988 suicide hotline launches soon. Here’s how it works: Shots

From 16 July, people in mental crisis will have a new three-digit number, 988, through which they can reach trained counselors.

Jenny Kane / AP

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Jenny Kane / AP

From 16 July, people in mental crisis will have a new three-digit number, 988, through which they can reach trained counselors.

Jenny Kane / AP

From 16 July, people in mental crisis will have a new way of reaching out for help. Instead of calling the current 10-digit National Suicide Prevention Lifeline, they can simply call or text the numbers 9-8-8.

Modeled after 911, the new 988 Suicide & Crisis Lifeline is designed to be a memorable and fast-paced number that connects people who are at risk of suicide or in any other mental health crisis to a trained mental health professional.

“If you are willing to address someone in your moment of crisis, 988 will be there,” Xavier Becerra, secretary of health and human services, said at a recent press briefing. “988 will not be a busy signal and 988 will not put you on hold. You will get help.”

The primary goal of the new number is to make it easier for people to call for help. But mental health lawmakers and advocates see this as an opportunity to transform the mental health system and make behavioral health care readily available throughout the United States.

Here’s what you need to know about the new track and what to expect when it launches.

988 fills a huge gap in mental health crisis management

Currently, most people who experience a mental health emergency end up calling 911.

The problem is that 911 was not created to meet mental health needs. Either callers end up in a hectic emergency room waiting for hours and sometimes days to receive care, or they end up interacting with law enforcement, which can lead to tragedy or trauma.

Advocates for mental health hope that 988 will become a widely known, safer and more effective alternative.

“Unlike other medical emergencies, mental health crises overwhelmingly result in a law enforcement response,” said psychologist Benjamin Miller, president of the Well Being Trust. “If you look at data from the police, about 20% of their total staff time is spent responding and transporting people who are experiencing a mental crisis.”

Just last year, he adds, more than “2 million people with serious mental illness were jailed.” And nearly a quarter of police fatal shootings in recent years have involved people with mental illness, he adds.

Miles Hall was one of them. The 23-year-old was shot by police during a mental health breakdown outside his home in California.

Miles had schizoaffective disorder, says his mother, Taun Hall, who started the Miles Hall Foundation to push for mental health reform.

But he was never violent, even when he experienced delusions or hallucinations, she adds. “He was just an amazing child. He walked into a room and he had an infectious smile. He was just a beautiful soul.”

On June 2, 2019, when he experienced a mental breakdown, his family called 911 in hopes that they could get Miles into an ambulance and a hospital. Instead, police showed up at their door.

“He was shot and killed in a major cul-de-sac in the middle of the street,” Taun Hall said. “Miles was shot four times.”

The goal of the effort behind 988 is ultimately to reduce these forms of law enforcement confrontations and connect people in crisis to help immediately. It is part of a long-term effort to increase mental emergency teams around the country.

The idea for 988 has been underway for a few years. In 2020, President Donald Trump signed a bill to create this issue to respond to all mental health crises. It is a joint effort of the Department of Health and Human Services (HHS), the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Department of Veterans Affairs.

988 connects callers to a network of trained counselors

The 988 lifeline will connect people to the existing network of more than 200 local shelters around the country. (The 10-digit suicide prevention number – 1-800-273-8255 – will remain active, but calls will be directed to 988 when the three-digit number starts.)

People who call or text the number will connect to a trained counselor at a shelter closest to them. If a local shelter is too busy to respond immediately, the call will be directed to one of 16 backup centers around the country.

For the vast majority of people calling the current National Suicide Prevention Lifeline, the call itself is an effective intervention.

“We know that close to 90% of callers get what they need from the phone call,” said Chuck Ingoglia, executive director of the National Council for Mental Wellbeing.

The remaining 10% of callers may need additional support or personal care, and trained lifelong counselors will try to connect them with this care.

It can encourage communities to develop more personal crisis support

In preparation for the launch of 988, a growing number of states are beginning to build their capacity to offer on-site emergency mental health care to people calling in a crisis.

Angela Kimball, senior vice president of advocacy and politics at the nonprofit organization Inseparable, was fortunate to have experienced what good care can look like during a mental crisis.

In 2017, Kimball’s son, who had bipolar disorder, had a severe manic episode. He was 32 years old and living in Portland, Ore., At the time.

“He had torn out all the kitchen cabinets. He smashed the stove with a sledgehammer,” Kimball recalls. “He talked about how soap was poisoned and how he felt he was being monitored.”

Kimball reached out to the local shelter, which sent a mobile crisis team to her son’s house. “They came in – they spoke very respectfully and kindly to my son,” Kimball recalls.

Kimball says her son willingly went with the team to a local crisis stabilization unit and was treated immediately.

This type of mental health crisis response is still rare. The 988 initiative needs to change that.

“Over time, the vision for 988 is to have additional crisis services available in communities across the country, just as emergency medical services work,” said Miriam Delphin-Rittmon, HHS Assistant Secretary to SAMHSA, in a statement.

Serious federal funds support 988’s launch

Ever since its launch in 2005, the existing 10-digit lifeline has been increasingly used. But until recently, local call centers received very little federal funding.

“They’ve been operating on shoes for many, many years,” said John Draper, CEO of National Suicide Prevention Lifeline. Many centers have closed due to lack of resources in recent years.

According to HHS, the 2021 lifeline received 3.6 million calls, chats and text messages. But a report from SAMHSA from 2021 showed that the current system is only capable of answering 85% of calls, 56% of text messages and 30% of chats.

Health authorities expect the number of calls, chats and text messages to at least double in the first full year after 988 goes live.

To prepare for this increase in demand, the federal government has made significant investments in the network.

“Earlier this year, Congress finally began allocating additional dollars to provide support to call centers so they could hire dedicated staff to work on the 988 number,” said Ingoglia, of the National Council for Mental Wellbeing.

More than $ 400 million – up from $ 24 million – has gone into increasing the capacity of local and backup call centers and providing affiliate services, including a Spanish-speaking subnet, according to a statement from HHS.

And that’s important, Draper says. “It’s a number of centers [now] being funded in ways they have never received funding before, so it is very encouraging, ”he says.

The centers have been able to hire new staff, and the lifeline has been able to expand the capacity of backup centers.

And he already sees an impact on the lifeline’s ability to respond to those who reach out, he says. For example, he says, “right now we are answering over 90% of our chats. And this time last year it was closer to 20 to 23%.”

This could be the start of a new era, but there is a long way to go

It will take time for 988 to reach its final goal, proponents say.

“This is the beginning of a story,” says Ingoglia. “It will continue to require investment at the federal level, at the state level, at the local level to really ensure that this reaches its potential.”

However, making 988 fully operational and able to respond to all calls in a timely manner will require significant state-level funding as well as federal funding. The 2020 law allows states to pass legislation to add a small fee to cell phone bills as a permanent source of funds for 988 and related mental health services. (That approach is used to help support 911 services.) But so far, only four states have done so, and only two more have legislation in place.

A recent survey among 180 public health officials from across the country conducted by nonprofit research group Rand Corp. showed that 51% of respondents said they were not involved in developing a strategic plan for 988. And only 16% said they had created a budget to support 988 operations.

But “many states recognize the truly critical need for mental health and mental health emergency access right now,” said Lauren Conaboy, vice president of national policy at Centerstone, a behavioral health and addiction provider operating in several states.

So she hopes that when the number goes live, more states will eventually begin to pass legislation to better support 988 in the long run. It would include investing in initiatives such as the Mobile Crisis Team and Crisis Stabilization Unit that assisted the Kimball family in Oregon, as well as other behavioral health services, including addiction care.

“The transition to 988 has come to represent a once-in-a-generation opportunity to revisit and reconceptualize how crisis services are resources and delivered in communities across the country,” said Colleen Carr, director of the National Action Alliance for Suicide Prevention at the Education Development Center.

SAMHSA’s Delphin-Rittmon calls on states and territories to invest more in transforming the country’s crisis response system for mental health.

Despite the slow progress in many states, advocates for mental health are enthusiastic about 988.

“We need to get the training wheels on it and get it out of the garage and start pedaling, knowing that this is a process,” said Becky Stoll, vice president of crisis and disaster management at Centerstone. “We can continue to mature it and make it adequately skilled in all areas.”

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