The United States has a new crisis hotline: 988. Is it ready for an increase in calls?


Americans in distress have a new number to call for help — 988, a revamped national suicide prevention lifeline that’s billed as the mental health 911.

The issue, set to go live Saturday and backed by more than $400 million in federal funding, is intended to address a growing wave of mental illness in the United States. But there are lingering concerns that short-staffed call centers across the country may not be ready for the surge.

Many of those who called Lifeline in recent months disconnected before they got help. About 18% of the roughly 1 million phone calls made to Lifeline in the first half of this year were dropped, according to an analysis of New York Times data. Earlier analysis by The Times in March found similar issues, and the move to a high-profile three-digit phone number is expected to further strain capacity.

Xavier Becerra, the health and human services secretary, applauded the efforts to prepare for 988 while acknowledging that considerable work remains to be done. “Once you’ve started, there has to be someone answering the phone,” he said in an interview. “It’s not enough to have a busy signal or to be put on hold.”

Hundreds of millions of federal dollars have given Lifeline a major jolt over the past half year. The money helped the chronically underfunded hotline — long answered by a patchwork of call centers, often nonprofits that juggle multiple hotlines and rely on both paid advisers and volunteers – to recruit additional phone banks across the country, bringing the total from 180 to over 200.

The funding also strengthened a Spanish-speaking network; national emergency centres, where counselors can respond locally to unanswered calls; and digital messaging services, seen as a crucial tool for reaching young people in need of help.

Lifeline’s text messages and chat lines received around 500,000 contacts in the first half of 2022, but only 42% of them were answered. Yet the data, provided by the organization that administers Lifeline, showed steady improvement – the response rate soared to 74% in June and the average wait time fell from 16 minutes in January to around three minutes on last month.

There have been no significant gains in phone call response rates, although one of 988’s goals is to answer 95% of calls within 20 seconds. According to Lifeline, 80% of callers who disconnected last year did so within two minutes of the automated greeting, and about a quarter of those who hung up tried again within 24 hours and were successful.

John Draper oversees the Lifeline and is an executive with the nonprofit Vibrant Emotional Health, which operates the Substance Abuse and Mental Health Services Administration service. Mr Draper pointed to the “huge increases” in responses to digital messages. He predicted that the new investments would lead to improvements in answering phone calls in the coming months, noting that call centers have already been able to keep pace with the steady increase in volume.

“We want to make sure we respond to everyone in crisis,” he said.

But less than half of public health officials responsible for rolling out 988 were confident their communities were prepared, according to a recent RAND Corporation survey.

The redesign of the Lifeline is not limited to calls, texts and chats. While data shows that helplines can resolve around 80% of crises without further intervention, the vision for 988 is that counselors will eventually be able to connect callers with mobile crisis teams who can come to where they are, as well as short-term mental health services. sorting centers.

These changes are expected to reduce law enforcement interventions and the use of emergency rooms, ultimately keeping more people alive, advocates say.

The new Lifeline comes at a time when mental illnesses are on the rise, including what the US Surgeon General has called a “devastating” crisis among young people. Suicide was the 12th leading cause of death for Americans of all ages in 2020, according to the Centers for Disease Control and Preventionand the second leading cause among 10 to 14 year olds and 25 to 34 year olds. One person died by suicide every 11 minutes in 2020. Many believe the pandemic has exacerbated mental health issues, and the revamped helpline is set to expand beyond the scope of suicide to help anyone in crisis.

Despite the expected increase in volume, questions remain about the long-term sustainable funding for 988. That’s in part because the law establishing it, signed by President Donald J. Trump in October 2020 with bipartisan support, left funding for call centers largely to the states. .

Although it gave states the ability to fundraise for 988 the same way they do for 911, with monthly charges on phone bills, only four states have authorized a charge on the telephone bill. Many other states have used grants or general funds or have enacted other laws to prepare for the new Lifeline.

“I think 988 represents the best and worst of how America approaches mental health,” said Benjamin F. Miller, psychologist and president of Well Being Trust, a mental health foundation. “At best, it’s ingenuity, creativity, positioning. At worst, it is the lack of resources, the lack of leadership and follow-up.

Dr Miller worries about the continuity of funding, he said, because mental health in the country has always been an “afterthought”.

“It’s the marginalized aspect of our health care that we continue to avoid investing heavily in,” he said.

Jennifer Piver, executive director of Mental Health America of Greenville County, the only 988 call center in South Carolina, said federal funding allowed her to fill eight new positions. But she feared it might not be enough in the long run and said her team was looking for grants and raising money through a GoFundMe page.

“I’m sure we’ll be fine on Saturday,” Ms Piver said. “But as word spreads, you know, dealing with that growth is not something we are financially prepared for in terms of personnel.” The center responds to more than 80% of calls in the state, but if the funding stays the same, she said, “we could see that drop pretty quickly to 50, 40, even 30% when you factor in of some of the systems that are going to change. ”

The national labor shortage has also affected the ability to hire and retain employees. The Substance Abuse and Mental Health Services Administration has a long page on their website which lists job opportunities Across the country.

Labor was an issue for the mental health field “long before the pandemic,” said Hannah Wesolowski, advocacy manager for the National Alliance on Mental Illness, who noted that burnout was also a concern for professionals already in this space.

Although a lot of work has been done since Law 988 was enacted, Ms Wesolowski said, “We’re trying to build a comprehensive system, and that’s going to take more than two years.”

Rep. Tony Cárdenas, a California Democrat and leading 988 supporter in Congress, noted that 911, which was established more than 50 years ago, “did not start off without a hitch.”

Despite the uncertainties, supporters remain hopeful that 988 will deliver on its promises.

“People’s lives are at stake, so we have to make it happen,” said Preston Mitchum, advocacy director at the Trevor Project, a crisis intervention organization for LGBTQ youth.

“We will get there.”


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