Mental health groups express concern about readiness of new suicide prevention hotline

By Veronica Stracqualursi and Jacqueline Howard, CNN

Leading mental health and suicide prevention groups are expressing concern that the new, shorter number for the National Suicide Prevention Lifeline — 988 — will not be ready to handle an anticipated influx of calls when it’s available nationwide next month.

Starting July 16, people seeking mental health services can call 988 to access counselors and response teams at the 24/7 National Suicide Prevention Lifeline. Calls will be redirected to the current number, 1-800-273-8255, which will stay operational during and after the 988 expansion.

The new number is intended to make it easier for those in a crisis to reach out to someone who can help, and the federal agency in charge of the hotline expects the number of callers to double from what it was in 2020. But with the more than 200 call centers currently in existence nationwide already stretched thin, mental health groups are worried that 988 could exhaust resources and result in longer wait times and dropped calls. Without additional funding to the upcoming service, these groups say, callers won’t get the help they need, and officials acknowledge that the hotline isn’t expected to be fully staffed when it rolls out.

“While this is a watershed moment, while this is an exciting opportunity for transforming our current crisis care system into something that is not a one-size-fits-all model but takes into account the lived experiences and realities of many communities who are experiencing behavioral or mental health crisis, we are a little concerned that implementation may not be ready,” said Preston Mitchum, the director of advocacy and government affairs for The Trevor Project, a suicide prevention organization for LGBTQ young people.

Bob Gebbia, the CEO of the American Foundation for Suicide Prevention, told CNN that a “big concern is that the demands might outstrip the capacity very quickly and these centers will be overwhelmed.”

“When that happens, then calls get dropped, waiting times go up, and the individuals who are on the other end and struggling don’t get the connection they need,” Gebbia said.

Bracing for surge in use

The call line received 3.6 million calls, chats and texts in 2020. After the 988 transition, the Substance Abuse and Mental Health Services Administration, an agency under the Department of Health and Human Services, expects the contact volume to double in that first year to 6 million, possibly up to 12 million.

Since the FCC’s approval in 2020 of 988, the federal government and the administrator of the call line, Vibrant Emotional Health, have been gearing up for the nationwide implementation of the three-digit number by providing grants to states to support call centers and actively trying to recruit more crisis counselors. (People who are interested in learning more can visit www.samhsa.gov/find-help/988/jobs.)

The Biden administration has provided $282 million for the 988 transition, including funding for states and territories to improve response rates and capacity to meet future demand. A 2021 SAMHSA appropriations report to Congress reported that the lifeline capacity was sufficient to address approximately 85% of calls, based on Vibrant’s internal analysis of data as of December 2020, the most recent data available.

Dr. John Palmieri, the acting director of SAMHSA’s 988 and Behavioral Health Crisis Coordination Office, acknowledged to CNN that states are currently in various degrees of readiness, adding, “it’s going to take some time for us to build out the capacity in the way that we think will be necessary.” Some states have funding in place and plan to ramp up staffing for 988, but only four — Colorado, Nevada, Washington and Virginia — have implemented a monthly fee on phone bills similar to the fee Americans pay to fund 911, according to the National Alliance on Mental Illness.

SAMHSA and mental health groups have all stressed the need for states to approve the fee, saying it’ll help sustain 988 beyond this year.

But in the meantime, several states have reported challenges in getting up to speed.

One such member of the lifeline, the Arkansas Crisis Center, has seen a 700% increase in calls over the past two years but has been working with the same number of staff, according to its executive director, Rebecca Brubaker.

Alaska’s Careline crisis intervention service said it recently had the opportunity to increase wages and is now seeing a significant increase in applicants, said executive director Susanna Marchuk. But along with the short timeline to the July 16 rollout, building back the workforce after departures amid the Covid-19 pandemic has presented another challenge.

The Central Wyoming Counseling Center presently has the staffing to answer the roughly 500 phone calls it receives a month, and recently received a one-time $2.1 million funding injection from the state legislature to provide services 24/7, according to Andi Summerville, the executive director of the Wyoming Association of Mental Health and Substances Abuse Center. But Summerville called the funding a “band aid” and said that after two years, it won’t have the necessary funding to maintain round-the-clock service.

Training requirements for hotline staffers vary from state to state and can require hours of instruction. Alaska’s crisis center, for example, averages about 50 hours of “classroom time” coupled with 30 hours of “shadow time,” Marchuk said.

Hannah Wesolowski, the chief advocacy officer for the National Alliance on Mental Illness, told CNN that her organization is “really worried” about the increase in demand once people learn of 988 in July and beyond given that “call centers are struggling to keep up with demand now.”

“Some states are well equipped to respond, and others will rely heavily on national back-up centers — meaning not every caller will get the value of a local response that they urgently need,” she said.

A push to ‘plug those gaps’

John Draper, the lifeline’s executive director and Vibrant’s executive vice president of national networks, acknowledged to CNN the challenge with 988 lies in resourcing the crisis centers, which he said have been operating “on a shoestring for years.”

And he acknowledged that not every center is going to have the staff they need by July, referring to it as a “longterm building process.”

Vibrant’s “most intensive focus right now” is supporting the national backup call centers, so that by July they’re able to “plug those gaps where crisis services are insufficient to respond locally,” Draper said.

Palmieri told CNN that it’s also going to take time to build the national backup centers’ capacity, saying they’re currently comparable to what the local call center capacity is.

But, in Wesolowski’s view, “Ideally, we want these calls answered locally.”

“Because it’s only a local call center that can connect an individual to resources within their community and dispatch emergency services when needed,” she said.

And without states and communities acting to build up local call center capacity, Wesolowski cautioned, “we really are in a difficult situation.”

“The crisis system we are looking to build is coming together quickly but much more work needs to be done,” Wesolowski said. “We are in a better place than just a few months ago, and the system is improving daily. But this is going to be a lot of work.”

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