As Calls to Missouri Mental Health Line Rise, Supporters of Concerned State Will Not Commit to Funding | KCUR 89.3

If you are in Eastern Missouri and you call 988, you may end up talking to the Jennifer Brown Crisis Surgery Clinic.

Brown responds to requests for Behavioral Health Response, the crisis response line for the St. Louis region and other parts of the state.

“Many people call simply because they don’t know what to do with those feelings, with the energy they feel outside of their bodies. They are looking for hope and help, ”she said.

In July, Missouri officials unveiled 988, an emergency mental health hotline that connects callers to dozens of organizations across the country based on the caller area code. During the first month of hotline service, calls to Missouri mental health centers increased 30 percent.

It’s not just suicidal people who call the hotline, Brown said. Sometimes, it’s just the ones who feel lost or helpless.

“I really want them to feel a connection when they call,” she said. “She is a real person on the other side of the line.”

Proponents of 988 say the easy-to-remember number will connect more people to professionals like Brown when they need it most: when they or someone they know is in a mental health crisis or thinking of killing themselves.

A frontline workforce

The hotline review means crisis response organizations need more workers and money to pay them. Supporters fear the state has not committed to long-term funding for the hotline.

The Missouri Department of Mental Health has received $ 16.7 million in state funding and block grants to support claims for the first fiscal year of 988, department officials said. But the Missouri legislature hasn’t produced a law that ensures ongoing funding, and the hotline doesn’t have a guaranteed source of money for years to come.

“It’s a fear of mine,” said Casey Muckler, who leads the 988 system for the department. “How can we make this a sustainable endeavor and keep it long term – this has kept me up at night pretty much since I started.”

State health officials are expecting an increase in calls as more people learn about the new number. Department of Mental Health officials estimate that the service will receive 172,000 calls in the first year of service alone, not including SMS and chat messages or follow-up calls.

That’s more than four times the number of calls Missouri Suicide Prevention Lifeline networks received in 2020, Muckler said.

To absorb that new volume, state response organizations will likely need to hire dozens of additional employees.

Even though the hotline was a national initiative, the federal government isn’t providing all the funding, Muckler said.

“It is really up to the state to fund 988 at the state level,” he said. “We have been looking for every possible funding we can find for over a year.”

A handful of states have enacted laws requiring a surcharge on telephone bills to pay for the line, but Missouri has not taken this approach.

“I can’t say I know for sure or can lean one way or another whether or not this will be sustainable with the governor’s office,” Muckler said. “But we certainly hope so.”

Proponents of line 988 say that once state officials see how effective the service is, they will be eager to fund it in perpetuity.

“I think we will be in a good position after this first year to really say, ‘This has worked and we need more funds to make sure we can continue this important service,'” said Muckler.

A special job

Unlike emergency health service workers, call center workers also provide assistance and can stay online for a long time, said Bart Andrews, director of behavioral health response.

“It’s really about creating a system that meets people’s needs, as they are, and lowering the barriers to accessing mental health services,” Andrews said.

Even with new funding, recruiting and training people to do the skilled and sometimes traumatic and strenuous work is a big task, Andrews said.

Behavioral Health Response is planning to use the first year of government funding to hire about 60 employees to cope with the new patient load, he said.

“There will be a huge hiring binge across the state of Missouri,” Andrews said. “Missouri will be in great shape for 988.”

To hire more workers, Missouri and other states have changed the qualifications needed to work for the line.

“Before, we only hired masters-level doctors. We will never have enough master-level doctors to handle the capacity we really need, the volume that will come. ”

He says being good at this job is less about education and more about experience and training. Workers in health response behavioral crises must have three weeks of training before they even take their first practice call.

New (and old) problems

Another way the 988 line differs from 911 is that the hotline routes calls based on a phone’s prefix, not its location.

This could cause problems connecting people with local services, Andrews said.

“In metropolitan areas, up to nearly 50% of people have cell phones outside the area,” he said. “A lot of people got rid of their fixes. So we have a problem. ”

Crisis doctors say they can still transfer calls to local response centers or send teams to people in crisis wherever they are in the country, but they hope the line will soon route calls based on the caller’s location.

There is also the problem of follow-up care. In addition to listening to someone, 988 doctors can connect people in need to services or help in person.

“The important thing is not just to respond,” said Gena Terlizzi, executive director of the National Alliance on Mental Illness Missouri. “But to know how to connect people with any immediate needs, follow-up care referrals they might need.”

But depending on where someone lives, it can be expensive or logistically difficult, for example, to make an appointment with a psychiatrist, he said. According to the Rural Health Information Hub, which compiles federal HRSA data, all but two of Missouri’s 114 counties have professional mental health deficiencies. If someone is not insured, it can take them even longer to get an appointment with a therapist or psychiatrist.

“If you are able to achieve Goal # 1 … and prevent that person from taking that action, we still need to make sure they get the care and services they need in the future,” Terlizzi said. “It’s not a one-time thing. It is a long-term commitment to try to improve the mental health of society ”.

What callers want

Andrews said research shows that many people who call it the lifeline don’t actually want follow-up services.

“They just want to be able to call the lifeline when they’re struggling, when they want help, when they need to talk to someone,” she said. “We are actually making it easier for people to get the services they want, the way they want it.”

Crisis call operator Jennifer Brown said some callers just want to talk.

“Often, when people are at their lowest, the thing you need is a connection with someone, someone they can trust and feel safe,” she said.

Follow Sarah on Twitter: @petit_smudge

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