“I see 988 as a starting point where we can really reinvent mental health care,” said Hannah Wesolowski, director of advocacy for the National Alliance on Mental Illness, a nationwide grassroots group. “We’re really seeing a fundamental sea change in how we respond to people in mental health crises.”
The network of more than 180 local call centers, severely underfunded throughout its history, received 3.6 million calls, chats and text messages in fiscal year 2021, according to the Child Abuse and Mental Health Services Administration. Substances (SAMHSA). Officials expect him to jump to 7.6 million contacts next year, when the National Suicide Prevention Lifeline — 800-273-TALK (8255) — makes way for 988. The 800 number will remain active indefinitely. (The expected increase in contacts does not include a hotline option reserved for veterans.)
the direct line in Tucson, for example, is Widely considered the gold standard for comprehensive care for people experiencing mental health crises. When someone calls that 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 dispatched to the caller’s door, or elsewhere, day or night.
And those who need even more assistance can be brought to the the “stabilization center” of the city where psychologists, doctors, nurses and other specialized personnel provide everything from urgent mental health care to drug treatment medications.
The settlement 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 help to the people who need it.
“We have the space. We have the staff. We have the training,” said Margie Balfour, chief of quality and clinical innovation for Connections Health Solutions, the company that runs the Tucson stabilization center.
SAMHSA organized what had been a collection of individual call centers into a national network in 2004, awarding the contract to operate and grow the system to the nonprofit organization Vibrant Emotional Health (then known as the Mental Health Association of New York). City).
Call centers are funded by local, state, and federal resources, creating a wide variation in each center’s ability to handle its call volume. When local centers are overwhelmed or understaffed, centralized support centers across the country respond. There are 14 now and up to 17 will be operating in August.
But local centers are preferable, because staff there are better familiar with nearby mental health resources, officials said. Its ability to handle capacity varies substantially by location.
In the first quarter of 2022, for example, North Carolina was able to handle 90 percent of its calls within the state, while Illinois answered only 20 percent. according to data from Vibrant.
Overall network capacity was able to handle 85 percent of calls, 56 percent of text messages and 30 percent of chats, according to a government reportciting a December 2020 analysis. Increased hiring and spending has already improved call centers’ ability to keep up with demand, said John Draper, executive vice president of Vibrant.
Xavier Becerra, secretary of the Department of Health and Human Services, told a briefing for reporters this month: “988 will work if states commit to doing 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 answer and a person in another state gets a busy signal.”
Lack of resources can be dangerous: The Wall Street Journal recently estimated that 1 in 6 callers hang up without contacting anyone.
Research has repeatedly confirmed that phone lines are highly effective in their mission. In the vast majority of cases, a trained counselor who listens and sympathizes with the caller or texter can help you get through a short-term crisis over the phone.
Staff and volunteers also learn how to separate a person with suicidal thoughts from anything that could be used to cause harm, send family or friends to help, arrange follow-up care, or contact the police if necessary.
“Suicidal crisis callers report significant reductions in death intent, hopelessness, and psychological pain over the course of their crisis call,” Madelyn Gould and Alison Lake, researchers at Columbia University, wrote in a report. of September on the 988 and the prevention of suicide to the National Association of State. Directors of Mental Health Programs.
They added that “crisis counselors can secure caller cooperation in an intervention on more than 75% of imminent risk calls.”
SAMHSA has spent more than $280 million to strengthen the system, and Congress appropriated an additional $150 million.
“Our goal is to make the 988 like the 911,” Becerra said. “If you are willing to turn to someone in your time of crisis, someone will be there. 988 will not be a busy signal. 988 will get you help. That is the goal.” But he made it clear that states, not the federal government, will have to fund call centers on an ongoing basis.
The number of suicides in the United States rose steadily from 29,350 in 2000 to 48,344 in 2018, before declining to 45,979 in 2020. according to the National Center for Health Statistics. In the wake of the coronavirus pandemic and other factors, government and health officials agree the country is on the brink of a mental health crisis, especially among young peoplewith rates of depression and anxiety on the rise.
Tucson’s continuum of services grew over 20 years, a collaboration of state, county and private participants, Balfour said. Now officials across the country point to his program as a model for other places.
Dispatchers from mobile crisis teams sit down with 911 dispatchers and sometimes redirect police calls to pairs of doctors, Balfour said. The 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 an ER. There is a dedicated entrance into the law enforcement facility so officers don’t have to take out and store their weapons, he said.
Slots available for follow-up care at mental health clinics are entered into the hotline computer, making it easy to access help. The hotline handles about 10,000 calls a month, Balfour said. The stabilization center treats about 1,000 adults a month, as well as 200 to 300 children and teens, he said.
It has an observation area with chairs for 34 adults and 10 youths and a 15-bed inpatient unit for adults, where patients can stay for three to five days, he said, even while they withdraw from drugs and begin medically assisted treatment. . The beds help avoid hours and days of “boarding” in emergency rooms without treatment while hospital staff search for a bed in a suitable facility.
The center strives for “90 minutes door-to-door” and does not turn anyone away, including walk-ins, Balfour said. Patients may be suicidal, violent, intoxicated, psychotic, or detoxifying.
“Our model is that we accept everyone,” he said. “We want the people who are normally denied elsewhere. We want those very sharp and potentially violent people.”
If you or someone you know needs help, visit suicidepreventionlifeline.org.
