline': It gives
mental health help before a crisis heats
"It was a wonderful call," said Massie, now 38 and a mental health advocate. I was laughing by the end, and I got in the holiday spirit.
Massie, a San Francisco resident, later used the line multiple times when she needed additional support, then began to volunteer there.
Now anyone in California who needs a little help or even a referral to a professional therapist can receive it by phone or instant message. In October, the San Francisco-based warmline expanded beyond Northern California to cover the whole state through a state budget allocation of $10.8 million for three years.
Unlike a hotline for those in immediate crisis, warmlines provide early intervention with emotional support that can prevent a crisis and a more costly 911 call or ER visit. The lines are typically free, confidential peer-support services staffed by volunteers or paid employees who have experienced mental health conditions themselves.
"People pay attention when the biggest state in the union decides to say mental health services are not just for crisis," said Mark Salazar, the San Francisco associations executive director.
Such help lines arent limited to California, though. About 30 states have some form of a warmline within their borders, including in Salt Lake City and Omaha, Nebraska. Still, the loose network of call lines faces no regulation or standardization. They're relatively new, so they haven't been extensively studied. And their advocates admit quantifying results can be difficult.
Better known are the suicide crisis lines for those who need help immediately. This summer, the Federal Communications Commission proposed a 988 national hotline number for those considering suicide or having a mental health crisis. Yet mental health advocates say warmlines help fill another important health care gap.
"Warmlines help people who think, 'I don't know why I'm not feeling great, or who to turn to, or where to get care, and I dont know for sure if I even need care,'" said Sarah Flinspach, a project coordinator for the National Council for Behavioral Health, which advocates for mental health care services. "It might be the call that helps someone go back to work that day."
Filling gaps, saving money
Since the San Francisco Peer-Run Warm Line began in 2014, it has answered more than 100,000 calls and served more than 5,000 people. Approximately 85% of callers were repeat users, said Salazar, and that's just fine.
"Many people are housed, have jobs and function in society, but they're struggling," said California state Sen. Scott Wiener, a Democrat from San Francisco who backed the statewide expansion of the line. "They don't necessarily need full intervention they just need support. In the peer-to-peer situation, they can take from someone's firsthand experience and learn how to navigate these problems."
People often struggle to access basic mental health services without such help, according to Wiener. They have the choice between nothing, a friend or going to the ER, he said.
Warmlines can fill a need in rural communities where access to care is limited or provide after-hours support in urban areas, said Rebecca Spirito Dalgin, who has studied warmlines and directs rehabilitation counseling at the University of Scranton in Pennsylvania.
Advocates say they also can save public money by preventing simmering teapots from boiling over.
Angel Prater, a peer support expert, co-authored a federally funded report in 2015 of Oregon's Community Counseling Solutions warmline that found the average cost of a single call to the line was about $10 over a five-year period, far less than the estimated $100 cost of a 911 call or a trip to the ER, around $700. By giving callers direct referrals to health care providers and helping them avoid higher levels of care, she added, the warmline saved approximately $1.2 million per quarter by 2016.
In addition, the warmline reduced crisis line calls and psychiatric hospitalizations, she said. It also gave police a resource if they encountered people undergoing a mental health challenge who didn't require a higher level of services.
"We gave local law enforcement a little warmline card with our phone number," Prater said. "They could pass it along if they felt someone needed no further intervention at that time.
The Salt Lake County Warmline, begun in 2012, is part of an effective larger crisis intervention and diversion services program "that saves millions of dollars a year," according to Barry Rose, crisis clinical manager at the University Neuropsychiatric Institute at the University of Utah. The line receives approximately 2,500 calls monthly, which includes repeat users.
"We're making relationships as we get to know people and they get to know us," said Rose, who is also a licensed clinical social worker. "Emotional support keeps us all healthy and establishes the kinds of connections we need in our lives."
In Omaha, 9 in 10 people who contact Safe Harbor Peer Crisis Services reported its warmline prevented their hospitalization, said Aileen Brady, executive vice president and chief operating officer of Community Alliance, a mental health agency that operates the program.
Safe Harbor's state-funded warmline also began in 2012 and fields roughly 1,000 calls a month. An annual budget of $670,000 funds the line and a complementary on-site program for people to resolve their distress in person.
Calls change a day and a life
A 2018 survey from the National Council and nonprofit philanthropy Cohen Veterans Network cited knowledge gaps as one of the primary barriers that prevent Americans from getting mental health care. It said 46% of those who have never sought treatment would not know where to go if they needed mental health services for themselves, a family member or a friend.
"It's unimaginable, hard to conceptualize, for those who don't work in this field, what the level of need really is," said Quinn Anderson, who manages the National Alliance on Mental Illness HelpLine, which offers referrals to all sorts of mental health support.
Mental health advocates and users admit the warmline system isn't perfect. Even people who are aware they exist may not get through immediately depending on the volume of calls.
Unlike some crisis lines, the network of warmlines doesn't blanket the whole country, and many warmlines won't take out-of-state calls. A caller out of geographic range may be directed to a line with closer resources. The quality of service offered by those who answer calls can be uneven, and few warmlines offer services in another language.
It can also be difficult to assess how effective the help is, said Spirito Dalgin, who authored studies about warmlines in 2011 and 2018.
"If services are funded on outcomes, how do we measure the outcome of these calls? she said. You need access to be able to follow a group of people using the warmline, and they need to self-report."
Even then, quantifying results is tough. Brady said, "It's hard to measure what doesn't happen."
The lack of tangible proof of success could jeopardize the widespread adoption of warmlines, even while basic and affordable mental health care remains hard to access. Still, some warmline operators are optimistic.
"We could see a national network for warmlines in about five years," said Salazar. "That's really needed since, day-to-day, no one really focuses on people who are not yet in crisis."
For the San Francisco line, Salazar said fewer than 1% of callers from August 2014 to August 2018 reported ever reaching a full-blown crisis.
Massie hasn't forgotten that first Mental Health Association of San Francisco warmline experience or the time she was at an association event and heard a familiar voice from across the room. It was the same one that had greeted her on that initial call and helped ease her angst.
She mustered the courage to introduce herself and thank her previously unknown warmline supporter, who responded he was also thankful to meet her. The two still greet each other enthusiastically at local mental health events, reminding Massie of how she was helped and why she remains dedicated to helping others with mental health challenges.
How to find a warmline near you:
Crisis manager Claudee Garnett talks to a suicidal client who called Línea PAS, a state-run suicide prevention hotline in Bayamón, Puerto Rico. The client called after taking too many Xanax. Suicide rates have gone up since Hurricane Maria hit the island.
For every person who dies by suicide, 280 people think seriously about it but dont act, according to the National Suicide Prevention Lifeline.
There's not one answer to what makes someone move from thinking about suicide to planning or attempting it, but experts say feeling connected to other people can help.
"Reaching out ... can save a life," said Jill Harkavy-Friedman, a clinical psychologist and vice president of research at the American Foundation for Suicide Prevention. "Everybody can play a role.
Tip 1. If someone seems different, don't ignore it
The most important thing you can do is look for a change in someone's behavior that suggests they are struggling, said April Foreman, a licensed psychologist who serves on the American Association of Suicidology's board of directors. It could look like a friend who would always pick up your calls but now seems to be avoiding you. Or a family member who was an adventurous eater now barely eating or skipping meals.
"Trust your gut," Foreman says. "If youre worried, believe your worry."
Foreman notes changes in behavior are some of the most telling indicators, but it's also important to look for specific warning signs:
Tip 2. Don't be afraid to ask. Then act
The most important thing you can do if you think someone may be suicidal is to ask. It may be hard, but it works. Don't buy into the disproven idea that there's nothing you can do to help, or that bringing up suicide might do more harm than good.
The National Action Alliance for Suicide Prevention and the National Suicide Prevention Lifeline have identified these five steps to help reduce deaths:
Ask: In a private setting, ask the person you're worried about directly if they're thinking about suicide. Studies have shown that it does not "plant the idea" in someone who is not suicidal but rather reduces risk. It lets the person know you're open to talking, that there's no shame in what the person may be feeling. If a person tells you they're thinking about suicide, actively listen. Don't act shocked. Don't minimize their feelings. Don't debate the value of life itself. Focus on their reasons for living. You could ask questions such as, "What's kept you safe up to this point?" or "What stops you from killing yourself?"
Keep them safe: Determine the extent of the person's suicidal thoughts.
"We want to know, are you thinking about killing yourself? Do you have a plan? What were you thinking of doing? Do you have the materials to do that? Have you gathered those things? Where are they? What could I do to help you stay around until this passes?" Harkavy-Freidman said.
If a person does have a plan, it's important to take action to remove the lethal means. (Guns were used in 23,000 of the 45,000 deaths by suicide in 2016, according to the Centers for Disease Control and Prevention.)
Be there: If someone tells you they're thinking about suicide, continue to support them. Ask them to coffee. Give them a call. Some people will eventually stop having suicidal thoughts and feelings, others will continue to struggle throughout their lives.
Deena Nyer Mendlowitz, 40, of Cleveland, is a suicide attempt survivor who has had chronic thoughts of suicide since she was 8. Mendlowitz said one of the moments she felt most supported was when she was going through electroconvulsive therapy and a friend brought her a meal.
"I just felt like I had a regular disease at that point, because they were doing an action they would have done for a friend who was going through anything else," she said. "And I thought, somebody cares about me in the regular way they care about people."
Help them connect: Encourage them to seek additional support. That could mean calling the Suicide Lifeline (800-273-8255), suggesting they see a mental health professional or helping them connect with a support group.
Jennifer Sullivan, a 21-year-old college student at Worcester State University in Massachusetts, struggled with suicidal ideation as an adolescent. It grew worse after she was raped twice, she said. Joining a sexual assault support group made her feel less alone.
"I met a fantastic group of young ladies," she said. "One became one of my best friends. When I had feelings of wanting to die or cut, I would tell her I was having a bad day."
Follow up: Keep checking in. Call them, text them. Ask if there's anything more you can do to help.
Tip 3. Pay special attention when someone is going through a difficult time
You can check in on people based on what you know about them, said John Draper, director of the National Suicide Prevention Lifeline.
"All those warning signs that weve listed for what makes a person look suicidal are fairly generic and hard for us to be able to spot unless youre a diagnostician," Draper said. "However, you know when a person is having relationship problems or going through a divorce you know when somebody has serious financial loss. ... These are very human recognizable signs that people could be needing help."
While experts caution that suicide is never the result of a single cause (bullying, a breakup, job loss), when those events are combined with other health, social and environmental factors they can heighten risk.
Tip 4. If someone makes an attempt and survives, continue to be there
One of the risk factors for suicide is a prior attempt. Studies show that suicide survivors often experience discrimination and shame and may struggle to talk about their feelings because they are worried people will judge or avoid them.
"When I started publicly speaking about my experience ... people would treat me differently," said Chief Warrant Officer Cliff Bauman, a suicide survivor in the Army National Guard. "Somebody, if he was my friend and we laughed and joked the day before, now suddenly doesnt know how to approach and talk to me."
If someone you know is a suicide survivor, the Suicide Lifeline says:
Tip 5. You dont need to have all the answers
It's important to encourage someone who is having suicidal thoughts to call the Lifeline (800-273-8255), find a support group or reach out to a therapist, particularly one who specializes in evidence-based suicide prevention techniques such as Dialectical Behavior Therapy and Cognitive Behavior Therapy for Suicide Prevention.
Resources to get help
Suicide Lifeline: If you or someone you know may be struggling with suicidal thoughts you can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time of day or night or chat online.
Crisis Text Line provides free, 24/7, confidential support via text message to people in crisis when they text SOS to 741741.
For people who identify as LGBTQ, if you or someone you know is feeling hopeless or suicidal, you can also contact The Trevor Project's TrevorLifeline 24/7/365 at 1-866-488-7386.
The Military/Veterans Crisis Line, online chat, and text-messaging service are free to all service members, including members of the National Guard and Reserve and veterans, even if you are not registered with the U.S. Department of Veterans Affairs (VA) or enrolled in VA health care. Call 1-800-273-8255 and press 1.
Stories of hope:
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To connect with suicide survivors and others, join USA TODAY's Facebook group I Survived It
with 988 crisis hotline start-up
Most people have memorized their Social Security number, cell phone number, anniversary, birthday and the 911 emergency medical, fire and police protection services number. On July 16, the number 988 became an easy-to-remember crisis hotline number we should log into our memory bank.
Dialing or texting 988 can be used by anyone who needs support for a suicidal, mental health, substance use crisis and/or other emotional issue. The new nation-wide set-up should strengthen and expand the existing Lifeline system, which is a national network of over 200 local, independent and state-funded crisis centers.
Both the new 988 hotline number and the previous 10-digit number (800-273-8255) will remain in operation, providing 24/7 free and confidential support for people in distress.
Johns Hopkins Medicine reports (2022) an estimated 26% of Americans over age 18 suffers from a diagnosable mental disorder in a given year. According to 2022 State of Mental Health Report from Mental Health America, the US has witnessed every year since 2011 nearly a 5% increase of adults having serious thoughts of suicide. In 2020 alone, the US had one death by suicide about every 11 minutes and is a leading cause of death for 10-34 year-olds and veterans.
However, problems abound with Americas readiness for the 988 hotline number, which was unanimously approved by the US House and Senate in 2020. Despite a federal mandate and $430 million allocated to states to expand their crisis networks, federal officials note few states have kept their end of the bargain (Politico, July 12).
Alabama, Arkansas, Florida, Iowa and Missouri are among 29 states predominantly Republican driven that did not introduce any legislation to address 988 hotline funding. Only 21 states enacted legislation to ensure local call centers will be fully funded (Axios, July 15).
Secondly, Wall Street Journal data revealed about one in six calls to the heretofore 10-digit national mental-health crisis line werent answered (July 12). Its tragic this mishandling of calls was not rectified prior to implementing the new 988 hotline.
Third, state and federal officials project the 988 easy-to-memorize hotline number will create an increase from over 3.3 million contacts per year to 6-12 million calls, texts or chats annually. According to a recent Rand report, fewer than half of the public health officials responsible for deploying 988 say they are confident their communities have the necessary staff, financing or equipment to field the anticipated surge of calls (Axios, July 15).
Finally, Xavier Becerra, Secretary, US Health and Human Services (HHS), expressed concern that more than half of the states were sending most of their crisis calls to 15 out-of-state backup call centers. State health officials say in-state call centers are more familiar with local services, including the availability of mobile response teams, psychiatric urgent care facilities and crisis stabilization beds (Politico, July 12).
On a positive note, the Associated Press reports with the 988 hotline number, instead of police, firefighters or paramedics being dispatched, callers will be connected with mental-health professionals (Wall Street Journal, July 16-17). It is reported at least a third of 911 emergency calls to which police respond could instead be safely directed to mental-health first responders, reducing the risk of a tragic encounter with police (Wall Street Journal, July 9-10).
Mental health is a serious issue. Its a shame no, make that gross negligence that 29 state legislatures did not address fully funding the federal mandate to protect their citizens with mental health conditions. No governor is exempt from blame since HHS sent a letter to every governor telling them how their mental health hotlines ranked.
Memorize 988 as it may
be needed to save a loved one you know, including
the 988 mental health crisis line goes live, advocates worry
it may not be ready 7/15/22
The U.S. faces significant mental health challenges, which have been exacerbated by the COVID-19 pandemic. Theres a shortage of mental health workers, facilities and programs to provide care. According to the National Institute of Mental Health, nearly 1 in 5 Americans 52.9 million people live with some form of mental illness, and, in 2020, fewer than half received treatment.
When mental illness becomes a crisis, the first line of help in this country has been a patchwork of local crisis hotlines, national crisis lines for veterans and youth, and the National Suicide Prevention Lifeline a toll-free number (1-800-273-TALK) that connects callers to a network of local and national emergency counseling call centers.
In 2020, President Donald Trump signed a law designating a single, easy-to-remember, three-digit number for all mental health crisis calls: 988. It will go online nationwide for incoming calls (landline and wireless as well as for text and chat) on Saturday. But health policy analysts and advocates worry that the new system might not be ready for the increase in demand thats predicted.
When a person suffering a mental health crisis, or a friend or family member seeking information or help for someone in crisis, dials the 988 national emergency line, the first thing they hear is a recorded voice telling them to wait one moment. Theyre then informed with an option to listen to the message in Spanish that theyve reached the National Suicide Prevention Lifeline: If you are in emotional distress, or suicidal crisis, or concerned about someone who might be, were here to help.
Theres an option to reach a crisis line for military veterans or wait to be connected to a local crisis call center, based on the callers area code.
In Oregon, that call center might be Lines for Life, a Portland-based nonprofit for which Deborah Dedrickson manages crisis-line operations and answers calls.
When I answer the phone, Im really aware that picking up the phone and calling to talk to a stranger is a hard thing to do, she said. Its really difficult to be vulnerable. It takes a lot of courage and strength just to reach out.
And yet, as of 2020, the system that 988 calls will now feed into could only meet the needs of about 85% of its callers, said Heather Saunders, a researcher at the Kaiser Family Foundation who recently published a report on suicide prevention and 988.
That means roughly 1 in 7 callers were disconnected or hung up before a crisis counselor answered. 14%
Saunders worries that the problems could get worse. When 988 rolls out, its anticipated that the call volume will up to triple the first year alone, and then continue to grow from there.
In fact, increasing the number of people who seek help is part of the point of switching to 988.
The concern is, if there were challenges with the current infrastructure meeting the call volume, said Saunders, people might reach out to the new 988 number in a state of crisis but not be able to reach someone on the other side of the line.
That could cause people to abandon their efforts to contact whats supposed to be the new, easy-to-access number for all mental health problems, said Jodi Manz, project director at the National Academy for State Health Policy.
If call volume overwhelms a system, youre going to see higher levels of abandonment, she said, because people are going to be waiting. Thats the thing giving folks in state policymaking, advocates and stakeholders the most anxiety.
Part of the problem is there has been relatively little state and local funding, planning and resources devoted to the setup and rollout of 988.
Rand Corp. recently surveyed 180 mental-health directors across the country, per researcher Jonathan Cantor, to find out whether or not there would be long-term budgeting for this. That was lacking, which is concerning. Only about 1 in 7 respondents had established a budget to support 988.
Of those, fewer than half included budgeting for infrastructure, clinical personnel, marketing material or service coordination between 988 and 911, Cantor said.
Only 13 states have passed dedicated funding mechanisms so far, including four Colorado, Nevada, Virginia and Washington that added a fee to residents telecom bills, similar to the way 911 is funded in many states. (See the National Academy for State Health Policys tracker on legislation, planning and funding for the 988 rollout.)
The lack of funding is especially problematic in states that already have poor track records answering crisis calls states whose residents often end up speaking to counselors elsewhere, Manz said. The ideal response would be to have somebody who is local, who understands local resources, the local provider landscape, those sorts of things.
According to data published by the National Suicide Prevention Lifeline and its coordinator, Vibrant Emotional Health, just 21% of Illinois spring 2021 calls were answered by in-state call centers. In four other states, fewer than half of all calls were answered in-state: Texas, 38%; Arkansas, 42%; Minnesota, 43%; and Wyoming, 47%.
The calls that in-state centers cant handle spill over to a network of more than a dozen national backup sites that take the overflow 24/7.
That includes Oregons Lines for Life, which has increased capacity to meet an expected doubling of calls in the coming year, from 40,000 to 80,000, according to CEO Dwight Holton.
Starting Aug. 1, well be part of that national backup network, and we will be seeing increased volume from bigger states, other states that dont support crisis intervention the way Oregon does. I have no doubt well be able to handle it. We have hired dozens of additional call counselors.
Crisis-line director Deborah Dedrickson tries to make sure every call is answered promptly, with knowledge and compassion, whether the caller is from Oregon or a state thousands of miles away.
People do sometimes have to wait, Dedrickson said. I work tirelessly every day to prevent that. And in fact, the national standard for 988 is that we answer 95% of calls within 20 seconds.
Meeting that goal
would ensure that more people who reach out for mental
health support in a crisis get the help they need.
This story comes from a collaboration between the health policy podcast Tradeoffs and Side Effects Public Media, a public health news initiative based at WFYI. It is part of a Tradeoffs series on 988 supported, in part, by the Sozosei Foundation. Subscribe to Tradeoffs here, and read more of Tradeoffs coverage in State of Mind.
Americas new national mental health crisis line988goes live on July 16. The three-digit hotline is supposed to make it easier for people struggling with addiction, suicide, and mental illness to get help fast.
Congress established the line in October 2020, passing legislation to convert the existing 10-digit National Suicide Prevention Lifeline into an easy-to-remember three digits. Mental health advocates see the launch of this new number as a rare opportunity to connect millions more people in crisis with the help they need.
While hopes are high for the new line, there are still significant questions about whether states are ready. Most call centers will not be fully staffed when the line goes live, a fact some who work in the field blame in part on inadequate funding from states and the federal government.
Theres also apprehension over whether the other parts of the so-called crisis care continuumsuch as mobile crisis teams staffed with mental health professionals and community-based treatment optionswill be ready to meet the expected increase in demand. Federal officials expect up to 12 million calls, chats, and texts could come into 988 in its first year, and research suggests around 20 percent of those contacts will need some sort of in-person response.
As 988 prepares to go live, communities are continuing to grapple with these core elements of the lines promise: a place to call, someone to respond, and a place to go.
A place to call: confronting a tight labor market
Mental health advocates and law enforcement have celebrated 988s launch as much needed and overdue.
It helps divert a significant portion of the people that otherwise might end up in the criminal justice system for no other reason than the fact that they are mentally ill, said Tony Thompson, sheriff of Black Hawk County, Iowa.
But 988s rollout is proving to be complicated.
Emily Blomme, the CEO of Foundation 2 Crisis Intervention Services in Iowa, said shes scrambling to hire the extra staff she needs in time for the launch.
Foundation 2 is one of two nonprofits contracted with the state of Iowa to set up 988 call centers. It already operates a call center under the National Suicide Prevention Lifeline.
Blomme said her goal is to fill 23 new positions for her call center with the funding shes received from the Iowa Department of Human Services.
As of late June, she had filled just 10 of those positions, and has only been able to recruit six of the 18 additional crisis counselors she would like to have.
Its really hard to say, Hi, you need to have a bachelors degree and two years of experience, and Im going to pay you $17 an hour, she said.
Foundation 2 has pulled from its reserve funds to try to boost hourly rates and offer sign-up bonuses of up to $1,500.
Blomme is fighting against a tight labor market, and the job shes recruiting for is emotionally taxing.
To sit with someone while theyre sufferingits just not an easy thing to do, she said. And to do that for an eight-hour shift, you know, five days a week, it wears on our teams quite a bit.
Iowa officials said they are using federal funding, including American Rescue Plan Act dollars attached to 988, to fund call centers for the first two years of the lines existence while they assess what kind of sustainable funding they need from state lawmakers.
But state officials said 988 contractors like Blomme are welcome to ask for more funding if they need it.
Vibrant, the nonprofit that runs the National Suicide Prevention Lifeline, estimates Iowa will receive 71,800 calls, texts, and online chats under 988 in its first yeara significant increase from the 19,476 in-state calls Iowa received in 2020 under the National Suicide Prevention Lifeline, Blomme said.
Someone to respond: coordinating between 911 and 988
Calling 911 can be dangerouseven deadlyand thats especially true for people of color, who are more likely to be killed by police.
Another risk factor? Having a mental illness. Thats why many are hopeful that going forward, more mental health calls will be diverted from 911 to the trained mental health professionals at 988.
In Kentucky, Mike Sunseri, deputy executive director at the Kentucky Office of Homeland Security, has spent the past few years trying to make sure that 911 and 988 can coordinate effectively.
Doing so is a challenge because Kentucky has 120 countiesand a 911 call center in virtually every onebut only about a dozen 988 call centers. And while 911 calls are routed based on a persons physical location, 988 calls are routed based on area code.
What weve been trying to do with our colleagues in 988 is help establish a set of guidelines, Sunseri said. So essentially like a phone tree: If a caller calls with this situation and this action happens, then is it appropriate to continue the call with 911? Or would the call be better served with 988?
People who answer 911 calls are used to thinking in terms of three buckets: fire, ambulance, or police. The new protocols will add a fourth: mental health.
Sunseri, who is also administrator of the states 911 Services Board, is looking toward California, which he says is a few steps ahead of the game in this kind of work, and places like Austin, Texas, where theyve figured out how to route calls seamlessly without putting people on hold.
That kind of coordination between 911 and 988 may be more feasible in larger cities with more resources. There are at least a few places in Kentuckycities like Owensboro and Louisvilletaking steps in that direction, but its likely trickier to pull off in more rural parts of the state.
There are also questions about liability, Sunseri said. What if 911 passes a call off to 988, loses knowledge of what happens to the caller, and theres a bad outcome?
One of the things Kentuckys looking at is: What kind of exchange of information can we have after the call is transferred either direction, to find out how the call was treated and ultimately resourced? he said.
Sunseri said efforts to coordinate will continue after 988 goes live, and it gives him hope that coordination of 911 and 988 has been part of preparations from the very beginning.
A safe place to go: the Living Room approach
Across the U.S., emergency departments and jails are the primary providers of emergency mental health care. While the vast majority of 988 calls will be resolved over the phone, its unclear where people who need in-person assistance can go.
In Illinois, theres been success with a program that some hope will help fill this gap.
The state is home to nearly two dozen so-called Living Rooms. Theyre designed as an alternative to the ER, where people experiencing suicidal or homicidal thoughts, panic attacks, severe depression, or struggles with substance use can easily find help.
We have absolutely had clients come in here, who were definitely struggling and have said, This saved my life, coming here, having this to be able to talk to somebody, said Christina Gerlach, the crisis services manager at a Living Room in Peoria, Illinois.
These facilities are usually grant-funded and primarily staffed with recovery support specialists, Gerlach said. This role requires about a year of training and personal experience with mental health struggles or addiction.
In all of Illinois Living Rooms, visitors can just walk-inno doctors note or payment required.
One downside is they arent open 24/7. But these facilities are promising, even though research on them is limited.
In one small study, researchers found of the more than 200 visits to a Living Room outside Chicago, 93 percent didnt need further care at an ER. Lead researcher Michelle Heyland said this saves money for both health care providers and patients.
Two-thirds of participants reported learning coping skills as the most helpful aspect of their Living Room experience, she added.
Eighty percent said the most helpful thing was the ability to talk through the situation and problem solve, said Heyland, an associate professor at Rush University in Chicago.
There are at least a dozen states that have similar models, including Arizona, Tennessee, and Georgia.
As public awareness of both 988 and Living Rooms remains low, its uncertain whether more people will be directed toward these community-based centers. In the meantime, leaders from many Living Rooms say theyre preparing.
??If you need to talk, or if you or someone you know is experiencing suicidal thoughts, text the Crisis Text Line at 741-741 or call or text 988 to reach the Suicide & Crisis Lifeline.
State of Mind is a
partnership of Slate and Arizona State University that
offers a practical look at our mental health systemand
how to make it better.
US Mental Health Hotline Network Is Expanding, but Rural
Areas Still Face Care Shortages 7/28/22
But the U.S. is a patchwork of resources for crisis assistance, so what comes next isnt universal. The level of support that 988 callers receive depends on their ZIP code.
In particular, rural Americans, who die by suicide at a far higher rate than residents of urban areas, often have trouble accessing mental health services. While 988 can connect them to a call center close to home, they could end up being directed to far-away resources.
The new system is supposed to give people an alternative to 911, yet callers from rural areas who are experiencing a mental health crisis may still be met by law enforcement personnel, rather than mental health specialists.
More than 150 million people in the U.S. most from rural or partially rural communities live in places designated as mental health professional shortage areas by the federal Health Resources and Services Administration. That means their communities dont have enough mental health providers usually psychiatrists to serve the population.
The Biden administration distributed about $105 million to states to help increase local crisis call center staffing for the new 988 system. But states are responsible for filling any gaps in the continuum of care that callers rely on if they need more than a phone conversation. States also shoulder most of the responsibility for staffing and funding their 988 call centers once the federal funding runs dry.
The federal Substance Abuse and Mental Health Services Administration, which runs the existing 800-273-8255 lifeline that 988 expands upon, has said that a state that launches a successful 988 program will ensure callers have a mental health professional to talk to, a mobile crisis team to respond to them, and a place to go such as a short-term residential crisis stabilization facility that offers diagnosis and treatment. The federal agency also intends for 988 to reduce reliance on law enforcement, expand access to mental health care, and relieve pressure on emergency rooms.
Those objectives may not play out equally in all states or communities.
If a call center has no mobile crisis team to dispatch, you dont have the stabilization, then youre basically going from the call center if they cant meet your needs to the emergency room, said Dr. Brian Hepburn, executive director of the National Association of State Mental Health Program Directors. The group developed model 988 legislation for states that emphasizes the need for consistent services regardless of caller location.
For the new call system to be consistent, you really need that full continuum of care, Hepburn said. The expectation isnt that its available now. The expectation is, he said, your state would eventually get you there.
But as 988 launched, most states had not passed legislation to fill gaps in mental health care.
In South Dakota, which has the eighth-highest suicide rate among states, health officials said responding to mental health crises in rural counties will be a challenge. So they plan to incorporate volunteer emergency medical services and fire department personnel into the emergency response to 988 calls on the ground. More than two-thirds of South Dakotans live in a mental health professional shortage area.
The state has only one professional mobile crisis team that responds to emergencies in person, according to South Dakota Department of Social Services Cabinet Secretary Laurie Gill. The mobile response team is located in South Dakotas largest city, Sioux Falls, and serves the southeastern corner of the state.
Some of our communities have virtual mobile crisis teams, said Janet Kittams, CEO of Helpline Center, the South Dakota nonprofit that will answer the states 988 calls. Some of our communities have co-responder models. Some of our communities will do direct response with law enforcement. So it really does vary quite a bit across the state.
Sioux Falls is also home to one of the states two short-term crisis facilities. The other is more than 300 miles away, in Rapid City. South Dakota also has 11 community mental health centers that assess patients and provide outpatient treatment. Those centers also use law enforcement agencies to respond to mental health crises.
A Helpline Center counselor could direct a 988 caller to one of those centersSometimes, yes, you will have to drive a couple hours to get to a community mental health center, but sometimes not, Kittams said. Generally speaking, people who live in the rural parts of South Dakota very much understand that they potentially are going to have to drive to a resource, because thats probably true in the other aspects of their life, not just for mental health care, but for other types of care or resources that they need.
Helpline Center reported that its operators de-escalate 80% of calls without deploying a crisis team. But Vibrant Emotional Health, a nonprofit that co-administers the nationwide lifeline, has projected a fivefold increase in calls for South Dakota in the first year that 988 is in place. Any spike in calls will likely increase the demand on crisis teams.
Vibrant has said that 988 will reach at least an additional 2 million people nationwide in its first year. Half of them are expected to come through the diversion of mental health-related calls from 911 and other crisis centers to 988.
Just next door to South Dakota, Iowa entered the 988 era with a more robust mobile crisis response system at least on paper, said Peggy Huppert, executive director of the Iowa chapter of the National Alliance on Mental Illness. Eighty-seven of the states 99 counties have a mobile crisis provider, but most Iowans live in a mental health professional shortage area.
The remaining 12 counties all rural rely on law enforcement and emergency medical technicians, Huppert said.
We still have a long way to go with properly training all first responders, especially law enforcement, because law enforcement are trained to come to a scene and take control of the scene, she said. People who are in a behavioral health crisis, who are perhaps psychotic, sometimes theyre hearing voices, theyre hallucinating, theyre in an altered state. They are not prone to obeying commands. Thats where things often go sideways.
Officials at a 988 call center for nine counties in east-central Iowa operated by CommUnity Crisis Services said that their mobile crisis teams will be composed only of counselors but that law enforcement agencies may be called if a team determines thats necessary for its safety.
CommUnity Crisis Services has three mobile crisis service providers who arrive in unmarked vehicles.
Adrianne Korbakes, chief operating officer at CommUnity, said the mobile crisis teams are a great option in rural communities where seeking mental health treatment might carry a stigma. And with 988, she said, you can call or text or chat from the privacy of your own home nobody has to know that youre accessing services.
To prepare for those contacts, CommUnity has nearly doubled its staff during the past seven months expanding from 88 employees in January to 175 in July.
Despite the 988 preparations in Iowa and South Dakota, neither states legislature has funded the system long term. In the National Suicide Hotline Designation Act of 2020, Congress gave states the authority to cover 988 expenses by adding a surcharge to cellphone service, but most have not done so.
Only 13 states have enacted 988 legislation, according to the National Alliance on Mental Illness, with varying applications and prescriptions on the continuum of care.
In Iowa, Huppert said,
theres very much a wait-and-see
There is an elevated risk for suicide in the year following psychiatric hospitalization. The present study examined whether perceived coercion during admission into psychiatric hospitalization increases risk for postdischarge suicide attempts.
Of 905 participants, 67% endorsed perception of coercion into psychiatric hospitalization, and 168 (19%) made a postdischarge suicide attempt. Patients who perceived coercion during hospitalization admission were more likely to make a suicide attempt after discharge than those who did not, even after adjusting for established covariates (OR = 1.29, |z| = 2.87, p = .004, 95% CI = 1.08, 1.54). There was no interaction between recent self-harm or suicidal ideation at time of admission and perceived coercion on postdischarge suicide attempts.
Patients perception of the
context in which they were hospitalized is associated with a
small but significant increase in their likelihood of
postdischarge suicide attempts.
Key Considerations to Ensure Effectiveness of New 988
Suicide and Crisis Lifeline - PEW - 7/14/22
A new national three-digit phone number debuts July 16 with the goal of making it easier for people at risk of suicide or grappling with other mental health and substance use emergencies to access care safely and quickly.
In 2020, Congress enacted a law to designate 988 as the new National Suicide Prevention Lifeline number. The legislation broadened the original mission of the linenow shortened from 10 to three digits, similar to 911to address other mental health and substance use emergencies in addition to trying to help those at risk of suicide. The Federal Communications Commission (FCC) issued regulations that July on how 988 should operate.
The stakes are high for this years 988 rollout and implementation: By 2027, analysts project, the emergency help line will receive 24 million calls, texts, and online chat requests annually, although they say the number could reach 41 million, depending on variables such as the number of calls diverted to 988 from other local or regional emergency numbers.
In 2020, nearly 46,000 Americans died by suicide, a 30% increase in the rate since 2000. An additional 1.2 million adults and 629,000 adolescents attempted suicide in 2020. As the COVID-19 pandemic continues to amplify mental health distress and substance use, both of which contribute to suicide risk, experts know that 988 must effectively connect people in crisis to the services they need.
State and local leaders should keep three key considerations in mind as they plan for the rollout:
1. States are largely responsible for implementing the new number. That includes building the infrastructure as well as training and retaining staff. Sponsors of the legislation intend 988 to expand and strengthen the existing network of more than 200 crisis centers throughout the country, which is critical because many of them have historically been underfunded and under resourced. In December 2021, the U.S. Department of Health and Human Services announced grants totaling $282 million for states and territories to help increase capacity and build the infrastructure to meet demand for these services.
State and national lawmakers, regulators, and other stakeholders have an important opportunity to help people at risk of suicide or experiencing other mental health and substance use crises. They will need time to create a seamless system for 988, but lessons learned from 911 call centers and other relevant resources offer a blueprint for improved responses to behavioral health crisis calls.
If you or someone you know needs help,
please call the National Suicide Prevention Lifeline at
800-273-8255 or text SOS to 741741 to reach a crisis text
line counselor 24/7.
role should police play in mental health calls? Seattle
has small, limited crisis staff. The Seattle Times, Aug
Hes not here as far as they can see, but it was worth a shot.
Earlier that month, the man who appears to face mental health challenges was detained by police after yelling at some schoolchildren nearby who were teasing him. Because verbal threats were made, school staff called law enforcement. Thats when Binder, a Seattle police officer, and Jevmore, a social worker on the crisis response unit, followed up.
Today, they were hoping to check in with the man and build rapport with him.
For people with severe, untreated mental illnesses, care is often experienced as a series of stops and starts. A long night in an emergency room bed. Weeks in a secured facility. A stint in jail.
Frequently, those encounters with the mental health crisis response system begin with police.
In the midst of a continuing national debate over policing and a federal rollout of the new 988 crisis phone line, a key question remains: What role should law enforcement play in responding to mental health crises?
This month, The Seattle Times
Mental Health Project is exploring different facets
of Washingtons mental health crisis response
system, how it works and doesnt, and
examining solutions people are bringing to improve
it. The discordant network of emergency rooms,
psychiatric institutions, jails, courtrooms and law
enforcement, which has long faced challenges, has
become even more strained since the pandemic
This month, The Seattle Times Mental Health Project is exploring different facets of Washingtons mental health crisis response system, how it works and doesnt, and examining solutions people are bringing to improve it. The discordant network of emergency rooms, psychiatric institutions, jails, courtrooms and law enforcement, which has long faced challenges, has become even more strained since the pandemic began.
In large West Coast cities like Seattle that face growing homelessness, and tangled in it, mental illnesses and drug use among some of their most vulnerable residents, the question is particularly crucial. Seattle received an estimated 11,000 to 14,000 emergency calls last year for mental and behavioral crises alone.
Evidence shows people with mental health problems experience worse sometimes lethal outcomes when police get involved. According to a national 2015 study by the Treatment Advocacy Center, people with untreated mental illness are 16 times more likely to be killed during a police interaction than other residents.
Since 2016, Seattle police have killed at least five people in a mental health crisis or with a prior record of mental health challenges, according to Seattle Times records and an analysis of news coverage, though in many other cases it was unclear whether mental health could be a factor.
Police response can be traumatic or triggering for people, said Summer Starr, the deputy director of the Washington chapter of NAMI, the National Alliance on Mental Illness. She said police were dispatched to her Bellingham home in 2016 while she was in a manic episode. We dont need that kind of armed response.
In many cities, residents are interested in alternatives that keep marginalized communities safe and incorporate mental health professionals or peers in response to mental health crises.
While cities continue to pilot new approaches, some of these types of programs including in Seattle have been around for years. Theyve shown some success, but theyve often remained small, needing the necessary alchemy of funding, sufficient staffing, political willpower and trust among departments.
The result? That by and large, most communities still send out officers for mental and behavioral crises.
10 a.m. Binder and Jevmore strike out they cant find the man at Miller Playfield. This happens often in their line of work. Other times, they reconnect with people, but theyre not interested in services. The team leaves business cards behind.
We never know what might change, Binder said. It could be one really bad night and theyre like, You know what? I want housing.'
The team then heads to Capitol Hill to respond to a man whos called 911 over a dozen times this morning saying he wants to die.
Hes a frequent
flyer, someone who calls often enough that dispatch
and officers recognize him. But its hard to connect
with him both to build a trusting relationship and
in Six Calls to National Suicide Prevention Lifeline End
Without Reaching a Counselor - 7/11/22 - WSJ
Health officials preparing to broaden the reach of a national mental-health crisis line are working to strengthen an overstretched network of call centers that didnt connect with about one in six callers in recent years, a Wall Street Journal data review showed.
The National Suicide Prevention
Lifeline will transition on July 16 to a three-digit number
for calls and texts, 988, from a 10-digit
number that has operated since 2005
in coordination with local crisis centers. The lines
operators, including the Substance Abuse and Mental Health
Services Administration and the nonprofit Vibrant Emotional
Health, said they expect an increase in calls to the shorter
and more memorable 988 number during the next year. Stress,
suffering and disruption of routines during the pandemic has
worsened many peoples mental health, clinicians have
said.. Continue reading your article with a WSJ