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March 15, 2022

How 988 could become the '911 for mental health'

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    Through new federal funding, the National Suicide Prevention Lifeline will soon get a much-needed upgrade, which could transform it into- "the 911 for mental health," Steve Eder writes for the New York Times—however, some experts still worry the Lifeline won't meet growing demand.

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    The national crisis hotline gets a much-needed upgrade

    Starting in July, the Lifeline will have its own three-digit number, 988, that people can call to access trained counselors and responders during mental health crises. As part of the rollout, new federal grants will also allow call centers to hire more counselors, upgrade infrastructure, and backup centers are getting new funding to build capacity.

    In addition, there are plans to eventually expand the Lifeline's services to include emergency workers and mental health triage centers, which advocates say will help save lives by reducing police interventions and ED visits.

    HHS Secretary Xavier Becerra said the new Lifeline system will be a "lean, clean, working machine so that we can get this done for the people that call in."

    Currently, around 4% of people who call the Lifeline are believed to be at immediate risk of or actively attempting suicide, while another 23% have had suicidal thoughts within 24 hours of calling. Of the calls made to the Lifeline, around 80% of crises are resolved without further intervention, such as the police, Eder writes.

    According to researchers, the Lifeline is so effective because it gives people who are struggling someone to talk to during their darkest moments. "That can make the difference between someone being alive and not alive," said Madelyn Gould, a psychiatric epidemiologist at Columbia University.

    Many callers have shared similar feedback on social media, with one writing that the Lifeline "has saved my life on multiple occasions, including tonight."

    More funding, staff is needed for 988 to be effective

    However, some experts have voiced concerns about whether the Lifeline will meet the demand for its services when it is upgraded later this year. In the next few years, estimates suggest the Lifeline will receive calls from tens of millions of people seeking help, Eder writes.

    "Our concern is very much about whether there will be someone to answer that call when someone is in crisis," said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness.

    Currently, calls to the Lifeline are answered by a "patchwork national network of more than 180 call centers, often nonprofits," Eder writes. Most of these centers rely on both paid counselors and volunteers to answer several hotline numbers and receive little or no funding from states. Oftentimes, this has led to many calls to the Lifeline going unanswered.

    According to a New York Times analysis, around 17% of the 2 million calls to the Lifeline last year were abandoned before the caller could get help. Taking into account texting and online chat lines, which fielded another million conversations, 41% of texts and 73% of chats were abandoned.

    In a December report from the Substance Abuse and Mental Health Services Administration (SAMHSA), the agency said the current Lifeline system is "understaffed" and has "not grown quickly enough to keep pace with existing demand."

    "[People contacting the Lifeline] have every right to expect that the system is available to them, and we know that it's going to take time to build upon what was really a system that was under-resourced and quite fragmented," said John Palmieri, who is leading SAMHSA's 988 rollout efforts.

    According to Eder, how to fund further expansion of the Lifeline is a "contentious issue." While each call center receives an annual federal stipend of $2,500 to $5,000, as well as occasional larger grants, they are largely responsible for their own funding.

    One way to fund the Lifeline is to collect a monthly fee on phone bills, like what is already done for 911, but some lawmakers are wary of adding what they consider a new tax. Many telecommunications lobbyists, who have been broadly supportive of 988, have also pushed back on some proposed fees.

    So far, only four states have authorized a phone bill charge for 988, and around a dozen others are considering legislation on the 988 rollout, with some looking to use general funds or Medicaid funds to pay for it.

    Lata Menon, CEO of First Choice Services, the lone call center in West Virginia that answers the Lifeline, as well as 15 other hotlines, said her organization has kept up with demand so far, but the new responsibilities associated with the Lifeline's 988 upgrade, such as fielding text and chat messages, will require much more funding.

    "We have a very real fear that without funding our program in a substantial way, our West Virginia callers will suddenly be facing what has been a problem nationally," she said. (Eder, New York Times, 3/13)

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