The National Suicide Prevention Lifeline’s 988 telephone number, which launched on July 16, was created as a universal mental health support tool for callers anytime, anywhere.
But the US is a pool of resources for crisis relief, so what comes next is not universal. The level of support 988 callers receive depends on their ZIP code.
In particular, rural Americans, who die by suicide at a much higher rate than residents of urban areas, often have problems accessing mental health services. While 988 may connect them to a call center close to home, they may end up being routed to distant sources.
The new system is supposed to give people an alternative to 911, however callers from rural areas who are experiencing a mental health crisis may still be met by law enforcement personnel, rather than mental health specialists.
More than 150 million people in the US – most from rural or semi-rural communities – live in places designated as mental health professional shortage areas by the Federal Health Resources and Services Administration. This means their communities do not have enough mental health providers – usually psychiatrists – to serve the population.
The Biden administration distributed about $105 million to states to help increase local crisis call center staffing for the new 988 system. But states are responsible for filling any gaps in the continuum of care that callers rely on if they need more. more than a phone conversation. States also retain most of the responsibility for staffing and funding their 988 call centers once federal funding runs out.
The federal Substance Abuse and Mental Health Services Administration, which runs the existing 800-273-8255 hotline on which 988 is expanding, has said that a state that launches a successful 988 program will ensure that callers have a professional mental health to talk, a cell phone. crisis team to respond to them, and a place to go—such as a short-term residential crisis stabilization facility—that offers diagnosis and treatment. The federal agency also aims for 988 to reduce reliance on law enforcement, expand access to mental health care and relieve pressure on emergency rooms.
These objectives may not be achieved equally in all states or communities.
If a call center doesn’t have a mobile crisis team to dispatch, “you don’t have stabilization, then you’re basically going from the call center — if they can’t meet your needs — to the emergency room,” said Dr. Brian Hepburn, executive director of the National Association of State Mental Health Program Directors. The group developed model 988 legislation for states which emphasizes the need for consistent services regardless of the caller’s location.
For the new call system to be consistent, “you really need that full continuity of care,” Hepburn said. “The expectation is not that it’s available now. The expectation is,” he said, “your state will eventually get you there.”
But at the start of 1988, most states had not enacted legislation to fill gaps in mental health care.
In South Dakota, which has the eighth-highest suicide rate among states, health officials said responding to mental health crises in rural counties will be a challenge. So they plan to involve volunteer emergency medical services and fire personnel in the emergency response to 988 calls in the field. More than two-thirds of South Dakotans live in an area with a mental health professional shortage.
The state has only one professional mobile crisis team that responds to emergencies in person, according to South Dakota Department of Social Services Cabinet Secretary Laurie Gill. The mobile response team is located in South Dakota’s largest city, Sioux Falls, and serves the southeast corner of the state.
“Some of our communities have virtual mobile crisis teams,” said Janet Kittams, CEO of Helpline Center, the South Dakota nonprofit that will answer the state’s 988 calls. “Some of our communities have co-responder models. Some of the communities ours will respond directly with law enforcement. So it really varies a lot across the state.”
Sioux Falls is also home to one of the state’s two short-term crisis facilities. The other is more than 300 miles away, in Rapid City. South Dakota also has 11 community mental health centers that assess patients and provide outpatient treatment. These centers also use law enforcement agencies to respond to mental health crises.
A Helpline Center counselor can direct a 988 caller to one of those centers.
“Sometimes, yes, you’ll have to drive several hours to get to a community mental health center, but sometimes not,” Kittams said. “In general, people who live in rural parts of South Dakota are very aware that they will potentially have to move to a resource, because that’s probably true in other aspects of their lives, not just for care. to mental health, but to other types of care or resources they need.”
The Helpline Center reported that its operators reduce 80% of calls without deploying a crisis team. But Vibrant Emotional Health, a nonprofit that co-administers the statewide helpline, has predicted a fivefold increase in calls for South Dakota in the first year 988 is in place. Any increase in calls is likely to increase demand for crisis teams.
Vibrant has said that 988 will reach at least 2 million more people nationwide in the first year. Half of those are expected to come through the diversion of mental health-related calls from 911 and other crisis centers to 988.
Right next door to South Dakota, Iowa entered the 988 era with a more robust mobile crisis response system — “at least on paper,” said Peggy Huppert, executive director of the Iowa chapter of the National Alliance on Disease Mental. Eighty-seven of the state’s 99 counties have a mobile crisis provider, but most Iowans live in an area with a mental health professional shortage.
The remaining 12 counties — all rural — rely on law enforcement and emergency medical technicians, Huppert said.
“We still have a long way to go with proper training of all first responders, especially law enforcement, because law enforcement is trained to come to the scene and take control of the scene. event,” she said. “People who are in a behavioral health crisis, who are maybe psychotic, sometimes they hear voices, they hallucinate, they’re in an altered state. They’re not inclined to obey orders. That’s where things often go wrong. “
Officials at a nine-county 988 call center in east central Iowa operated by CommUnity Crisis Services said their mobile crisis teams will be staffed only by counselors, but that law enforcement agencies may be called if a team decides that it is necessary for his safety.
CommUnity Crisis Services has three mobile crisis service providers who arrive in unmarked vehicles.
Adrianne Korbakes, chief operating officer at CommUnity, said mobile crisis teams are a great option in rural communities where seeking mental health treatment can carry a stigma. And with 988, she said, “you can call or text or chat from the privacy of your own home — no one has to know you’re using services.”
To prepare for those contacts, CommUnity has nearly doubled its staff over the past seven months — expanding from 88 employees in January to 175 in July.
Despite 988 preparations in Iowa and South Dakota, neither state’s legislature has funded the system long term. In the National Suicide Hotline Designation Act of 2020, Congress gave states the authority to cover 988 costs by adding a surcharge to cell phone service, but most have not done so.
Only 13 states have adopted 988 legislations, according to the National Alliance on Mental Illnesswith different applications and prescriptions in the continuum of care.
In Iowa, Huppert said, “there’s very much a wait-and-see approach.”
This article was reprinted from khn.org courtesy of the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.