Let's Talk About Mental Health Hotline '988': Readiness, Need, and a Chance for Change

While I believe it’s vital we start addressing mental health before it becomes an emergency, we also need a strong system in place for when mental health emergencies do happen. And right now, that system is a mess (to put it nicely). Emergency mental health is something I’m so passionate about because I’ve been through this system plenty of times, and have seen others go through it many more. And while there are incredible workers out there who are just doing the best they can with the resources they’ve been given, in my experience at least, the system has only left me in a worse place from where I started. 

That being said, the launch of 988 is definitely a step in the right direction for mental health, even if it is long overdue. Come mid-July, the 10-digit National Suicide Prevention Lifeline number will change to the 3-digit number 988 that people will be able to call or text in mental health emergencies. This is a huge undertaking, and while the vision is certainly there, it’s going to take time before 988 becomes the mental health equivalent of 911. 

So, are we ready?

The short answer? No. In a recent study surveying 180 behavioral health program directors across the U.S., over half reported they/their agency had not been involved in strategic planning related to the launch of 988. That’s a startling statistic for a number of reasons, but largely because that survey was done in March 2022, just four months before the launch of 988. It also suggests a lack of communication and coordination among mental health programs at local, state, and federal levels, which will be a key charge for the new hotline. Additionally, the survey reports only 16% had established a budget for the transition and long-term support of 988 as of March 2022. It’s safe to say staffing and funding/budget will be key areas of need.

3 Components to Emergency Mental Health Care

In an attempt to provide some direction, the National Association of State Mental Health Program Directors has outlined three key components to emergency mental health services. Let’s break them down in context of 988.

1. Having someone to talk to. 

Obviously. There needs to be someone to pick up the phone and talk with the caller. But that requires having the staff and funding for 24/7 call centers. Right now, centers are already struggling to keep up with demand, which is only expected to increase after the implementation of 988. SAMHSA estimates the volume of calls will more than double (reaching about 7.6 million calls) in the first year.

Wait times are so high that abandonment rates among callers (those who disconnect within 30 seconds) have reached an all-time high of 17 percent (1 in 6 calls) with even higher numbers for texters and chatters. Some people don’t even find these hotlines helpful, so ensuring the appropriate training is in place for workers answering the calls is key. The ability to coordinate with existing community services will also help ensure people are able to access care after hanging up. Making sure we have enough appropriately trained people answering these calls in a timely manner calls for a critical increase in staff, training, and funding. 

2. Having someone to respond. 

And not just someone, but the right someone. If there is a need for someone to go out and respond to the call, there needs to be a plan in place for who will be responding. Is it a police officer? In some jurisdictions, there simply won’t be the option of anyone else. Are they trained in emergency mental health? Will they receive training? Can we send a mental health worker out instead? Is there a mobile crisis team? 

Who responds to these calls is absolutely pivotal. If untrained police officers are the ones responding, this becomes no different than calling 911, and often results in an increase in the criminalization of mental illness (which is the last thing we need right now).

I mean, think about it. You’re struggling with suicidal thoughts, you’re scared, you’ve been debating reaching out to someone or calling a hotline for the last hour. You finally decide to. A bit later, there’s a knock on your door. It’s a police officer. They ask if you can step outside for a chat. Never mind the slew of questions you’re going to get asked by everyone inside (if you get to even go back in). They tell you someone’s called and they’re worried about your safety. 

This isn’t the first time this has happened. You know better than to tell the truth, you’ve done that before. It just landed you waiting in a hospital, stripped of everything you have, alone, staring at a blank wall until someone is finally able to see you, and even then, you don’t get the care you need. So, why would you be honest? 

You tell them what they want to hear until they clear you. You go back inside as everyone stares or tries to act normal despite what just happened. Now that’s in your profile/record, great. But there’s no use in worrying about that right now, because all this started from feelings of intense suicidality, which, are now even worse given that interaction. So to recap, you’re feeling worse than you were to begin with, probably feel like you can’t talk to anyone about it ever again, and you now have to deal with the consequences of all this. 

That’s happened to me more times than I can count. And that’s the best-case scenario. I’ve talked to people who have been taken away with handcuffs in the back of cop cars. I’ve heard of people who were told by police officers not to call unless they already attempted suicide, and if they called again, they’d be taken to jail. 

Executive Director of CIT International (a crisis training program for police-based crisis intervention) Ron Burno says it best:

“We have to challenge the belief that mental health crisis services must come in a police car.”

In short, having the appropriate people responding is absolutely critical.

3. Having a place to go.

This third piece is so important. If there is nowhere to take people, they often end up in jail or in an emergency room where they could be waiting for days before being seen or transferred. The solution to the mental health crisis is not as simple as hospitalizing everyone who seems suicidal. If that worked, it would’ve worked by now. There have to be options available for care. And we have to be able to communicate and coordinate those options between 988 workers, the community, first responders, etc.

A Few More Implications

Cost

If you don’t really care about mental health at all (which, if you’ve made it this far, probably isn’t you), the financials alone should be enough cause for concern. Though numbers vary, Thomas Insel, former director of the National Institute on Mental Health (NIMH), estimates mental illness costs the U.S. at least $444 billion a year — about 1/3 going to medical care, and the majority coming from the cost of lost productivity and disability payments.

Insel says, “The way we pay for mental health today is the most expensive way possible.” Those numbers speak for themselves. If we’re able to get 988 right (with time), not only will lives be saved, but wallets too.

911 to 988

Figuring this out might be tricky at first, but the better collaboration 911 and 988 are able to have with each other, the better chances people have of accessing the right type of care. If someone calls 911 in a mental health emergency, their ability to transfer that call over to 988 could very well be lifesaving.

A Hopeful Look Forward

The implementation of 988 is huge. And while there are definitely components of this that need more help, this is an incredible opportunity for the U.S. to make 988 a turning point in mental health care. We have an opportunity to shift our response to emergency mental health and rethink/rework our systems to truly provide care for individuals. By no means do I think this will be easy or smooth, but that’s OK. 911 becoming what it is didn’t happen overnight, and we can’t expect 988 to either. But the chance for change 988 is bringing is an exciting one. Let’s make sure we take the time to get it right.