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The nationwide mental health emergency hotline is switching to a simple 988 number on Saturday, a transition expected to result in millions more calls, chats and texts in a system where readiness to handle the surge varies from place to place.
At the same time, advocates hope that the renewed focus on emergency care and the costs that accompany it will will spur the expansion of other mental health services that are in desperate short supply in many communities.
“I look at 988 as a starting point where we can really rethink mental health care,” said Hannah Wesolowski, chief advocate for the National Alliance on Mental Illness. national group at the local level. “We are really seeing a fundamental shift in the way we respond to people in mental health crisis.”
The network of more than 180 local call centers, drastically underfunded throughout its history, fielded 3.6 million calls, chats and texts in fiscal year 2021, according to the federal Substance Abuse and Mental Health Services Administration (SAMHSA). Officials expect that to jump to 7.6 million contacts next year as the National Suicide Prevention Lifeline — 800-273-TALK (8255) — gives way to 988. The 800 number will remain active indefinitely. (The expected increase in contacts does not include a veterans-only hotline option.)
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The hotline in Tucson, for example, is like that widely regarded as the gold standard for comprehensive care for people suffering from mental health crises. When someone calls this city’s hotline, trained counselors help resolve the emergency over the phone 80 percent of the time. If they can’t, one of 16 “mobile crisis teams” is sent to the caller’s door – or anywhere else – day or night.
And those who need even more help can be taken to the city’s “stabilization center,” where psychologists, doctors, nurses and other specialized staff provide everything from emergency psychiatric care to drug treatment.
The agreement keeps people who may be considering suicide or have other acute mental health needs out of emergency rooms and jails, reduces police and EMT involvement in behavioral health cases, and speeds up help for people who need it.
“We have room. We have the staff. We have the training,” said Margie Balfour, chief of quality and clinical innovation at Connections Health Solutions, the company that operates the Tucson stabilization center.
In 2004, SAMHSA organized a collection of individual call centers into a national network, awarding the contract to manage and develop the system to the nonprofit Vibrant Emotional Health (then known as the Mental Health Association of New York).
Call centers are funded by local, state, and federal resources, creating wide variation in each center’s ability to handle its call volume. When local centers are overwhelmed or understaffed, centralized backup centers across the country respond. Now there are 14, and by August 17 will be working.
But local centers are preferable because staff there are more familiar with nearby mental health resources, officials said. Their ability to handle capacity varies greatly by location.
In the first quarter of 2022, for example, North Carolina was able to handle 90 percent of its calls in the state, while Illinois answered just 20 percent, according to Vibrant data.
Total network capacity was able to address 85 percent of calls, 56 percent of text messages and 30 percent of chats, according to a government report citing a December 2020 analysis. Already, increased hiring and spending has improved call centers’ ability to keep up with demand, said John Draper, Vibrant’s executive vice president.
Xavier Becerra, secretary of the Department of Health and Human Services, told reporters at a briefing this month: “988 will work if the states are committed to it. It won’t work well if they aren’t. There is no reason or excuse that a person in one state can get a good response and a person in another state will get a busy signal.”
Lack of resources can be dangerous: The Wall Street Journal recently estimated that 1 in 6 callers hang up without getting through to anyone.
Research has repeatedly confirmed that hotlines are very effective in their mission. A trained counselor who listens and empathizes with the caller or texter can help them overcome a short-term crisis over the phone in most cases.
Staff and volunteers are also trained in how to separate a person with suicidal thoughts from anything that could be used to do harm, send family or friends for help, arrange aftercare or contact law enforcement if necessary.
“Suicide crisis callers report significant reductions in intent to die, hopelessness, and psychological distress during their crisis call,” Columbia University researchers Madeline Gould and Alison Lake wrote in a September report on 988 and Suicide Prevention to the National State Association Mental Health Program Directors.
They added that “crisis counselors are able to secure the cooperation of the caller in intervention in over 75% of immediate risk calls.”
SAMHSA has spent more than $280 million to strengthen the system, and Congress has appropriated another $150 million.
“Our goal is to make the 988 like the 911,” Becerra said. “If you want someone to turn to in a time of crisis, someone will be there. 988 will not be a busy signal. 988 will help you. This is the goal.” But he made it clear that states, not the federal government, would have to fund the call centers on an ongoing basis.
The number of suicides in the United States rose steadily from 29,350 in 2000 to 48,344 in 2018 before declining to 45,979 in 2020, according to the National Center for Health Statistics. As a result of the coronavirus pandemic and other factors, government and health officials agree that the country is in the grip of a mental health crisis, particularly among younger people, with levels of depression and anxiety soaring.
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Tucson’s continuum of services has been growing for 20 years, in collaboration between state, county and private actors, Balfour said. Now officials across the country point to his program as a model for other locales.
Mobile crisis dispatchers sit with 911 dispatchers and sometimes refer police calls to clinician pairs instead, Balfour said. Police are trained to take people to the stabilization center instead of hospitals or jails when appropriate. They can be in and out in minutes instead of spending hours with patients in the emergency room. The facility has a dedicated entrance for law enforcement so officers don’t have to remove and store their weapons, she said.
Available follow-up care slots at mental health clinics are entered into the hotline’s computer, making it easier to access help. The hotline handles about 10,000 calls a month, Balfour said. The stabilization center serves about 1,000 adults a month, as well as 200 to 300 children and teenagers, she said.
It has an observation area with chairs for 34 adults and 10 younger people and a 15-bed adult inpatient unit where patients can stay for three to five days, she said, including while they come off drugs and begin medically assisted treatment . The beds help prevent hours and days of “staying” in emergency rooms without treatment while hospital staff search for a bed in an appropriate facility.
The center aims for “90 minutes from the door to the doctor” and doesn’t turn anyone away, including walk-ins, Balfour said. Patients may be suicidal, aggressive, intoxicated, psychotic, or detoxing.
“Our model is that we accept everybody,” she said. “We want the people who normally give up in other places. We want these people with high insight, potentially aggressive.
If you or someone you know needs help, visit suicidepreventionlifeline.org.
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