Is Behavioral Health Ready for 988?

It’s one of the brightest healthcare developments in recent years: 988, the suicide hotline shortcut that goes live on July 16. Similar to 911, the National Suicide Hotline Designation Act of 2020 offers 988 as an easily remembered, quickly dialed, lifeline for people in crisis.

In case you’re wondering – yes, 988 connects to the National Suicide Prevention Lifeline, which offers “compassionate, accessible care and support for all Americans who might be experiencing suicidal thoughts, who are at risk of suicide, or who are struggling with emotional distress,” according to Substance Abuse and Mental Health Services Administration (SAMHSA.) Suicide prevention is more valuable than ever given the pandemic-fueled rise in mental health issues. But is the 988 rollout ready, given the shortage in mental health resources? If behavioral health systems are already struggling to provide care for patients, how will they ramp up capacity to address 988 callers?

If you’re not familiar with 988, here are the facts:

  • 988 will be available nationally for call, text, or chat starting July 16, 2022.
  • The National Suicide Prevention Lifeline number, 800-273-8255, will remain active alongside 988.
  • The hotline is staffed by a national network of more than 180 local, independent, and state-funded crisis centers whose workforce is trained to help people experiencing a suicidal crisis.
  • The lifeline is for anyone who is in emotional distress, feeling suicidal, or experiencing a substance use crisis. It can also be used by someone helping a loved one.
  • 988 will connect callers to staff trained to respond to mental health and substance use emergencies – not law enforcement.

While 988 offers much-needed help to all people, it’s especially relevant to Native American communities. Across the U.S., the suicide rate is up 33% since 1999. For Native American men, however, the suicide increase is 71% – and for Native women, it’s a 139% increase, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics. But staffing shortages in Tribal nations and a lack of culturally sensitive care have made it difficult for people to access care.

988: Simplicity and Sensitivity

We’ve all seen the suicide hotline number flashed at the end of articles or TV shows that mention suicide. But let’s be real – how many of us remember it? Even if you write it down or put it in your phone, will you remember that in a moment of anguish? Will an unprepared person know it or have time to Google it when helping a friend in crisis?

The brevity of 988 solves that. Everyone can remember to dial 988. But the shortcut does so much more. Unlike calling 911 – as many people do when they or a loved one are suicidal – calling 988 avoids law enforcement involvement. This is important, because many mentally ill people in crisis encounter police before a doctor. Those encounters can be deadly, especially for people of color. Between 2015 and 2020, 1 in 4 people who were shot and killed by police had a mental illness; 1 in 3 were people of color. 988 means that trained specialists will respond to a caller’s mental health or substance use emergency, which can avoid the horrifying consequences that can happen in a police response.

In 2020, more than 2.1 million callers dialed the suicide hotline. The accessibility of 988 will almost certainly mean a dramatic increase in requests for help. Crisis centers will need to expand their capacity, while states will need to beef up their crisis infrastructure. But is our nation ready? And does “ready” include culturally appropriate resources for Indigenous people and other underserved callers?

Delays in Local Resources

You might wonder who is going to pay for the additional staff and boost in crisis response. In December, SAMHSA announced $282 million in grants available to support 988 efforts – $177 million to strengthen hotline operations, with the other $105 million dedicated to increasing call center staff. President Biden’s American Rescue Plan also offers funding to support the 988 workforce. The National Suicide Hotline Designation Act also allows states to enact new state telecommunication fees to support 988 operations.

But while states have known about this since late 2020, only a few have passed implementation laws with fee measures to pay for the expected increase in calls. Mobile crisis teams aren’t always abundant either. That could mean some underserved 988 callers find themselves dialing up a team of ghosts. When local resources aren’t available for hotline callers, their calls get routed to a backup center in the national network – something that typically means longer wait times for a response and a higher likelihood of abandoned calls.

It’s difficult to imagine a world where we witness a stabbing or a man having a heart attack and call 911 to learn there’s no local help to be found. The cries of outrage would be deafening. Yet people experiencing a substance abuse or mental health crisis are at extreme risk too. Suicide is the 10th leading cause of death in the United States. Prevention and treatment deserve the same effort and impetus as other urgent healthcare issues.

A Step Forward for Behavioral Care

Let’s be clear – 988 is a fantastic idea. Just as emergency medical services have evolved over the years, 988 can represent a big step forward for suicide prevention and mental health crisis response. But even the best behavioral care strategies only work well when they’re fueled by funding and expertise. To pull off this transformation, federal, state, and local organizations will need to strengthen their crisis resources and systems. They’ll also need to train staff in culturally responsive care and collaborate with Indigenous healthcare organizations and other underserved players. Only then will the roll-out dismantle existing barriers and reach the people who need it most.

If you or someone you know is experiencing suicidal thoughts or a crisis, please reach out immediately to the Suicide Prevention Lifeline at 800-273-8255 or text HOME to the Crisis Text Line at 741741. Please note the 988 service will not be available until July 2022.

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