Crisis services utilization has increased year after year as accessibility improves and people are more aware of their benefits. Established in 2005, the National Suicide Prevention Lifeline has answered over 12 million calls. The Crisis Text Line, founded in 2013, has responded to over 5 million conversations.
Given the ever-emerging technology and science surrounding crisis intervention, these services are continually evolving. Training and accreditation processes improve standards, professionalism, and quality assurance.
What Is the New Movement to the 988 Crisis Hotline?
In many ways, I am encouraged by moving our mental health crisis support to the 988 call system. First, 988 is much easier to remember than (800) 273–8255, so access to qualified mental health crisis supports should increase significantly. Second, with the appropriate infrastructure and funding support required to make this successful, the shift to 988 symbolizes the importance of mental health crisis support. 911 responses to community safety will be on equal footing in importance to the 988 mental health crisis responses. Third, I hope that this shift to 988 also means a shift in the way crisis services are delivered.
Less reliance on a law enforcement response and increased engagement with peer support
Less fear and more compassion
Finally, the development of 988 will bring much-needed coordination of services similar to air traffic control. So, people will have a better chance of getting matched to the right level of service.1
In late 2019, a new law to create a three-digit number for mental health emergencies came into effect. It will pave the way for more support, implementation, and adoption of the 988 number many call centers already use and make it easier for people in distress to get the support they need.
A simple three-digit number is easier to remember and dial during mental health emergencies. In addition, the branding of the new crisis response will go beyond just support for people experiencing suicidal despair and will include all psychological emergencies and even emerging mental health hardships. The design of the new system is intended to help facilitate a warm-hand-off connection to qualified supports and to follow up to make sure those referrals are a good fit.
Funding and infrastructure support need to be commensurate with the scope of the shift to 988 to work. This will resolve the funding issues that make it hard for local crisis centers to respond to callers through the current line.
Taking the National Suicide Prevention Lifeline as an example, there is a general misperception in the community about how the Lifeline works. While the leaders of the Lifeline call center system are under one umbrella, each call center is responsible for its own funding and operation. As the calls to Lifeline have swelled each year, the call centers have been left to manage the load with minimal margins. The increased support required by the shift to 988 will give the call centers a fighting chance to be sustainable.
Less Fear. More Care.
The 988 line will significantly reduce the numerous problems arising from calling 911 during mental health crises and aid people in getting the help they need.
911 usually activates a law enforcement response. Law enforcement is best suited to take control of chaotic and life-threatening situations. The skills and mental abilities of law enforcement under these circumstances are NOT best when responding to someone having a mental health crisis. Many police officers can feel out of their element when responding to people who are despondent, grieving, traumatized, or highly anxious.
Additionally, for communities of color or for transgender people, a 911 call can often escalate to violence, regardless of the nature of the call. People of color living with mental health conditions are much more likely to be detained than white people. Thus, they are highly reluctant to call 911.
The new number of 988 will link people to crisis responders trained to help them cope with and feel supported and understood during suicidal intensity and other mental health challenges. They'll get the assistance and care they need instead of becoming embroiled in aggressive altercations with the law and/or ending up in institutions ill-equipped to help them recover. So, calling for help will connect them to people trained to listen empathically and provide accurate information and referrals instead of worsening their situations.
Help during the Transition
The line won't be available for another year. Given the mental health crisis caused by the pandemic, that's disheartening and distressing. Policy and funding changes that could help significantly during this transition include the following.
Establishing LOSS teams in every community for suicide "postvention" support
Establishing peer respite centers in more regions for people experiencing mental health challenges who do not need urgent care
Incentivize the continued development and evaluation of the technology (e.g., virtual peer support or apps for peer support)
Looking Forward: Additional Advancements
988 call centers need to not only be prepared to support people experiencing suicidal intensity but also people impacted by a suicide death. Many crisis call centers would benefit from specialized services addressing the complicated trauma and grief suicide brings.
Integrating more people with lived experience with suicide and mental health crises will be essential in 988's effectiveness. The voices of people who have been there give us tremendous insight into what works and what doesn't—when the focus is on helping people. What the wisdom of people with "lived expertise" tells us is that we will all be better off moving away from a fear-based approach and toward one built on upholding dignity, collaboration, and compassion.
The new law is a significant and positive development. It promises an opportunity to reduce the bias of mental health issues and people fighting through them. Three simple numbers—988—send an unspoken message that these emergencies are legitimate and require a different kind of care and vigilance.
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