Influx of Calls to Suicide Prevention Hotline Could Test Some States

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The 988 emergency phone system has widespread support. But its launch comes after decades of lagging investment overall in mental health services.

A new, three-digit number for mental health emergencies is set to roll out nationally in about nine weeks but some states still aren’t ready to handle what experts predict could be a crush of calls.

The federally-mandated 988 system will strengthen and expand the existing 10-digit National Suicide Prevention hotline. It’s meant to make it easier for people in crisis to get the help they need without routing their calls through 911 public safety dispatchers. 

“Every state is working on this, and every state is excited about it and every state is scared about it,’’ said Brian Hepburn, executive director of the National Association of State Mental Health Program Directors. “Like any change, it’s going to take a lot of work…but there has been years of planning for this."

The phone line has widespread support among mental health advocates, but funding for comprehensive mental health services has lagged for years. And some are worried that a surge in calls when the 988 system goes online won’t be met with a corresponding increase in services to people once the immediate crisis is over.

“Leaders in the various states want to make sure people are aware of 988 but they also don’t want people to have unreasonable expectations that, as of the end of July, you can call 988 and all the services that you need are going to be there,’’ Hepburn said.

“There are certain places that if you call 988 on Aug. 1, the phone will be picked up quickly and if you need a mobile crisis [unit], it will respond quickly, but that’s only in certain parts of the country."

'Work in Progress'

Former President Trump signed a bill in 2020 creating the easy to remember number for people experiencing an urgent emotional crisis. The measure won bipartisan support in Congress and was widely praised by mental health advocates.

The 988 system is already in place in some jurisdictions and is set to go live everywhere on July 16. The date is somewhat arbitrary, said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness. 

“This is a work in progress,’’ Wesolowski said. “We've come a long way in the last 18 months. We’re in a much better spot today than we were six months ago and we'll be in an even better spot six months from now but it’s going to take time to scale up.’’

Under the new system, telecommunications providers will connect callers who dial 988 with the National Suicide Prevention Lifeline: 1-800-273-TALK. The long established hotline has seen a sharp spike in calls over the past few years, especially as the coronavirus crisis has brought on what some experts are calling a mental health pandemic.

The suicide prevention line is staffed by behavioral health experts, who are far better equipped to help someone in distress than the police are, said Wesolowski. Unlike the 911 system, 988 will be staffed not by public safety dispatchers but by trained mental health professionals who will listen to callers and provide resources for additional help.

“For law enforcement, this isn’t a job they signed up for nor is it a job they should be doing,’’ she said. “There’s a lot of agreement that a mental health crisis deserves a mental health response.’’

Part of a Larger Overhaul

The 988 system will provide free and confidential help to people who are struggling with any type of emotional health emergency—from those seeking substance abuse treatment to those who need someone to talk to—not only callers experiencing thoughts of suicide.

The federal Substance Abuse and Mental Health Services Administration envisions the hotline as a key part of a larger overhaul of how mental health crisis services are provided across the U.S. The agency aims to build a mental health system that links callers to the crisis line with community-based providers and a full-range of services, including mobile crisis teams.

In some places around the U.S., such a system already exists. Wesolowski said Tucson has long provided a “continuum of care” to people grappling with an urgent mental health crisis, and could serve as a model for other places. 

She also cited several states, from Pennsylvania, which has increased the number of crisis call centers, to New York, where the new budget package includes money for both call centers and mobile crisis teams.

The federal government has also helped: Last month, the U.S. Department of Health and Human Services awarded $105 million to states and territories for the 988 launch. (The Substance Abuse and Mental Health Services Administration expects calls made to 988 in its first year of operation will double the 3.3 million calls, texts and chats made to the existing suicide hotline in 2020.)

But some states may be less prepared than others to get the 988 program up and running. The National Academy for State Health Policy surveyed states in January and found that just 13 of them had enacted legislation to implement and fund the system.

“Mental health services have been underfunded for decades and this infusion of money that we’re seeing is great but it’s going to take time to build up that capacity,’’ Wesolowski noted.

Officials are grappling with other issues as well, including a shortage of trained mental health professionals. 

Hepburn, the director of the state association for mental health program directors, cautioned that the public shouldn’t expect that “a switch will be flipped” on July 16 and suddenly decades of lacking investment in mental health will be reversed. 

He also pointed out that it took a full decade after the creation of the 911 emergency dispatch line in 1967 for the system to be fully operational across the U.S. 

“It’s probably going to take five years for 988 to be fully implemented across the country,’’ he said. “It’s going to take a while to get everything going.”

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