Home With 1 Month Until Launch of 988, Experts Wonder if States Are Ready

With 1 Month Until Launch of 988, Experts Wonder if States Are Ready

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With the 988 number set to replace the current 10-digit number for the National Suicide Prevention Lifeline in mid-July, stakeholders discussed ways to ensure that the rising number of Americans seeking mental health support can access the help they need, during a webinar hosted by the Bipartisan Policy Center on Wednesday.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “a trained crisis counselor will answer the phone, listen to the caller, understand how their problem is affecting them, provide support, and share resources if needed. If the local crisis center is unable to take the call, the caller will be automatically routed to a national backup crisis center.”

Every 11 minutes, a person in the U.S. dies by suicide, according to the CDC. The COVID-19 pandemic has exacerbated the mental health crisis, particularly among young people. In a nationwide survey, more than a third of high school students reported poor mental health during the pandemic.

“Nationally, more than half of parents express concern over their children’s mental health and well-being,” said Andrea Palm, the deputy secretary for HHS.

Furthermore, one in five older adults will experience a mental illness at some point in their lifetime, Palm added.

Answering the Call

Anita Everett, MD, director of the Center for Mental Health Services at SAMHSA, offered an anecdote to illustrate the agency’s vision for 988.

She described a mother hearing her son crying, who goes to his room and finds a noose fashioned out of an item of clothing lying on his bed. The mother calls a friend, who tells her about 988. She phones the hotline and, together with the operator, assesses the urgency of the situation. Initially, the child seems to calm down and the mother is relieved, but an hour later the child gets angry. The mother calls 988 again, and this time a mobile crisis unit responds.

“It’s not a policeman with a red flashing light … [or] an ambulance that all the neighbors are going to see,” Everett noted, but “an interventionist,” a trained individual accustomed to these problems.

If necessary, the child may be taken to an emergency department or a “crisis receiving unit,” staffed with professionals who have been trained to help stabilize individuals in a mental health crisis. After the visit, the mother will either bring her son home with a tight discharge plan or seek inpatient care.

“We know from experience in various states that systems that have these three elements built out — someone to talk to, a place for someone to respond, and a place to go — really reduce avoidable hospitalizations and the stress that’s associated with hospitalization,” Everett said.

The goal for the hotline is to mirror 911 in its ability to link individuals to the right level of care sooner, she explained.

However, the panelists acknowledged that many states are not prepared for the launch of 988.

Fewer than half of the public health officials responsible for rolling out the hotline in their states felt confident that their jurisdiction was prepared, according to a June 2 report from the RAND Corporation.

Just under half of those surveyed said their jurisdictions had short-term crisis stabilization programs, and only 28% had urgent care units for mental health.

One advantage to 988 is that callers are supposed to be able to call, text, or chat online with an operator, but fewer than half of the officials surveyed said their states offer text communication and even fewer offer the option to chat online — an essential option, researchers stressed, given the high rates of suicide among adolescents and young adults.

Federal Preparedness

Asked what the federal government is doing to help states prepare, Everett said that SAMHSA has taken steps to address challenges, including bolstering the existing infrastructure of the National Suicide Prevention Lifeline by expanding call center staff in anticipation of increased volume.

The volume of contacts is expected to “nearly double” to 6 million, or even to as many as 12 million, in the first full year after transitioning to 988, a SAMHSA spokesperson told MedPage Today, citing modeling data from SAMHSA’s 988 Appropriations Report.

Approximately $177 million of the Biden administration’s $282 million investment in 988 has been dedicated to expanding the existing Lifeline operations, including telephone infrastructure, chat/text response, backup center capacity, and special services, such as a “sub-network” for Spanish speakers.

That investment also includes $105 million in grant funding to 54 states and territories as part of the American Rescue Plan, which will be used to improve response rates; build capacity; and route calls to local, regional, or state crisis call centers, noted the spokesperson.

SAMHSA is encouraging states to take advantage of the opportunity for grant funding “to build up crisis systems,” Everett said.

“The Lifeline network of nearly 200 crisis call centers has been massively underfunded and under-resourced since it began in 2005,” John Palmieri, MD, acting director of SAMHSA’s 988 and Behavioral Health Crisis Coordination Office, told MedPage Today. “While this administration has significantly increased funds to support the Lifeline, states must do their part to rev up investments too.”

Recommendations for Transitioning to 988

In conjunction with Wednesday’s webinar, the Bipartisan Policy Center also released a report detailing recommendations for transitioning to 988.

To date, state and local governments have received “limited federal guidance” on how to effectively implement and utilize crisis response services across the care continuum, the report’s authors noted.

“The federal government should establish federal standards for a coordinated state and local crisis response beyond the 988 call centers,” they added. Specifically, CDC and SAMHSA should issue “joint guidance to states to support state-level crisis response systems more effectively.”

The report also called for developing a national score card, an idea Mary Giliberti, JD, chief public policy officer for Mental Health America, applauded. “Mental health services at times have been traumatizing to people and sometimes even dehumanizing. So, we’ve got to gather that data on what is the experience in a standardized way,” keeping in mind any disparities in demographics, she said.

Former Surgeon General Jerome Adams, MD, suggested that standardizing services across the continuum of care with a score card would help to “tackle disparity” by enabling “state-to-state comparisons,” which would help to identify those states that need more support.

The report also recommended that HHS task SAMHSA with developing a “988 communications strategy” to help raise awareness about the hotline itself and trust in the services it provides.

“There are communities of color that are scared to call 911,” Adams said, noting that friction exists between some African-American communities and law enforcement, and that EMS and law enforcement are “ill-equipped” to address mental health issues in some situations.

“988, if launched properly, can be a real lifeline to many communities out there that currently don’t have one,” he added.

Finally, the Bipartisan Policy Center urged HHS to link crisis response service administrators and supervisors with peer-support specialists — people with lived experience of mental or behavioral health challenges.

“The evidence actually shows how effective peer-support [specialists] are, especially for people in crisis in reducing hospitalization and high-cost [emergency department] visits, connecting people to housing and other supports, decreasing stigma … increasing confidence, and being able to help their loved ones feel less alone, less stigma and shame,” noted Keris Jän Myrick, co-director of the Mental Health Strategic Impact Initiative.

988 is set to launch on July 16.

Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

Source : MedPageToday

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