“The need for quick, easy, and reliable access to emotional support and crisis counseling in the United States has never been greater. The COVID-19 pandemic laid bare the stressors faced by Americans. Too often, such stressors result in suicidal and mental health crises,” said Tom Coderre, acting assistant secretary for mental health and substance use and the interim head of the Substance Abuse and Mental Health Services Administration (SAMHSA). This is why the National Suicide Prevention Lifeline (1-800-275-TALK (8255)) change to 988 cannot come at a more opportune time.
According to the website of Vibrant Emotional Health, the administrator of the National Suicide Prevention Lifeline, a direct 3-digit line to trained counselors can open the door for millions of Americans to seek the help they need, while sending the message to the country that healing, hope, and help are happening every day.
Once the 988 number is formally launched on July 16, 2022, anyone in mental health crisis or emotional distress can still call the National Suicide Prevention Lifeline at 1-800-275-TALK (8255). Calls will be routed to the 988 system. Texting to 988 will also be available.
We spoke with Robert Gebbia, CEO of the American Foundation of Suicide Prevention (AFSP) about this important and timely change to the National Suicide Prevention Lifeline system.
What is the American Foundation for Suicide Prevention (AFSP)?
Gebbia: We have chapters all around the country, every state, and a brand new chapter in Puerto Rico and have attacked the problem of suicide in multiple ways. We invest in research, so we can better understand what works, how to prevent suicide, why it even occurs, and understand the brain and behavioral aspects, as well as environmental aspects.
We also engage in a lot of advocacy, both at the state and federal level for policies and legislation that can advance suicide prevention, and then we do quite a bit in the area of education. A lot of it is public education and awareness, everything from understanding risk factors and warning signs, to what to do if someone is struggling.
We believe in mental health literacy and having a more informed public with a goal of reducing the suicide rate 20% by 2025. It’s a daunting goal, but we have seen some progress in recent years.
How will the 988 change transform crisis and mental health intervention?
Gebbia: If we look at this in historical context, I think crisis services generally have been undervalued and not seen, perhaps, as part of the health care field, and certainly underfunded. So, being undervalued and underfunded, this is really quite a moment in time, because it says that crisis and mental health intervention is important and that it has an important part of the overall mental health of the nation.
When people are struggling, they need a way to connect to services and connect to care, so 988 is a great opportunity. I think it does 3 really important things: the first is, just like with 911, we now have a 3-digit, easy-to-remember number. We know that if we’re having any kind of physical pain, we call 911. Well, when you’re in emotional distress, you call 988, so the number change makes it easy to remember.
Second, the number change has provided an opportunity to invest in the infrastructure and the capacity to address people in crisis. And then thirdly, it gives us a chance to reimagine what an in-person response looks like. Historically, in-person response has been driven by default more by law enforcement, and yet, no other part of our health care field relies on law enforcement. So, it’s a chance to reimagine that by using mobile crisis teams and trained mental health personnel when there’s someone who needs an in-person response. It’s really an exciting opportunity.
What do clinicians need to know ahead of 988 going live?
Gebbia: Certainly, they need to know its availability and what we’re sensing is that it’s not as well-known as you would think at this point. I realize we’re in the pre-launch phase, but I think it’s important for your readers to know that it’s available, and to communicate this to their clients so that if someone is struggling and it is off-hours, and you can’t reach people, there’s a way for patients to connect to somebody who can help get them through that crisis. And I think it’s also important to know that based on the data, 9 out of 10 of these crises can be resolved over the phone and I’m not sure that’s understood.
Also, when you call 911, you get a dispatcher and with 988 you get a trained counselor on the other end of that phone. I think the other piece is this connection to care that this system could provide means more referrals to clinicians, more follow-up, as well as more use of obviously evidence-based interventions for someone in crisis. I think those are really important opportunities, and important for the clinical field to understand.
What gives us a little bit of concern is that this could increase the demands on an already stretched mental health workforce. And so, as a part of this, we also have to look at how are we building the workforce for tomorrow. What kind of additional clinicians will be needed with what kind of training? We want to make sure the workforce is there and that they’re compensated. I think there are a lot of questions that still need to be answered but, for the clinical workforce, it does mean there will be more demand for their services.
What entity actually administers the national suicide hotline?
Gebbia: The National Suicide Prevention Lifeline is a federally funded program through SAMHSA who funds Vibrant Emotional Health to operate the lifeline. Calls come in to their system and Vibrant has crisis centers all over the country that are part of the network. The call gets routed to the closest center to the caller, so that will be the same, but Vibrant does a lot of other things — they certify these centers, they make sure they have standards, and that they have trained personnel that provide all that kind of support to the system as well, which is really important.
Will the 988 number help to divert calls from 911?
Gebbia: I think over time, it would, and I also would add that it should, because there may be calls coming in to 911 that are better handled by 988 with a mental health response rather than law enforcement or some other response that may get triggered from 911. I think this is an important part of this transition, and I don’t think it’s going to happen instantly. For a person to understand when to call 911 and when to call 988, I think that’s going to take some time to educate the public, but I would hope over time, there will be less calls when someone is in emotional distress to 911 since 988 would be better prepared to handle the issue at hand.
I would say one other thing we are hearing but maybe not uniformly, that at the state level there are discussions going on between 911 and the local crisis centers about how to better integrate services. So, when does that call that comes in to 911 get routed to 988 because it’s better suited for the situation? So, we’re hoping that there will be good coordination at the state and federal level between 911 and 988.
What was the reasoning behind the change to 988?
Gebbia: Part of it stems from a recognition that our crisis system was not up to what it should be and there has been increasing demand on the current system already, and realizing there are so many people who are not reaching out for help and who are struggling. We know from our own work that about half of people who die by suicide every year are not in any kind of treatment in mental health care, and so we know there’s a gap there, and it’s a lethal gap, quite frankly. So, I think the growing recognition that we needed to do something to improve crisis response, to make it more available to those who are struggling.
The other thing that changed is political will. Our politicians are starting to get that mental health is important, and I think COVID-19 only exacerbates that because everyone knows that during COVID-19 we saw and continue to see increases in rates of depression, increases in rates of anxiety, substance use, and suicidal ideation, and so I think that helped to move this forward. But the conversations about this started before COVID-19, and I think COVID-19 really added more urgency to it. The National Suicide Hotline Designation Act designating 988 as the 3-digit dialing code for the lifeline was signed into law in October 2020 and had strong bipartisan support. All of those things came together and the timing was right to make this kind of investment and change, and now we need to make it work well. I really feel we’re on the right path with this.
What is the next step for the helpline?
Gebbia: Now that we have this change, we need to make it work really well and that’s going to take some sustained and large funding. The federal government has started that and I think through SAMHSA we’ve seen some good investments in the lifeline itself, but there’s a lot more that has to happen; I say in the coming year, the advocacy efforts are really critical. At the federal level, the President’s proposed budget for next year includes $697 million which would cover increasing the capacity of local call centers, increasing the public awareness efforts about 988, and creating a behavioral health crisis coordinating office at SAMHSA.
These are all really important, but it’s not a given. We’re going to have to advocate for that to make sure that it passes. And at the state level, the National Suicide Hotline Designation Act did include the ability for states to have fees on telecom bills that would support 988, and we think that’s a real game changer in terms of having sustainable funding source to support their local crisis centers in their state. So far, 4 states have passed it. A total of 6 more passed legislation to support 988 in their state, but not with these fees, and about 5 or 6 more states are studying it, and so we think in the coming year we’d like to see more states consider this and pass this kind of support so that their crisis services in their state can be sustained and continue to grow as demand requires it.
Obviously, there’s a lot of advocacy work to get that legislation passed both at the federal and the state level, and that’s something that I think everyone can be involved in, whether you’re a researcher, a clinician, an advocate, or someone who has been personally affected with mental health struggles. Hopefully, everyone will get behind this.
This article originally appeared on Psychiatry Advisor