Mental health advocates fear new 988 hotline may not be ready

If you or someone you know is considering suicide, the National Suicide Prevention Lifeline is available 24/7 at 1-800-237-8255.

The United States faces significant mental health challenges, which have been exacerbated by the COVID-19 pandemic. There is a shortage of mental health workers, facilities and programs to provide care. According to the National Institute of Mental Health, nearly one in five Americans – 52.9 million people – live with some form of mental illness, and in 2020 less than half received treatment.

When mental illness becomes a crisis, the first line of help in this country has been a patchwork of local hotlines, national veterans and youth crisis lines, 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 call centers.

In 2020, President Donald Trump signed legislation designating a single, easy-to-remember, three-digit number for all mental health crisis calls: 988. It will go live nationwide for incoming calls (landline and wireless as well as for SMS and chat) on Saturdays. But analysts and health policy advocates worry the new system may not be ready for the predicted surge in demand.

When someone suffering from a mental health crisis, or a friend or family member seeking information or help for someone in crisis, dials the national 988 emergency line, the first thing they hear is a recorded voice telling them to wait “a moment”. They are then informed – with the option to listen to the message in Spanish – that they have reached the national lifeline for suicide prevention: “If you are in emotional distress, or in a suicidal crisis, or if you are worried for anyone who might be, we’re here to help.

There is an option to join a military veteran crisis line or wait to be connected to a local crisis call center, depending on the area code of the caller.

In Oregon, this call center might be Lines for lifea Portland-based nonprofit organization 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 speak to a stranger is a hard thing to do,” she said. “It’s really hard to be vulnerable. It takes a lot of courage and strength just to reach out.

And yet, from 2020, the system in which 988 calls will now power “could only meet the needs of about 85% of its callers,” said Kaiser Family Foundation researcher Heather Saunders, who recently published a report on suicide prevention and 988.

This means that around 1 in 7 callers were disconnected or hung up before a crisis counselor answered.

Saunders fears the problems are getting worse. “When 988 is rolled out, call volume is expected to triple in the first year alone and then continue to grow from there.”

In fact, increasing the number of people asking for help is part of the appeal of switching to 988.

“The problem is that if there were problems with the current infrastructure to respond to the volume of calls,” Saunders said, “people could contact the new 988 number in a crisis but not be able to reach anyone. one on the other side of the line.”

That could cause people to abandon efforts to contact what’s supposed to be the new easy-to-reach number for all mental health issues, 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 abandonment levels,” she said, “because people are going to wait. That’s what industry leaders are most concerned about.” state policymaking, advocates and stakeholders.

Part of the problem is that there has been relatively little state and local funding, planning, and resources devoted to setting up and deploying 988.

Rand Corp. recently surveyed 180 mental health directors across the country, according to researcher Jonathan Cantor, to find out “whether or not there would be long-term budgeting for this. This was missing, which is concerning. Only about 1 in 7 respondents had budgeted to support 988.”

Of these, “less than half included budgeting for infrastructure, clinical staff, marketing materials, or service coordination between 988 and 911,” Cantor said.

So far, only 13 states have enacted dedicated funding mechanisms, including four — Colorado, Nevada, Virginia and Washington — that have added charges to residents’ telecom bills, similar to how 911 is funded in many states. many states. (To see the National Academy for State Health Policy Tracker on legislation, planning and funding for the deployment of 988.)

The lack of funding is particularly problematic in states that already have a poor track record of responding to crisis calls — states whose residents often end up talking to advisers elsewhere, Manz said. “The ideal response would be to have someone who is local, who understands local resources, the local supplier landscape, that sort of thing.”

According data published by the National Suicide Prevention Lifeline and its coordinator, Vibrant Emotional Health, only 21% of Illinois Spring 2021 calls were answered by call centers in the state. In four other states, less than half of all calls were answered in the state: Texas, 38%; Arkansas, 42%; Minnesota, 43%; and Wyoming, 47%.

Calls that centers in the state cannot handle spill over to a network of more than a dozen nationwide relief sites that take overflow 24/7.

That includes Oregon’s Lines for Life, which has increased its capacity to respond to an expected doubling of calls over the coming year, from 40,000 to 80,000, according to CEO Dwight Holton.

“Starting August 1, we will be part of this national relief network, and we will see increased volume from larger states, other states that are not supporting crisis response like Oregon does. I’m sure we’ll be able to handle it. We have hired dozens of additional telephone advisers.

Crisis Line Director Deborah Dedrickson tries to ensure every call is answered quickly, with knowledge and compassion, whether the caller is from Oregon or a state thousands of miles away.

“People have to wait sometimes,” Dedrickson said. “I work tirelessly every day to prevent this. And in fact, the national standard for 988 is that we answer 95% of calls within 20 seconds.

Achieving this goal would ensure that more people who seek mental health support in a crisis get the help they need.

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