The US has a new crisis hotline: 988. Is it prepared for a flood of calls?

Americans in need have a new number to call for help — 988, a revised National Suicide Prevention Lifeline billed as mental health’s 911.

The number, which is set to go live on Saturday and is supported by more than $400 million in federal funding, aims to address a rising tide of mental illness in the United States. However, there are lingering concerns that short-staffed call centers across the country may not be ready to meet the surge.

Many who have called the Lifeline in recent months have been disconnected before they could get help. About 18 percent of the roughly 1 million calls made to Lifeline in the first half of this year were abandoned, according to data analysis from The New York Times. An earlier analysis by the Times in March revealed similar issues, and the move to a well-publicized three-digit phone number is expected to further strain capacity.

Xavier Becerra, the Minister for Health and Human Services, welcomed efforts to prepare for 988 but acknowledged there was significant work ahead. “Once you get that off the ground, there has to be someone to answer the phone,” he said in an interview. “It’s not enough to get a busy signal or to be put on hold.”

Hundreds of millions of federal dollars have given Lifeline a big boost over the past six months. The money has helped the chronically underfunded crisis hotline — which has long been run by a patchwork of call centers, often not-for-profit organizations, that juggle multiple hotlines and rely on both paid consultants and volunteers — to recruit additional phone banks across the country, causing increased the total from 180 to more than 200.

The funding has also strengthened a Spanish-speaking network; national backup centers where advisors can answer calls that go unanswered locally; and digital messaging services, seen as a crucial tool to reach out to younger people who need help.

The Lifeline’s text and chat lines came in about 500,000 times in the first half of 2022, but only about 42 percent of those were answered. Still, data provided by the organization that manages the Lifeline showed steady improvement — the response rate rose to 74 percent in June, and the average wait time dropped from 16 minutes in January to about three minutes last month.

There were no significant increases in phone call response rates, although a goal of 988 is to answer 95 percent of them within 20 seconds. According to The Lifeline, 80 percent of callers who disconnected last year did so within two minutes of the auto-greeting, and about a quarter of those who hung up tried again within 24 hours and got through.

John Draper oversees the lifeline and is an officer at the non-profit organization Vibrant Emotional Health, which administers service for the Substance Abuse and Mental Health Administration. Mr Draper pointed to “huge increases” in responses to digital messages. He predicted that the new investments would lead to improvements in how phone calls were answered in the coming months, noting that call centers were already able to keep up with the steady increase in volume.

“We want to make sure we respond to everyone in the crisis,” he said.

However, less than half of the health officials responsible for introducing the 988 were confident their communities were prepared, according to a recent survey by the RAND Corporation.

The Lifeline overhaul isn’t just limited to calls, texts, and chats. While data shows hotlines can resolve about 80 percent of crises without further intervention, the vision for 988 is that counselors will eventually be able to connect callers to mobile crisis teams who can come to them, as well as short-term mental health triage -centres.

These changes are intended to reduce law enforcement intervention and reliance on emergency rooms, ultimately keeping more people alive, proponents say.

The new Lifeline comes at a time of rising mental illness, including what the US Surgeon General calls a “devastating” crisis among young people. According to the Centers for Disease Control and Prevention, suicide was the 12th leading cause of death for Americans of all ages and the second leading cause of death among 10-14 and 25-34 year olds in 2020. One person died by suicide every 11 minutes in 2020. Many believe the pandemic has made mental health issues worse, and the revamped hotline aims to expand beyond the realm of suicide to help everyone in the crisis.

Despite the projected increase in volume, questions remain about 988’s long-term sustainable funding. That’s partly because the bill establishing it, signed by President Donald J. Trump in October 2020 with bipartisan support, left call center funding largely up to the states.

While states have been able to collect money for 988 the same way they do for 911, with a monthly fee on phone bills, only four states have approved a phone bill fee. Many other states have used grants, general funds, or enacted other legislation to prepare for the new Lifeline.

“I think 988 represents the best and worst of how America is approaching mental health,” said Benjamin F. Miller, psychologist and president of the Well Being Trust, a mental health foundation. “In the best case, it’s the ingenuity, the creativity, the positioning. At worst, it is lack of resources, lack of leadership and lack of execution.”

dr Miller has concerns about whether the funding would be continuous, he said, because mental health in the country has always been an “afterthought.”

“It’s the marginalized aspect of our healthcare that we continue to avoid investing heavily in,” he said.

Jennifer Piver, the executive director of Mental Health America in Greenville County, South Carolina’s only 988 call center, said federal funding has allowed her to fill eight new positions. However, she feared this would be insufficient in the long term and said her team is scouting for grants and raising money through a GoFundMe page.

“I’m sure we’ll be okay on Saturday,” said Ms. Piver. “But as word gets around, you know we’re not financially or humanly prepared to handle that growth.” The center answers over 80 percent of calls in the state, but if funding stays the same, she said, “we could do this one.” drop to 50, 40 or even 30 percent pretty quickly when you consider some of the systems that are going to change. ”

The nationwide labor shortage has also impacted the ability to hire and retain employees. The Substance Abuse and Mental Health Administration has a long page on its website listing job opportunities across the country.

The workforce was an issue for the mental health field “long before the pandemic,” said Hannah Wesolowski, the senior stakeholder for the National Alliance on Mental Illness, who noted that burnout is also an issue for professionals already working in the field problem.

Although a lot of work has been done since 988 was signed, Ms Wesolowski said: “We are trying to build a comprehensive system and that will take more than two years.”

Rep. Tony Cárdenas, a Democrat from California and a key congressional supporter for 988, noted that 911, which was founded over 50 years ago, “didn’t start without hiccups.”

Despite the uncertainties, proponents remain hopeful that 988 will deliver on its promises.

“People’s lives are at stake, so we have to get there,” said Preston Mitchum, the advocacy director of the Trevor Project, a crisis intervention organization for LGBTQ youth.

“We will make it.”

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