988-Issues
cALL 800-273-8255 or text "sos" to 741741
FLASH -
12/26/23 988
Lifeline Getting Mostly Good
Reviews FLASH -
021223 The data shows that in
August, 2022 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 Crisis Text Line
741741 We are currently recommending
caution on the use of the 988 texting crisis line
system,. We encourage everyone to read some of the
21 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 for
texting in crisis. It is also the only crisis text
service we are aware of that knows and understand
the level of lethality of some of the emojs that
are used by youth today. This can only happen with
texting systems using Ai. 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 FCC requires 988 calls be routed to local call centers - 10/17/24 Determining When to Start Widescale Promotion of 988 Nation’s Public-Private
Partnership for Suicide Prevention Announces Private Sector
Successor Behavioral Health Treatment Services Locator
Developing Messages About 988: Suicide & Crisis Lifeline (Scroll down)
COVID-19 Reinforces A Renewed Call to Make Suicide Prevention a National Priority - Survey
988 Lifeline
Getting Mostly Good Reviews - 12/26/23 In July 2022, we reported on the impending launchopens in a new tab or window of the 988 Suicide & Crisis Lifeline. In this report, we follow up on what has happened since then. The federal government-backed 988 Suicide & Crisis Lifeline launched about 18 months ago with much fanfare; the Biden administration hoped it would garner more calls than the cumbersome 10-digit number that had been in use previously. "The importance of our work to launch the '988' lifeline cannot be overstated," HHS Secretary Xavier Becerra said on a phone call with reporters in December 2021 during a "preview" of the new number. "Every 11 minutes an American dies from suicide. Too many Americans are experiencing mental health crises without the support and care they need. In 2019 alone, suicide was the second leading cause of death among young people and was the 10th leading cause of death in the nation. One of every 20 Americans [ages] 18 and older had serious thoughts of suicide, and one in 200 attempted it." Generally Positive Reviews The lifeline routes callers to a network of more than 200 state and local call centers that are financially supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), as well as state and local governments. In its first year, according to a July press release from SAMHSA, the lifeline answered nearly 5 million calls, texts, and chats from people looking for help with suicide, mental health, and substance use-related crises; that's 2 million more contacts than the lifeline received in the previous 12 months, when it was a 10-digit phone number. (That 10-digit number -- 800-273-8255 -- is still in operation.) So far, 1.5 years in, things seem to be going well overall, said Michele Gilbert, MPH, senior policy analyst at the Bipartisan Policy Center in Washington, D.C. "Luckily, the implementation of 988 has seen some real success," Gilbert said in a phone interview. "A lot of the operations have gone relatively smoothly." Debbie Plotnick, MSS, executive vice president for state and federal advocacy for Mental Health America, agreed. "We have seen tremendous increases in the number of people who call, and even more importantly, what has improved dramatically is the wait time to speak to an actual human being," she told MedPage Today. "Going back a couple of years, it could have been up to, like, 2 minutes, and now it's within 30 or 40 seconds that you are actually connected to a live human being." That decrease in wait time may not sound like a lot, but it's actually "huge," Plotnick said. "If you're at the point where you're going to hurt yourself and you don't know if anybody in the world cares, 2 minutes can really feel like an eternity. But now calls are being answered very quickly." She also praised the lifeline's addition of text and chat options, as well as special lines for veterans, for Spanish speakers, and for LGBTQ+ callers. Concerns With Routing Calls In addition to the successes, however, there are a few issues the lifeline struggles with. One has to do with routing callers to the closest call center, which becomes important in cases where the caller needs to access local resources such as a therapist or a mobile crisis team. Currently, the caller's phone number is used for routing, which doesn't work well if the caller has a phone number linked to where they previously lived (for example, if they moved from Los Angeles to Boston, but they bought their phone in Los Angeles and it has a Los Angeles area code and 7-digit number). For 911 calls, emergency officials use a geolocation system to pinpoint a caller's exact location. But due to privacy concerns, geolocation is not suitable for the 988 lifeline, mental health experts say -- some callers may not want to reveal their exact location to someone at a call center. Instead, what is being recommended is "georouting," a routing method that directs the caller to a 988 crisis call center based on cell tower location and wire-center boundaries, but does not reveal a caller's exact location, according to SAMHSA. "It's really important to fix that when you're talking about 988, so that when you talk to the crisis person who's answering the phone, they can send you to services that are in your location," said Plotnick. "They can tell you about resources that exist in your community" or -- in the small percentage of cases in which it's necessary -- send a mobile crisis team to the caller's location. The Federal Communications Commission (FCC) seems to agree. "Getting help got a lot easier when we implemented 988 as the easy-to-remember, 3-digit number for the 988 Suicide and Crisis Lifeline," FCC chairwoman Jessica Rosenworcel said in a September 28 press release "But more can be done to ensure those in need can reach local resources for mental health support. We need industry's help to improve access to this lifesaving service that the 988 Lifeline provides while being respectful of the privacy and confidentiality of callers reaching out for support." The same day, Rosenworcel and Miriam Delphin-Rittmon, PhD, assistant secretary for mental health and substance abuse at HHS, also sent joint letters to all the major wireless carriers as well as to CTIA, the telecom industry association, asking them to work on the issue. "We strongly encourage you, as a leading wireless carrier, to take the necessary steps to identify and develop a 988 georouting solution that could be deployed in your wireless network within a reasonable time," the letter to the wireless carriers said. "This is a surmountable technical challenge, and we hope you will take this opportunity to work toward georouting implementation that will both benefit your customers and be efficient for the operation of your network." Some members of Congress also are interested in solving this problem. Senators Alex Padilla (D-Calif.) and Thom Tillis (R-N.C.) -- co-founders of the Senate Mental Health Caucus -- introduced the Local 9-8-8 Response Act on December 7. This measure would require the FCC to "initiate the rulemaking process for regulations to ensure that each phone call, text message, and chat made or sent from a provider of commercial mobile service to 988 is geographically routed by the provider to the termination point designated by the participating crisis center that is responsible for the geographic location from which the phone call, text message, or chat originated." The bill would give the FCC 6 months to issue final regulations and also requires the agency to "ensure that the geographic location used to route the 988 call, text message, or chat is accurate enough to determine the proper participating crisis center without revealing the precise location of the individual who made or sent the phone call, text message, or chat." A companion bill was introduced in the House by Rep. Tony Cárdenas (D-Calif.). "Congress created the bipartisan 988 hotline to make it as easy as possible for Californians and Americans in crisis to quickly access lifesaving support," Sen. Padilla said in a press release. "Mental health response on the lifeline must be efficient and safe, but the current system risks connecting callers to response teams thousands of miles away. We need to improve access to the hotline and connect callers with their nearest center for support." Hiring Staff Is an Issue Finding enough people to staff the call centers is another problem. At a July 2022 mental health summit in Washington, D.C., Emily Blomme, CEO of Foundation 2 Crisis Services, a crisis prevention and intervention service in Cedar Rapids, Iowa, noted that the pay she could offer to prospective employees of the organization's 988 call center was low, largely because much of the funding for call centers was left to each individual state. Out of the 25 people Blomme needed to staff her crisis hotline, she had hired only 10. "Pay starts at $17.50 an hour; I'm competing with places like Target," she said at the event, which was sponsored by the Alliance for Health Policy. "I lost an employee to AirFX, which is a trampoline park ... Being a cashier is much easier than answering crisis calls. My teams work 8, 10, 12-hour shifts and they never know what's on the other end of the line when they pick it up. The dilemma is, what do I pay someone that saves lives for a living? What is that worth per hour? The answer is that I don't have enough money to pay people what they're worth." "Workforce is an issue throughout the
entire array of mental health services and supports," said
Plotnick. "That's one of the things that the advocacy
community works on is making sure that people have livable
wages, and wages that are competitive. So it's an ongoing
issue that is being addressed." She noted that several
states have passed bills that add a small fee -- usually
from 30 to 60 Examples of
how someone can #BeThere include:
Important
FCC Vote happened July 16, 2020 The Order: 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
online
chats Suicide
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." It's
not a hotline,
it's a 'warmline': It gives
mental health help before a crisis heats
up "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 association’s executive director. Such help lines aren’t 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 don’t 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:
Source: www.usatoday.com/story/news/nation/2019/12/12/988-suicide-prevention-number-fcc-approval/4411812002/
Suicide prevention
experts: What you say (and don't say) could save a person's
life 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 don’t 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 you’re 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 we’ve listed for what makes a person look suicidal are fairly generic and hard for us to be able to spot unless you’re 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 doesn’t know how to approach and talk to me." If someone you know is a suicide survivor, the Suicide Lifeline says:
Tip 5. You don’t 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: Suicide never entered his mind. Then 9/11 happened. Young, transgender and fighting a years-long battle against suicidal thoughts She worked in suicide prevention. Then one day she had to save herself. You may also be interested in: Suicide is one of the nation's top killers. When will we start acting like it? (Up 15% in the last 5 years) If you've ever had suicidal thoughts, make a safety plan To connect with suicide survivors and others, join USA TODAY's Facebook group I Survived It After a suicide, here’s what happens to the people left behind Source: www.usatoday.com/story/news/2018/09/10/suicide-prevention-how-help-someone-who-suicidal/965640002/ Problems
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 America’s 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 weren’t answered (July 12). It’s 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. It’s 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
yourself. As
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. There’s 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 that’s 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.” They’re then informed — with an option to listen to the message in Spanish — that they’ve reached the National Suicide Prevention Lifeline: “If you are in emotional distress, or suicidal crisis, or concerned about someone who might be, we’re here to help.” There’s an option to reach a crisis line for military veterans or wait to be connected to a local crisis call center, based on the caller’s 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, I’m really aware that picking up the phone and calling to talk to a stranger is a hard thing to do,” she said. “It’s 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, it’s 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 what’s 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, you’re going to see higher levels of abandonment,” she said, “because people are going to be waiting. That’s 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 Policy’s 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 can’t handle spill over to a network of more than a dozen national backup sites that take the overflow 24/7. That includes Oregon’s 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, we’ll be part of that national backup network, and we will be seeing increased volume from bigger states, other states that don’t support crisis intervention the way Oregon does. I have no doubt we’ll 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. 988
Promises to Be a Better Mental Health Crisis Line. Will It
Work? - 7/14/22 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. America’s new national mental health crisis line—988—goes 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. There’s also apprehension over whether the other parts of the so-called crisis care continuum—such as mobile crisis teams staffed with mental health professionals and community-based treatment options—will 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 line’s 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 988’s 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 988’s rollout is proving to be complicated. Emily Blomme, the CEO of Foundation 2 Crisis Intervention Services in Iowa, said she’s 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 she’s 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. “It’s really hard to say, ‘Hi, you need to have a bachelor’s degree and two years of experience, and I’m 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 she’s recruiting for is emotionally taxing. “To sit with someone while they’re suffering—it’s 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 line’s 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 year—a 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 dangerous—even deadly—and that’s especially true for people of color, who are more likely to be killed by police. Another risk factor? Having a mental illness. That’s 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 counties—and a 911 call center in virtually every one—but only about a dozen 988 call centers. And while 911 calls are routed based on a person’s physical location, 988 calls are routed based on area code. “What we’ve 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 state’s 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 they’ve 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 Kentucky—cities like Owensboro and Louisville—taking steps in that direction, but it’s 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 there’s a bad outcome? “One of the things Kentucky’s 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, it’s unclear where people who need in-person assistance can go. In Illinois, there’s 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.” They’re 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-in—no doctor’s note or payment required. One downside is they aren’t 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 didn’t 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, it’s uncertain whether more people will be directed toward these community-based centers. In the meantime, leaders from many Living Rooms say they’re 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 system—and
how to make it better. The
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 isn’t 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 don’t 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 don’t have the stabilization, then you’re basically going from the call center — if they can’t 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 isn’t that it’s 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 Dakota’s 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 state’s 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 state’s 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 centers“Sometimes, 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 that’s 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 state’s 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 they’re hearing voices, they’re hallucinating, they’re in an altered state. They are not prone to obeying commands. That’s 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 that’s 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 you’re 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 state’s 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,
“there’s very much a wait-and-see
approach.” Perceived
Coercion During Admission Into Psychiatric Hospitalization
Increases Risk of Suicide Attempts After Discharge Objective 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. Results 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. Conclusions 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. 3
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 line—now shortened from 10 to three digits, similar to 911—to 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 year’s 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. What
role should police play in mental health calls? Seattle
has small, limited crisis staff. The Seattle Times, Aug
2, 2022 He’s 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. That’s 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 Washington’s mental health crisis response
system, how it works and doesn’t, 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. Helping
someone in a mental health crisis: What to
know Designated
crisis responders, a ‘last resort’ in
mental health care, face overwhelming
demand How
an old federal rule limits inpatient mental
health beds in Washington The
role WA courts play in mental health care when
someone is in crisis Seattle’s
jail has an ‘astronomical’ suicide
rate. Little is changing. 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 don’t 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. They’ve shown some success, but they’ve 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 can’t find the man at Miller Playfield. This happens often in their line of work. Other times, they reconnect with people, but they’re 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 they’re like, ‘You know what? I want housing.'” The team then heads to Capitol Hill to respond to a man who’s called 911 over a dozen times this morning saying he wants to die. He’s a “frequent
flyer,” someone who calls often enough that dispatch
and officers recognize him. But it’s hard to connect
with him — both to build a trusting relationship and
quite literally. One
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 didn’t 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 line’s
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 people’s mental health, clinicians have
said.. Continue reading your article with a WSJ
membership At
988 Call Centers, Crisis Counselors Offer Empathy – and
Juggle Limited Resources - U.S. News - 9/8/22 On a Friday evening at a call center in southeastern Pennsylvania, Michael Colluccio stirred his hot tea, put on his headset, and started up his computer. The screen showed calls coming in to the suicide prevention lifeline from around the state. Colluccio, 38, said he knows what it’s like to be on the other end of one of those calls. “So, I had a suicide attempt when I was about 10, 11 years old,” Colluccio said. “And we do get callers who are about that age, or quite young, and they are going through similar stressors.” For people experiencing a mental health crisis, calling 988 can be a lifesaving decision. But what happens after they call depends on where they are. The new 988 system launched in mid-July, and one early estimate said calls went up 45% nationally during the first week. With calls likely to increase as more people learn about the helpline, some call centers said there are limits to what they can accomplish without boosting local resources. Colluccio said callers in his service area — Bucks County, just north of Philadelphia — have access to more services than in many other parts of Pennsylvania. His job with the Family Service Association of Bucks County, which runs the hotline locally, sometimes involves connecting callers with services such as homeless shelters, therapists, or drug and alcohol counselors. More than anything, his job is to listen Colluccio’s first call of the evening was from a woman who sounded panicked. Her partner had been using drugs and started making violent threats. Colluccio spent a lot more time listening than talking. He said that by listening closely to what a caller has to say, he offers relief, validation, and human connection. When he does talk, he usually asks questions — gently searching for specific ways to help. In this case, his questions led him to connect the caller with local domestic abuse services and a social worker. One service he rarely turns to is 911. Part of the idea behind 988 is to offer an alternative to involving police or an ambulance in a mental health crisis. Colluccio said he would typically use 911 only if someone was an immediate threat to themselves or others. Some people who’ve had poor experiences with the mental health system have voiced concerns and warned others about the possibility of a brush with law enforcement if they call 988. After talking with the woman for a half-hour, Colluccio asked her key questions to determine whether she felt suicidal. It is an important step to make sure each caller is safe after they hang up, he said. At the start of the call, it seemed the woman wanted help for her partner. But when Colluccio asked her directly on a scale of 1 to 5 how suicidal she was, she said that she was a 2 or maybe a 3 — and that she had attempted suicide before. Before they ended the call, Colluccio asked her if she would like a call back the next day. She said yes, so he scheduled one. Colluccio had just enough time for a sip of tea before another call came in. It was a young man in college, overwhelmed by stress. They talked for over an hour. This was a pretty typical evening, he said. “Sometimes it’s more of an immediate intervention because sometimes people call with pills in hand and are actively considering ending their lives,” Colluccio said. “There are people who have called and said, ‘If you did not pick up, I’d have killed myself.’” Nationwide, there are more than 200 call centers like this one. Calls are tied to area codes. If nobody picks up locally, the call gets kicked to somewhere else. The promise is to always have someone pick up the phone. (However, some county's have not made that promise and will not guarantee the call won't go to an answering machine. That is a problem.) In some places, like Bucks County, additional resources are available for callers who need more help than counselors can offer on the phone. Colluccio can dispatch a mobile crew of mental health workers to visit someone at home. But in Hanover, Pennsylvania, a town a few hours west, the 988 call center doesn’t have that option. Jayne Wildasin runs that center and said workers sometimes have to put down their headsets, get in their cars, and go meet with a caller who might live as far as an hour away. “So right now, if there’s a crisis at someone’s house, we could potentially go there,” Wildasin said. In another part of the state — rural Centre County — the local 988 call center relies on volunteers — mostly college students from Penn State. Denise Herr McCann runs the operation and said that her team can call in mobile mental health experts, but more of them are needed. There is also a need for additional mental health professionals who can help once a crisis has passed. “Sometimes those resources are other counseling services, and they don’t have capacity,” Herr McCann said. “People are calling, and providers are six weeks out if they’re lucky. That’s not any good.” For decades, suicide prevention call centers have scraped together funding from local, state, and federal sources. With the switch to 988, they now must meet new federal regulations, such as data collecting and licensure requirements, said Julie Dees, who oversees the call center in Bucks County. That all costs money. “There are increased responsibilities that are being put on the call centers, but there’s really no additional funding being put on that,” Dees said. It’s an issue around the U.S., according to a recent analysis from the Pew Charitable Trusts. The polling and research organization noted that states are largely left to foot the bill for the change to 988 — and many of the crisis centers doing the work have been underfunded for years. It recommended that state policymakers evaluate funding needs to ensure that crisis services connected to 988 will be sustainable and seamless. The Biden administration invested $432 million toward building the capacity of local and backup call centers and providing associated services. But the expectation is that states will come up with the main funding streams. The 2020 law enacting the 988 number also allows states to pass legislation to add a fee to cellphone bills as a permanent source of funds for 988 and associated mental health services. Pennsylvania’s outgoing Democratic governor has proposed a funding fee model but it hasn’t yet gained traction in the Republican-controlled legislature. The lack of a funding mechanism worries Kevin Boozel, who heads the County Commissioners Association of Pennsylvania. “This is life or death,” Boozel said. “And you can’t halfway do it.” Fearing that too many calls could flood the system, Pennsylvania has decided to hold back on publicizing the new 988 number until next year. Counties need more time to set up funding, hire workers, and build capacity for things like those mobile crisis teams. If you or someone you know needs help,
please dial 988, call the National Suicide Prevention
Lifeline at 800-273-8255, text SOS to 741741 or chat at
988lifeline.org to reach a crisis counselor 24/7. 3
Key Considerations to Ensure Effectiveness of New 988
Suicide and Crisis Lifeline - PEW Research -
9/8/22 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 line—now shortened from 10 to three digits, similar to 911—to 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 year’s 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. The Bipartisan Safer Communities Act, signed into law on June 25, also supports the implementation of 988 by providing an additional $150 million to the National Suicide Prevention Lifeline. The law also seeks to increase access to mental health care more generally through the expansion of the community behavioral health clinic demonstration program, which provides support for crisis services; $750 million in additional funding for the Edward Byrne Memorial Justice Assistance Grant (JAG) Program over 5 years to states that can be used for crisis intervention; and $250 million to increase access to mental health care through Community Mental Health Services block grants. State policymakers, however, will need to evaluate funding needs to ensure that the crisis services connected to 988 will be sustainable. Many states are considering or have already implemented surcharges on phone bills to pay for these expanded services, similar to funding for 911 systems. 2. Building the capacity of 988 will take time. Consider 911. Although that emergency line has existed for nearly 50 years, it has taken decades and significant resources to get it to where it is now. The anticipated volume of calls to 988 means that workforce needs and capacity must be measured and met. A national shortage of mental health professionals will complicate those challenges. Other critical tasks include creating the infrastructure, setting internal quality control for dispatching emergency responses, and ensuring continued funding in the years to come. 3. Coordinating with other emergency operations, such as 911, will be crucial to saving lives. In planning for the rollout of 988, state and local leaders should work to coordinate with existing 911 services. By establishing clear protocols for both lines, leaders can expand the continuum of care available within their communities. There may be instances in which a call coming to 911 will need to be dispatched to 988 or vice versa; clear guidelines and protocols can ensure that a person experiencing an emergency receives the appropriate response. 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 dial 988, call the National Suicide Prevention
Lifeline at 800-273-8255, or text SOS to 741741 to reach a
crisis text line counselor 24/7. Social
media posts warn people not to call 988. Here’s what
you need to know - OPB, 8/13/22 But not everyone felt the same way. Some advocates and people who had experiences with the mental health system took to social media to voice concerns about 988 and warn people not to call it. One Instagram post said, "988 is not friendly. Don't call it, don't post it, don't share it, without knowing the risks." The post, which had garnered nearly a quarter of a million likes as of early August, went on to list the risks as police involvement, involuntary treatment at emergency rooms or psychiatric hospitals, and the emotional and financial toll of those experiences. Other posts on Instagram and Twitter conveyed similar concerns, saying that the hotline sends law enforcement officers to check on people at risk of suicide without their consent and that people, especially from LGBTQ+ communities and communities of color, may be forced into treatment. (Oh for a really safe crisis service like Copline for members of Law Enforcement 800-267-5463, where the counselors aren't mandatory reporters and won't do an active rescue without your permission. I wish every youth that hasn't found an adult that they can trust, every veteran, fireman, first responder, had a service like that. It would give millions support when they need it without fearing "the system" taking over their lives, including possible job loss, hospitalization, or being outed to their parents or guardian. - Gordon Clay) So is 988 a critical mental health resource or a cause for concern? We decided to dig into these questions, figure out how 988 works, and explain what you need to know before dialing. Why are some people saying not to call 988? We reached out to the creators of some of the social media posts to ask them directly. Liz Winston, who authored the Instagram post calling 988 "not friendly," said she wanted people to understand all the potential outcomes of calling so they wouldn't be blindsided by the "traumatizing system" that she experienced. Last summer, Winston was having suicidal thoughts and visited a hospital in New York. She hoped to speak with a psychiatrist but instead was involuntarily detained in the psychiatric wing of the emergency room. She said that she did not receive any counseling during the 24 hours she spent there and that the experience was "extremely traumatic." Winston hadn't called the hotline, but she said those who do can end up in a similar situation. It's true that when police respond to calls about people in mental health crises, they often take them to an emergency room or psychiatric hospital. "I realize there is an urge to rescue people in crisis, but the reality is the services that exist make the problem much, much worse," said Winston, who works in mental health peer support and has started an online support group for people recovering from involuntary treatment.
Research shows suicide rates increase drastically in the months after people are discharged from psychiatric hospitals. Those who were sent involuntarily are more likely to attempt suicide than those who chose to go, and involuntary commitments can make young people less likely to disclose their suicidal feelings in the future. Some people also get stuck with large bills for treatment they didn't want.
Emily Krebs, a suicide researcher and assistant professor joining Fordham University this fall, said that involuntary treatment is viewed as a necessary part of suicide prevention in the U.S., but that other countries don't see it that way. The United Nations has called forced mental health treatment a human rights abuse and asked countries to ban it.
Like Winston, Krebs wanted people to be fully informed before deciding to call 988. That's why she wrote on Twitter that 988 can and will "send police if they deem it necessary."
That can be dangerous, she said, given that 1 in 5 fatal police shootings in 2019 involved a person with mental illness. Some years, the share has been even higher.
What does 988 say about how it handles crisis situations? Officials from 988 say they recognize the risks of having law enforcement officers involved in mental health emergencies. That's why 988 was created as an alternative to 911, said John Draper, executive director of the hotline and a vice president at Vibrant Emotional Health, the company tasked with administering it.
"We know the best way for a person to remain safe from harm is for them to be empowered and to choose to be safe from harm," Draper said. Dispatching police is a last resort, he said.
Counselors who answer the phones or respond to texts and online chats for 988 are supposed to be trained to actively listen, discuss the callers' concerns and wishes, and collaborate with them to find solutions. Most calls about suicide are de-escalated without law enforcement, Draper said. Instead, counselors talk through people's reasons for dying and reasons for living; have callers connect with supportive family, friends, religious leaders or others in their community; refer callers to outpatient treatment; or set up follow-up calls with 988.
Only when the caller cannot or will not collaborate on a safety plan and the counselor feels the caller will harm themselves imminently should emergency services be called, according to the hotline's policy.
At that point, Draper said, "we have the choice of just letting [harm] happen or doing whatever we can to keep them safe."
In previous years, before the 988 number launched, emergency services were dispatched in 2% of the hotline's interactions, the service reported. With about 2.4 million calls a year, that means emergency services were initiated for roughly 48,000 calls. Those services can be mobile crisis teams, consisting of people trained in mental health and de-escalation, but in many rural and suburban communities, it is often police.
Contrary to some information circulating on social media, 988 cannot geolocate callers, Draper said. When emergency services are called, 988 call centers share with 911 operators information they have about the location of the person who contacted the hotline — typically a caller's phone number, with area code, or a chat user's IP address — to help first responders find the individual.
Starting this fall, Draper said, 988 will update its policies to require supervisors to review all calls that result in the use of emergency services. Counselors for 988 nationwide will also receive additional training on the alternatives to involving law enforcement and the consequences callers can face when police respond.
So should I use 988 or not? We know it's not satisfying, but the honest answer is: It depends.
The 988 hotline is the nation's most comprehensive mental health crisis service and can provide crucial help to those in emotional distress. If you're thinking about suicide but not taking steps to act on it, 988 is unlikely to call law enforcement without your consent. Instead, 988 counselors can provide resources, referrals and a kind ear. However, if you're at imminent risk and could act on a plan to kill yourself, police may be called, and you could be taken to a hospital involuntarily.
Sonyia Richardson, a licensed clinical social worker who owns a counseling agency that serves mostly Black and brown clients in Charlotte, N.C., said she didn't immediately tell her clients about 988 when it launched. Even though she's a member of her state's 988 planning committee, she said she needed time to develop trust in the service herself. When she learned at a recent committee meeting that fewer than 5% of 988 calls in North Carolina led to a law enforcement response, she felt reassured.
"There are going to be issues perhaps with 988, but it might be one of the safer options for us," Richardson said. With suicide rates increasing among Black Americans, the community needs more ways to save lives, she added.
If I don’t want to call 988, do I have other options? Although the U.S. doesn't have a national, government-run mental health hotline that pledges not to call police without callers' consent, several alternatives that are smaller than 988 aim to decrease law enforcement involvement.
"Warm" lines are one option. They're typically staffed by "peers," people who have experienced mental health challenges. They focus less on crisis intervention and more on emotional support to prevent crises. You can find a directory of warm lines by state here.
Below are other hotlines and resources. This is not a comprehensive list, and some resources may limit their services geographically.
Blackline is a hotline geared toward the Black, Black LGBTQ+, brown, Native, and Muslim communities Kiva Centers offers daily online peer support groups M.H. First Oakland and M.H. First Sacramento operate during select weekend hours in the California cities of Oakland and Sacramento Peer Support Space hosts virtual peer support groups twice a day Monday through Saturday Project LETS provides support by text for urgent issues that involve involuntary hospitalization Samaritans of New York is a hotline based in New York City Trans Lifeline is a hotline for trans and questioning individuals Wildflower Alliance has a peer support line and online support groups focused on suicide prevention KHN (Kaiser Health News) is a national
newsroom that produces in-depth journalism about health
issues. It is an editorially independent operating program
of KFF (Kaiser Family Foundation). What
happened to you was not care.
Inpatient psychiatry
attract abusers. "I was a cult member in the cult of psychiatry,” published in the Substack newsletter Mental Hellth “Social media posts warn people to not call 988. Here’s what to need to know,” by Aneri Pattani, NPR “You can’t stop mass shootings by punishing people with mental illnesses,” by Sara Kenisgberg, Washington Post “He just wanted a new prescription. He ended up in the psych ward instead,” by Stuart Leach, Washington Post “Treatment beyond punishment,” published in the Substack newsletter Mental Hellth “The Challenge of Going Off Psychiatric Drugs,” by Rachel Aviv, the New Yorker “Shocking numbers of women forcibly restrained with drugs in psychiatric units,” by Maya Oppenheim, the Independent (trigger warning: severe medical violence) Revolutionary Non-Carceral Mental Health Organizations Institute for the Development of Human Arts The Bazelon Center for Mental Health Law Trauma Recovery Resources "What Happened to You?” by Oprah Winfrey and Dr. Bruce Perry Project LETS’ Emergency Action for Panic Attacks Project LETS’ notes on the “the Body Keeps the Score” (The Body Keeps the Score is NOT recommended reading for its author’s descriptions of gleeful participation in staff-on-patient violence on psychiatric wards, but Project LETS publishes a handy guide that summarizes the book’s key takeaways) Recommended somatic experiencing
practitioner with sensitivity towards psychiatric survivors:
Tiffany
Chandler A
bumpy 988 rollout in rural America - 8/4/2022 The 988 hotline has launched, but what is its impact on rural residents? It hasn’t even been a full month since the new Suicide and Crisis Lifeline and its 988 hotline for mental health emergencies launched. Still, it’s not too early to consider the gap the hotline is closing – or not – for rural residents. As Kaiser Health News reported, “the US has a patchwork of resources for crisis assistance…and the level of support that 988 callers receive depends on their ZIP code.” The service has a special burden since rural Americans die by suicide at a higher rate than their urban neighbors, often due to the scarcity of mental health services nearby. The federal Substance Abuse and Mental Health Services Administration wants states to develop a full range of services – not just 988 call centers but also mobile crisis teams to respond to callers and places to bring them for crisis stabilization, diagnosis and treatment. Key aims of 988 are to remove mental health calls from law enforcement response and to ease pressure on hospital emergency rooms. But in rural areas especially, a lack of capacity is likely to leave police officers, rather than mental health workers, responding to people in mental health crisis. The Biden administration provided
about $105 million to states to boost call center staffing
but it will take additional funds to expand the call
centers, run mobile crisis teams and provide additional
mental health resources for people who need extra help.
Congress authorized states to cover 988 expenses via a tax
on cell phone services back in 2020 – but only 13
states have done so. Rural
Issues: Dial new 988 hotline for mental health help -
12/13/2022 There is much for which to be grateful this Thanksgiving. I love the holiday season first and foremost because Christmas celebrates the birth of my Savior. I also love Christmas music and the spirit of giving that is inspired in many. The scents, sounds and tastes of Christmas are engrained in most of us as children and represent fond memories that we carry with us throughout a lifetime. Unfortunately, for many of our friends, neighbors and family members, the holiday season is a time of sadness instead of gladness. I know people who become melancholy and others who are overwhelmed with anxiety during this most wonderful time of the year. I’d guess there are very few of us who haven’t been a bit stressed with the demands — mostly self-inflicted — on our time and bank account, but many others experience full-blown depression throughout the Thanksgiving, Christmas and New Year’s holiday weeks. Farmers, compared to men and women in other occupations, are among those most likely to die by suicide. A 2020 study published by the Centers for Disease Control and Prevention brought to light what many in agriculture had known for some time. The same study found that overall suicide rates have increased by more than 40% in less than 20 years. Last year, American Farm Bureau Federation conducted a survey in which they asked farmers about their mental health and stigma associated with it. According to the survey, the four biggest stressors that impact farmers’ mental health are financial issues, fear of losing the farm, uncertain future and the state of the farm economy. The survey states that 60% of farmers were experiencing more mental health issues in 2021 than the year before. The survey also says that more farmers are becoming aware of the mental health resources available to them and that farmers are utilizing these resources more often. There is still much to be done when it comes to making sure that farmers are able — and willing — to seek mental health resources. Denying or failing to realize you are struggling with a mental health issue is not uncommon. If you or someone you know suffers from persistent sadness or anxiety, is plagued by physical complaints, excessive irritability, fatigue or loss of energy, or lacks interest in doing things they once enjoyed, professional help could be needed. According to the Centers for Disease Control, approximately 9% of Americans suffer from some form of depression. 988 is the new three-digit dialing code that will route callers to the National Suicide Prevention Lifeline. When people call, text, or chat 988, they will be connected to trained counselors that are part of the Lifeline network. These trained counselors will listen, understand how their problems are affecting them, provide support and connect them to resources is necessary. 988 — spread the word! Can
the New 988 Crisis Hotline Fix America’s Mental Health
Epidemic? - U.S. News & World Report, 11/3/2022 With calls increasing and wait times improving, early signs seemed to suggest the new 988 Suicide & Crisis Lifeline could help answer the nation’s unmet mental health need. But questions remain. In mid-July, 988 essentially took over for its 10-digit predecessor in a move that federal officials hoped would support more Americans in the throes of a mental health crisis. After the switch, data indicates the simplified number may be delivering on its promise. The volume of routed lifeline encounters – which includes phone calls, texts and messages through the network’s chat line – totaled 350,629 in September 2022, a nearly 33% increase over the 264,639 contacts in September 2021, according to figures from the Substance Abuse and Mental Health Services Administration, which funds the 988 system, and Vibrant Emotional Health, which administers it. The rate at which contacts were answered improved from 63% to 88%, while the average speed of answers through the nation’s network of call centers quickened from 2 minutes and 51 seconds in September 2021 to 42 seconds in September 2022. Despite those gains, the data also indicates overall contacts are slowing slightly, raising questions about whether 988 can one day overtake 911 as the first number people think to dial in a mental health crisis. The figures from this past September indicate the number of encounters fell by 3% compared with August – the first full month after the launch of the three-digit line – and declined by 1% from the number of lifeline encounters reported in July. Phone calls specifically fell by 7% from August to September, though SAMSHA noted that part of the call data for the month was "projected based on historical data." Chats, meanwhile, ticked up 3% and texts rose by 12%. Stakeholders say a major challenge is
the lack of overall public awareness about 988. Results of a
recent survey of more than 2,000 adults conducted between
July 28 and Aug. 9 for CNN and the Kaiser
Family Foundation found that
while 90% acknowledged there was a mental health crisis in
the U.S., 56% said they had heard “nothing at all”
about 988. Worst Counties for Mental Health in
the U.S. View All 29 Slides Any possible slowdown in lifeline encounters comes at a time when demand for mental health care is high. A recent KFF analysis of federal data found 33% of adults reported having symptoms of either anxiety or depression compared with just 11% in 2019. Experts believe raising awareness about 988 is the crucial next step needed for the number to become ingrained in people’s minds as the primary resource to turn to during a mental health emergency. “We know that this country is in a mental health crisis and more and more people need help and are struggling, and I don’t anticipate that that’s going to level off,” says Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness. Preparing for an Influx In Florida, the Crisis Center of Tampa Bay fields 988 contacts for the surrounding area, staffing a team of approximately seven specialists on call 24/7 to aid individuals who reach out through the lifeline. Eric Bledsoe, the center’s director of gateway services, says his team has seen a fourfold increase in the average number of weekly calls following the launch of 988, jumping from approximately 100 a week before July to as many as 400 a week. While Bledose feels the center is equipped to meet the demand, he notes that delays in initial program funding made it difficult to plan for the anticipated increase in volume. “It was really hard to prepare and staff because the funding wasn’t approved until around the beginning of August,” Bledsoe says. [ READ: Mental Health Crisis Teams Not Just for Cities Anymore ] Ken Gibson, senior director of marketing and public relations for the Crisis Center of Tampa Bay, feels this period has served as more of a “soft launch” for the system to ensure call centers across the country built up adequate capacity to handle more contacts. That may help explain why he says federal and state policymakers have yet to truly prioritize marketing campaigns to raise awareness of 988. “Wisely, I think they wanted to make sure the infrastructure was built before the big push,” Gibson says. Wesolowski agrees the lack of a full-bore awareness campaign has been partly by design to give call centers time to identify and address potential gaps in their systems that could hinder their ability to handle an influx of 988 users. But Wesolowski says she expects policymakers over the next year to ramp up public promotion of 988, as confidence about the system’s readiness continues to grow. “To me, it shows that a lot of the investments made on the federal and state level are bearing fruit at just the right time when people are becoming aware of this and reaching out for help,” Wesolowski says. “I anticipate when there are resources available for widespread public awareness efforts that volume is going to continue to increase.” Kyle Kinney, program manager for Boys Town, a not-for-profit organization that fields 988 calls in Nebraska and has its own national hotline, describes his team’s transition to 988 as relatively smooth, thanks in large part to having the infrastructure in place around the state to support calls well before July. Since 988 debuted, Boys Town has so far seen an increase of 30 to 50 daily lifeline calls, which are answered by a full-time staff of approximately 20 trained professionals. Kinney expects call volumes to keep rising as more marketing is committed to raising awareness of 988. “I think we’ve only seen the tip of the iceberg as far as it relates to growth,” Kinney says. Danielle Bennett, a spokesperson for SAMHSA’s parent agency, the U.S. Department of Health and Human Services, tells U.S. News in an email that HHS is “… working with Congress to ensure federal resources for a national campaign to advertise or promote awareness of 988 to the public.” Bennett mentioned SAMHSA has provided resources to its 988 partners in the form of a toolkit, which includes national guidelines, promotional documents, public service announcement scripts for radio, PowerPoint slides for presentations and content graphics for sharing on social media. [ MORE: U.S. Suicides Rose in 2021 ] At the local level, Bledsoe says awareness efforts have included printing information about 988 on the back of student identification cards for those attending public high schools in Hillsborough, Florida – the county surrounding his crisis center. He expects the real test for the system will come once more robust national efforts get off the ground. “We truly believe there are even more people out there who are still not reaching out for different reasons,” Bledsoe says. “Marketing is really going to eventually get those people to realize that there’s something out there for them.” Next Steps Chuck Ingoglia, president and CEO of the National Council for Mental Wellbeing, says the 988 system is the first of three pillars needed for the nation to build a system of care that can effectively respond to people in mental health crises. In addition to 988, he says states need appropriate and effective in-person mobile crisis intervention teams to be first responders for those experiencing a mental health emergency, as well as places of respite other than hospital emergency rooms or jail where those in crisis can get stabilized before receiving treatment. “You think of 911, and though it’s not perfect, they have figured out who’s responsible for doing what and they’ve built an infrastructure so that in most parts of the country, you can get a fairly timely response,” Ingoglia says. As part of the American Rescue Plan, states can get reimbursed for supporting community-based mobile crisis services for Medicaid beneficiaries, with Oregon becoming the first state to gain approval for such a program. Dr. Christine Yu Moutier, chief medical officer for the American Foundation for Suicide Prevention, says 988 is part of an ultimate goal to reduce the country’s reliance on police as the first responders to people experiencing a mental health crisis. Of the approximately 1,000 people fatally shot by police in 2015, close to 25% displayed signs of a mental illness, according to a study published in the International Journal of Law and Psychiatry. Ultimately, Moutier says any effort to establish a more robust response to mental health crises will involve normalizing discussion around behavioral health and eliminating any stigma associated with calling a crisis line for help. “That is a longer-game strategy that is essentially leaning on each state to implement their multiple layers of what we consider a crisis response system that needs to be reimagined and revised,” Moutier says. If you or someone you know is
struggling or in crisis, please call or text 988, or chat at
988lifeline.org Can
the New 988 Crisis Hotline Fix America’s Mental Health
Epidemic? With calls increasing and wait times improving, early signs seemed to suggest the new 988 Suicide & Crisis Lifeline could help answer the nation’s unmet mental health need. But questions remain. In mid-July, 988 essentially took over for its 10-digit predecessor in a move that federal officials hoped would support more Americans in the throes of a mental health crisis. After the switch, data indicates the simplified number may be delivering on its promise. The volume of routed lifeline encounters – which includes phone calls, texts and messages through the network’s chat line – totaled 350,629 in September 2022, a nearly 33% increase over the 264,639 contacts in September 2021, according to figures from the Substance Abuse and Mental Health Services Administration, which funds the 988 system, and Vibrant Emotional Health, which administers it. The rate at which contacts were answered improved from 63% to 88%, while the average speed of answers through the nation’s network of call centers quickened from 2 minutes and 51 seconds in September 2021 to 42 seconds in September 2022. Despite those gains, the data also indicates overall contacts are slowing slightly, raising questions about whether 988 can one day overtake 911 as the first number people think to dial in a mental health crisis. The figures from this past September indicate the number of encounters fell by 3% compared with August – the first full month after the launch of the three-digit line – and declined by 1% from the number of lifeline encounters reported in July. Phone calls specifically fell by 7% from August to September, though SAMSHA noted that part of the call data for the month was "projected based on historical data." Chats, meanwhile, ticked up 3% and texts rose by 12%. Stakeholders say a major challenge
is the lack of overall public awareness about 988. Results
of a recent survey of more than 2,000 adults conducted
between July 28 and Aug. 9 for CNN and the Kaiser Family
Foundation found that while 90% acknowledged there was a
mental health crisis in the U.S., 56% said they had heard
“nothing at all” about 988. The
988 Crisis Lifeline Callback Enigma 7/9/24 "We should project our thoughts ahead of us at every turn and have in mind every possible eventuality instead of only the usual course of events." -- Lucius Annaeus Seneca The launch of the 988 Suicide & Crisis Lifeline in July 2022 reminds us of the urgency of mental health crisis care. As a physician-scientist who has practiced emergency department psychiatry for decades, I would be interested to know what actually happens in these short, highly vulnerable moments immediately before and during crisis calls. Although this new entry point holds the potential for advancement in the field, concerns around the training and effectiveness of this new "comprehensive" crisis service continue to be raised and are likely valid. More research is needed beyond general acceptance, case reports, some favorable numbers, and clinical anecdotal literature. Improvements to the lifeline are necessary to better understand local mental health needs, to evaluate the clinical expectations of intake counselors, to increase the visibility of existing resources, and to improve access where the primary barrier is clear and convincing pathology, not social determinants. For example, there is no bias-free validity evidence demonstrating the crisis line's hypothesized efficacy in high-risk encounters. High-quality evidence demonstrating crisis line effectiveness during imminent risk of suicide is limitedo. Furthermore, concerns regarding the thoroughness of crisis call counselors' specific assessment of risk utilizing the Applied Suicide Intervention Skills Training (ASIST) are significant. On the one hand, ASIST states thatopens in a new tab or window it develops "nonjudgmental attitudes" and "...focuses not on the complexity of suicide and its causes, but on the simple concept and achievable goal of safety for now." However, in this prehospital setting, acuity must be determined by the patient's complaints at the intake dispatch level. As 988 counselors receive calls, they should not only identify a patient's acuity level through their complaints, primary symptoms, and comorbidities, but also route the call appropriately. While 988 advisers may diligently answer high-volume calls, engage with non-emergent clients utilizing several communication preferences, and help devise a safety plan, it is the prioritization of calls and call-backs to address those with the most pressing needs that is particularly important. Without knowing what takes place during these calls or if there is any triage protocol in place, I'm at a loss over whether this resource is being appropriately deployed. Callbacks Callbacks must be performed within a specific window of time based on the initial triage evaluation of a person's complaint. For example, crisis counselors should understand that some non-urgent callers who need help in a time of crisis may not answer a timely callback due to fear of police contact, stigmatization, involuntary hospitalization, or other severe personal or financial consequences from the call. In situations where individuals need immediate attention, the call should be transferred without delay to specifically trained triage counselors. In this way, the proper level of care can be customized. Unfortunately, with some stress-induced, rapidly progressive, often unobvious suicidal conditions, destructive behavior may occur during the crisis call itself or before the call-back is attempted. Some proximal real-life traumatic events, imagined or threatened with unique personal salience or vulnerability, may expose persons to a singular and particularly life-threatening event for whom ASIST is not helpful -- no matter how the 988 hotline is currently used. This is descriptively termed extrapyramidal induced or autonomous suicidality with both motor and mental manifestations, and often characterized by the person's belief that they are in the process of dying Latin, angor = distress, animi = animated). This dynamic angor animi is equivalent to near-death, acute coronary persons gasping and in poor clinical status requiring heroic intervention. In the interval before irretrievable slowed reaction time, difficulty initiating and prioritizing tasks, and internal preoccupation occur, there is a therapeutic window through which the person may still be psychologically available and accessible by phone. But it will close rapidly. Immediate transfer to specifically trained triage counselors or prompt call-back is essential here. Focused Factors Beyond randomized trials or nonrandomized designs with some form of control to identify best assessment practices, only focused factors that influence outcomes of crisis conversations will begin to improve crisis care. The evaluation of focused factors of risk is complex but essential. Observational studies to examine effectiveness should also be conducted. What represents a focused, goodness-of-fit factor of importance and survival in these highly vulnerable moments immediately before and during a crisis call? It is the early identification of seized neurocognitive capacity characterized by inhibition or loss of verbal or symbol fluency, i.e., phonological recoding to connect letters and numbers. Enigmatically, it is the 988 string of numbers itself. Here's why it is important. During a psychological crisis, cognitive functions can be significantly affected. Acute stress can lead to mental slowing, impaired task switching, difficulty concentrating, reduced processing speed, and diminished comprehension. Thus, for some during a disorganizing crisis, the 988 digital dialing code may not be an easy number to remember. Individuals in greatest need may not be able to access it cognitively at a certain point during their crisis. Therefore, the impact on the thoroughness of current, phenotype-specific risk training and assessment becomes essential with a pointed index of suspicion for unusual high-risk cases. I understand the challenge and complexity. Identifying cognitive impairment is one thing, but then considering potential etiologies and intervening is a whole other thing. Conclusion It should now be obvious that suicide risk determinations require examination of intricate sensory processing. What is the requisite process? In simpler terms, these findings speak to the importance of crisis counselors, during initial call and timely callback, to suspect and understand rapid transitioning and autonomous suicide probabilities. Counselors must assess neurocognitive functioning, regardless of ideation, early and quickly in these crisis encounters. Well-timed tests of executive function, such as the 1-minute phonic alpha-numeric trail-making examination, are additional, easy-to-learn and easy-to-administer tools for the identification of risk acuity in a distribution of high-risk callers. Future 988 training efforts and
implementation need to focus on improving consistency and
effectiveness of currently inadequate ASIST-like assessments
of risk. In-depth training on focused factors, clinical
guidelines, and suicide prevention strategies should be
based on emerging high-quality evidence in the field of
clinical usefulness. This should include empirical decision
trees and differential diagnosis of extreme risk
distribution phenotypes with intricate probability
models. 988
Calls Will Now Be Routed by Location Instead of Area Code -
- 9/26/24 "The launch of 988 georouting marks a significant leap forward in our nation's crisis response system," HHS Secretary Xavier Becerra said Wednesday in a press release. "With georouting in place, callers will be connected to 988 crisis contact centers closer to where they are, which will help us to more quickly connect people to local services and resources when they need additional on the ground support." Georouting connects cell phone callers to the closest 988 contact center to the caller's physical location. However, "georouting differs from geolocation in that it does not provide a precise location of the caller, allowing callers to maintain their location privacy," the press release noted. In a related development, Federal Communications Commission (FCC) Chairwoman Jessica Rosenworcel said Wednesday that at its upcoming October 17 meeting, the FCC will vote on final rules to codify georouting. Those rules will require all U.S. wireless carriers to begin georouting calls to the lifeline by 30 days after the rule's effective date; smaller, non-nationwide providers will have 24 months to do so. "In times of crisis, every minute matters -- especially when seeking help for yourself or a loved one in need of mental health support. There's a real benefit to connecting with resources available in your own backyard and speaking with those within your own community," Rosenworcel said in the press release. "Georouting means those responding to 988 calls have a lot more knowledge of local resources at their fingertips and are better equipped to get the caller the help they need, where they need it. Through our vote next month, the FCC is committed to making sure that everyone can connect to these local resources." T-Mobile is one of the affected national carriers, and it enabled georouting last week. "Around 80% of calls to the 988 lifeline are done through wireless phones, and many people have phone numbers with different area codes from where they live, work, or visit," Ulf Ewaldsson, president of technology at T-Mobile, said in an email to MedPage Today. "Georouting ensures that those seeking help will reach the available crisis center nearest their location for support. It's about making sure help is there when and where it's needed most." The 988 lifelineopens in a new tab or window connects cell phone callers to one of more than 200 call centers nationwide. Since 988's launch in July 2022opens in a new tab or window, trained counselors have answered more than 10 million calls, texts, and chatsopens in a new tab or window from people looking for help with suicidal thoughts and mental health and substance use-related crises, according to HHS. The Biden administration has spent almost $1.5 billion to strengthen the service, the agency noted. On the heels of the georouting announcement, the CDC reported Thursdayopens in a new tab or window that the U.S. suicide rate remained about the same in 2023 as it had in 2022, with just over 49,300 suicide deaths reported last year compared with a little less than 49,500 the year before. If you or someone you know is
considering suicide, call or text 988 or go to the 988
Suicide and Crisis Lifeline websiteopens in a new tab or
window. FCC
requires 988 calls be routed to local call centers -
10/18/24 Cellphone carriers will be required to use georouting to connect callers to the 988 call center closest to the caller’s physical location, a change intended to streamline connections to local resources and broaden services. “If we get more people connected to the Suicide and Crisis Lifeline to resources that are local, we can help more people with more meaningful assistance in more places,” FCC Chairwoman Jessica Rosenworcel said before the vote Thursday. “Georouting means that those responding to 988 inquiries have a lot more knowledge of local resources and local events.” The requirements would take effect 30 days from the effective date of the rule for wireless providers and 24 months afterward for smaller, non-nationwide providers. “The 988 Lifeline represents a portal to community resources that can help a person both navigate an immediate crisis and find ongoing care,” said Chuck Ingoglia, president and CEO of the National Council for Mental Wellbeing. “Georouting will make that easier for everyone involved.” The 3-digit lifeline number rolled out in July 2022 and typically connects callers to a center based on their three-digit area code. But many individuals use a mobile number whose area code does not match where they currently live. Two major carriers, Verizon and T-Mobile, voluntarily began the process last month to route calls based on location. Those carriers make up about half of all wireless calls to 988, according to the FCC. A third carrier, AT&T, said they will also begin the process soon. The FCC is also proposing that carriers use georouting to connect people who text 988 to local call centers and solicit input on how to do that. “Texting technology is different
and presents special challenges because texts contain unique
information and move along a different pathway than
traditional phone calls,” Rosenworcel said.
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