The national suicide hotline is changing to 988 starting Saturday
“I look at 988 as a starting place where we can really reimagine mental health care,” said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness, a nationwide grass-roots group. “We’re really looking at a fundamental tide shift in how 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 the 2021 fiscal year, according to the federal Substance Abuse and Mental Health Services Administration (SAMHSA). Officials expect that to jump to 7.6 million contacts in the coming 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 doesn’t include a hotline option reserved for veterans.)
The hotline in Tucson, for example, is widely considered the gold standard for comprehensive care of people suffering mental health crises. When someone calls that city’s hotline, trained counselors help resolve the emergency on 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 any other location — day or night.
And those who need even more assistance can be brought to the city’s “stabilization center,” where psychologists, doctors, nurses and other specialized personnel provide everything from urgent mental health care to drug treatment medication.
The arrangement 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 aid 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 at Connections Health Solutions, the company that runs the Tucson stabilization center.
SAMHSA organized what had been a collection of individual call centers into a nationwide network in 2004, awarding the contract to operate and grow the system to the nonprofit Vibrant Emotional Health (then known as the Mental Health Association of New York City.)
The 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 swamped or unstaffed, centralized backup centers across the country respond. There are 14 now and as many as 17 will be operating by August.
But local centers are preferable, because staff there are better acquainted with nearby mental health resources, officials said. Their 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 in-state while Illinois responded to just 20 percent, according to Vibrant data.
The overall network’s capacity was able to address 85 percent of calls, 56 percent of texts 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, executive vice president at Vibrant.
Xavier Becerra, secretary of the Department of Health and Human Services, said in a briefing for reporters this month: “988 will work if the states are committed to it. It won’t work well if they’re not. There is no reason, no excuse, that a person in one state can get a good response and a person in another state will get a busy signal.”
A lack of resources can be dangerous: The Wall Street Journal calculated recently that 1 in 6 callers hangs up without reaching anyone.
Research has repeatedly confirmed that call-in lines are highly effective in their mission. A trained counselor who listens to and empathizes with a caller or texter can help him or her past a short-term crisis on the phone in the vast majority of cases.
Staff and volunteers also are taught how to separate a person with thoughts of suicide from whatever might be used to commit harm, send family or friends to help, arrange follow-up care or contact law enforcement if necessary.
“Suicidal crisis callers report significant reductions in intent to die, hopelessness, and psychological pain over the course of their crisis call,” Columbia University researchers Madelyn Gould and Alison Lake wrote in a September report on 988 and suicide prevention to the National Association of State Mental Health Program Directors.
They added that “crisis counselors are able to secure the caller’s collaboration on an intervention on over 75% of imminent risk calls.”
SAMHSA has spent more than $280 million to bolster the system and Congress allocated $150 million more.
“Our goal is to make 988 like 911,” Becerra said. “If you are willing to turn to someone in your moment of crisis, someone will be there. 988 won’t be a busy signal. 988 will get you help. That is the goal.” But he made clear that the states, not the federal government, will have to fund call centers on a continuing 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 on Health Statistics. In the wake of the coronavirus pandemic and other factors, government and health officials agree that the country is in the grip of a mental health crisis, especially among younger people, with sharply rising rates of depression and anxiety.
Tucson’s continuum of services grew over 20 years, a collaboration of the state, county and private participants, Balfour said. Now officials around the country point to its program as a model for other locales.
Dispatchers for the mobile crisis teams sit with 911 dispatchers and sometimes redirect calls for police to pairs of clinicians instead, Balfour said. Police are trained to bring people to the stabilization center instead of hospitals or jails when appropriate. They can be in and out in minutes, rather than spending hours with patients in an emergency room. There is a dedicated entrance at the facility for law enforcement so officers don’t have to remove and store their weapons, she said.
Available slots for follow-up care at mental health clinics are entered into the hotline’s computer, easing access to help. The hotline handles about 10,000 calls per month, Balfour said. The stabilization center handles about 1,000 adults per month as well as 200 to 300 children and teens, she said.
It has an observation area with chairs for 34 adults and 10 younger people and an adult inpatient unit with 15 beds, where patients can stay three to five days, she said, including while they withdraw from drugs and begin medically assisted treatment. The beds help prevent hours and days “boarding” in emergency rooms untreated while hospital personnel search for a bed in an appropriate facility.
The center strives for “90 minutes from door to doc” and turns away no one, including walk-ins, Balfour said. Patients may be suicidal, violent, intoxicated, psychotic or detoxifying.
“Our model is we take everybody,” she said. “We want the people that typically get denied at other places. We want those high-acuity, potentially violent people.”
If you or someone you know needs help, visit suicidepreventionlifeline.org.