Many communities are not ready to run the 988 mental health hotline

A recent study found that many jurisdictions lack the resources to operate an incoming 988 mental health hotline, including sufficient consultants to handle any influx of calls. Photo by Utsman Media / Unsplash

The mental health equivalent of 911 is about to be launched in the United States, but a new study finds many communities may not be prepared for it.

Starting July 16, a new 988 number will be available 24/7 for Americans struggling with a mental health crisis. It is similar to 911, which has long been used to get help in medical emergencies.

The new code will replace the 10-digit number currently used to reach the National Suicide Prevention Lifeline, established in 2005. Health officials expect the easy-to-remember 988 to spur a surge in calls.

The problem is that few jurisdictions are ready for it, according to the new study, by the non-profit research organization RAND Corp.

“At the service level, the 988 transition is a simple number change,” said Ryan McBain, a RAND policy researcher who co-directed the study.

But on the pitch, McBain said, it’s a different story.

For one, local crisis centers need a sufficient number of consultants to handle any influx of calls. Beyond that, some callers will need additional in-person assistance.

However, the study found that many jurisdictions lack these resources. It interviewed 180 state, regional and county health officials and found that only half said their jurisdiction has short-term “crisis stabilization” services that callers could be directed to.

Even fewer, 28%, had emergency assistance units that could be sent to people in urgent need. Meanwhile, only 22% had call centers capable of scheduling mental health appointments on behalf of the people who wanted them.

In addition to these shortcomings, most of the local hotlines did not offer text or online chat options. This is a fundamental gap, McBain said, as teens and young adults often prefer these ways of communicating.

Overall, McBain said, the findings confirm the concerns of many mental health experts: jurisdictions did not have the time or resources to prepare for the 988 launch.

Code 988 was cleared by Congress in 2020, with the intent of offering Americans an easier way to reach the National Suicide Prevention Lifeline. The Lifeline is a network of nearly 200 crisis centers in the United States. When people call the national number, they contact the nearest center to speak to a qualified counselor and, if needed, get help finding local resources.

Lifeline’s intent, and 988, goes beyond suicide prevention, McBain noted. It offers help to people with mental health difficulties, including problems related to substance abuse.

Studies have shown that the existing Lifeline network helps most people who call.

“For many callers, the problem will be solved simply by having that contact with a consultant,” said Dr. Robert Trestman, president of the American Psychiatric Association’s Council on Healthcare Systems and Financing.

“It’s when it comes to referring to local services that things will get more complicated,” said Trestman, who was not involved in the study.

And this problem is nothing new. The new findings, Trestman said, simply highlight the nation’s fragmented and under-resourced mental health system.

The 988 designation, he noted, came in the midst of a pandemic that only worsened the situation, straining the mental health of Americans and putting a strain on existing mental health services.

Trestman put it bluntly: “We have a mental health care system that’s designed to fail.”

The upcoming 988 launch is just the beginning of efforts to support that system, said Dr. John Palmieri, acting director of the 988 coordination office at the US Substance Abuse and Mental Health Services Administration (SAMHSA).

“The Biden / Harris administration has made great strides in strengthening and expanding the existing Lifeline and we expect 988 to continue to grow and evolve in the coming months as more states begin to step forward,” Palmieri said in a statement. .

He added that the Lifeline network “has been massively underfunded and under-resourced since it started in 2005”.

The Biden administration has invested $ 282 million in the 988 transition, but, Palmieri added, states must also “switch on investments.”

Despite the challenges, everyone agreed that Americans should use the 988 when it becomes available. (According to SAMHSA, if a caller’s local crisis center is unable to answer, the caller will automatically be directed to a national “backup” center.)

“Yep, Lifeline is an amazing serve,” said McBain. “Studies show it.”

Trestman agrees, saying the 988 transition “will go through increasing pains,” but ultimately it’s a “good thing”.

It’s part of a broad effort, Trestman added, to eliminate the stigma on mental health care.

However, McBain said, there is still a long way to go before the system is the equivalent of 911 – where callers know, wherever they live, there will be local services available for their health emergency.

“Not having a mental health equivalent is inexcusable,” McBain said.

More information

The Substance Abuse Administration and Mental Health Services has more than 988.

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