The National Suicide Prevention Lifeline phone number 988, launched on July 16, was designed as a universal mental health support tool for callers anytime, anywhere.
But the United States is a patchwork of crisis assistance resources, so what comes next isn’t universal. The level of support received by 988 callers depends on their postcode.
In particular, rural Americans, who die from suicide at a much higher rate than urban residents, often have difficulty accessing mental health services. Although the 988 can connect them to a call center close to home, they may end up being directed to distant resources.
The new system is expected to offer people an alternative to emergency health service, but callers from rural areas who are experiencing a mental health crisis can still be greeted by law enforcement personnel, rather than mental health specialists. .
More than 150 million people in the United States, most from rural or partially rural communities, live in locations designated as areas of mental health professional shortage by the Federal Health Resources and Services Administration. This means that their communities don’t have enough mental health providers – usually psychiatrists – to serve the population.
The Biden administration has distributed approximately $ 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 service continuum callers rely on. if they need more than one phone conversation. States also take on most of the responsibility for staffing and funding their 988 call centers once federal funding runs out.
The Federal Administration for Substance Abuse and Mental Health Services, which operates the current lifeline 800-273-8255 on which 988 expands, said a state that launches a successful 988 program will guarantee callers a mental health professional to talk to, a cell phone crisis team to respond to them, and a place to go, such as a short-term crisis stabilization residential facility that offers diagnosis and treatment. The federal agency also intends that 988 will reduce dependence on law enforcement, extend access to mental health care, and relieve pressure on emergency rooms.
These goals may not perform equally in all states or communities.
If a call center doesn’t have a mobile emergency team to send, “you don’t have stabilization, you basically go 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 that emphasizes the need for consistent services regardless of the caller’s location.
For the new calling system to be consistent, “you really need that full continuum of support,” Hepburn said. “The expectation is not that it is available now. The expectation is, “she told her,” your state will eventually get you there.
But when 988 was launched, most states had not passed 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 incorporate volunteer emergency medical services and fire brigade personnel into the emergency response to ground emergency calls. More than two-thirds of South Dakotas live in an area of lack of mental health professionals.
The state has only one professional mobile emergency team that responds to emergencies in person, according to Laurie Gill, cabinet secretary at the South Dakota Department of Social Services. The mobile response team is located in South Dakota’s largest city, Sioux Falls, and serves the southeastern corner of the state.
“Some of our communities have virtual mobile crisis teams,” said Janet Kittams, CEO of Helpline Center, the South Dakota nonprofit organization that will answer calls to the state’s 988. “Some of our communities have co-responder models. Some of our communities will respond directly with law enforcement. So it really varies a bit across the state. “
Sioux Falls is also home to one of two short-term state crisis facilities. The other is over 300 miles away in Rapid City. South Dakota also has 11 community mental health centers that evaluate patients and provide outpatient care. These centers also use law enforcement to respond to mental health crises.
A help center consultant might refer a 988 caller to one of these centers.
“Sometimes yes, you’ll have to drive a couple of hours to get to a community mental health center, but sometimes you don’t,” Kittams said. “In general, people living in rural South Dakota understand very well that they will potentially have to drive to a resource, because this is probably true in other aspects of their life, not just mental health care, but other types of care or resources they need “.
The Helpline Center reported that its operators cut 80% of calls without using a crisis team. But Vibrant Emotional Health, a nonprofit that co-administers the lifeline nationwide, has predicted a fivefold increase in claims for South Dakota in the first year that 988 is in effect. Any spike in calls will likely increase the demand on crisis teams.
Vibrant said 988 will reach at least another 2 million people nationwide in its first year. Half of them are expected to come through the forwarding of mental health-related calls from 911 and other crisis centers to 988.
Right next 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 branch of the National Alliance on Mental Illness. Eighty-seven of the state’s 99 counties have a mobile crisis service provider, but most Iowans live in an area of lack of mental health professionals.
The remaining 12 counties – all rural – rely on law enforcement and emergency medical technicians, Huppert said.
“We still have a long way to go to properly train all rescuers, especially law enforcement, because law enforcement is trained to come to the scene and take control of the scene,” he said. “People who are in a behavioral health crisis, who are perhaps psychotic, sometimes hear voices, have hallucinations, are in an altered state. They are not inclined to obey commands. This is where things often go wrong. “
Officials from a 988 call center for nine counties in east-central Iowa run by CommUnity Crisis Services said their mobile crisis teams will only consist of consultants, but law enforcement could be called if a team determines. which is necessary for its safety.
CommUnity Crisis Services has three mobile crisis service providers arriving in unmarked vehicles.
CommUnity chief operating officer Adrianne Korbakes said mobile emergency teams are a great option in rural communities where seeking mental health care could carry a stigma. And with 988, she said, “you can call, text or chat from the privacy of your home – no one needs to know you’re accessing the services.”
To prepare for these contacts, CommUnity has nearly doubled its staff in the past seven months, from 88 employees in January to 175 in July.
Despite the 988 preparations in Iowa and South Dakota, neither state legislature has funded the system in the long term. In the National Suicide Hotline Designation Act of 2020, Congress granted states the authority to cover 988 expenses by adding a mobile phone service surcharge, but most did not.
Only 13 states have enacted 988 laws, according to the National Alliance on Mental Illness, with different applications and prescriptions on the continuum of care.
In Iowa, Huppert said, “there is a very wait-and-see approach.”
This story was originally published on July 28, 2022 by Kaiser Health News KHN, a national newsroom that produces in-depth journalism on health issues.