National suicide line changes to 988 from Saturday


The nationwide mental health emergency hotline will switch to a basic 988 number on Saturday, a transition expected to bring millions more calls, chats and texts in a system where the willingness to handle the wave moves from place to place. place differs.

At the same time, proponents hope that the renewed focus on emergency aid and the associated expenditure, will expand other mental health services that are desperately in short supply in many communities.

“I see 988 as a starting point where we can really reinvent mental health care,” said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness, a national base group. “We’re really looking at a fundamental shift in the way we respond to people in a mental health crisis.”

According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA), the network of more than 180 local call centers, drastically underfunded throughout history, handled 3.6 million calls, chats and texts in fiscal year 2021. Officials expect this to rise 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 does not include a hotline option reserved for veterans.)

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Into the hotline For example, Tucson is widely regarded as the gold standard of comprehensive care for people suffering from a mental health crisis. When someone calls that city’s hotline, trained counselors help on the phone 80 percent of the time to resolve the emergency. If they can’t, one of the 16 ‘mobile crisis teams’ is dispatched to the caller’s door – or to another location – day and night.

And those who need even more help can be taken to the city’s “stabilization center,” where psychologists, doctors, nurses and other specialist staff provide everything from emergency mental health care to medication for drug treatment.

The scheme will keep people who may be contemplating suicide or have other acute mental health needs out of emergency rooms and prisons, reduce police and EMT involvement in behavioral issues, and accelerate help to those who need it.

“We have the space. We have the staff. We have the training,” said Margie Balfour, head 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 call volume. When local centers are overrun or unmanned, centralized backup centers across the country respond. There are now 14 and by August 17 will be operational.

But local centers are preferred, as staff there are more familiar with nearby mental health services, officials said. Their ability to handle capacity varies significantly by location.

For example, in the first quarter of 2022, North Carolina was able to handle 90 percent of its calls in the state, while Illinois answered just 20 percent, according to Vibrant data.

The 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 report citing a December 2020 analysis. More hiring and spending has already 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 to reporters this month, “988 will work if the states commit to it. It won’t work well if they aren’t. There’s no reason, no excuse, that a person in one state can get a good answer and a person in another state gets a busy signal.”

A lack of resources can be dangerous: The Wall Street Journal recently calculated that 1 in 6 callers hang up without reaching anyone.

Research has repeatedly confirmed that dial-up 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 get through a short-term crisis on the phone in the vast majority of cases.

Staff and volunteers also learn how to separate a person with suicidal thoughts from anything that can be used to cause harm, send family or friends to help, arrange aftercare, or contact the police if necessary.

“Suicidal crisis calls report a significant reduction 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 Program Directors. mental healthcare.

They added that “crisis advisors are able to ensure caller cooperation in intervention on more than 75% of imminent risk calls.”

SAMHSA has spent more than $280 million to strengthen the system and Congress has allocated $150 million more.

“Our goal is to turn the 988 into a 911,” said Becerra. “If you are willing to turn to someone at your moment of crisis, someone will be there. 988 will not be a busy tone. 988 will help you. That is the goal.” But he made it clear that the states, not the federal government, will have to fund call centers on an ongoing basis.

The suicide rate in the United States rose steadily from 29,350 in 2000 to 48,344 in 2018, before falling 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 the country is in the throes of a mental health crisis, especially among young people, with soaring depression and anxiety.

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Tucson’s continuum of services grew over the course of 20 years, a collaboration of state, county and private participants, Balfour said. Now, officials across the country are pointing to the program as a model for other countries.

Dispatchers for the mobile crisis teams sit with 911 dispatchers and instead sometimes route police to pairs of clinicians, Balfour said. The police are trained to take people to the stabilization center instead of hospitals or prisons when necessary. They can be in and out in minutes, instead of spending hours with patients in an emergency room. There is a special entrance at the law enforcement facility so officers don’t have to remove and store their weapons, she said.

Available aftercare slots in mental health clinics are fed into the hotline’s computer, facilitating access to help. The hotline handles about 10,000 calls a month, Balfour said. The stabilization center treats about 1,000 adults a month and 200 to 300 children and teens, she said.

It has an observation room with seats for 34 adults and 10 younger people and an inpatient unit for adults with 15 beds, where patients can stay for three to five days, she said, including while they withdraw from medications and begin medically assisted treatment. The beds help prevent hours and days of being left untreated in the emergency room as hospital staff search for a bed in a suitable facility.

The center is aiming for “90 minutes from door to doc” and will not turn anyone away, including walk-ins, Balfour said. Patients may be suicidal, violent, intoxicated, psychotic, or detoxifying.

“Our model is that we take everyone,” she said. “We want the people who are denied in other places. We want those astute, potentially violent people.”

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