New suicidal national lifeline struggling to keep up with volume, advocates say
Kristi Daugherty remembers the announcement like it was yesterday.
It was March 11, 2021, one year since the World Health Organization declared COVID-19 a global pandemic, and in those twelve months, emerging data from the Centers for Disease Control and Prevention showed that historical rates of mental illness , overdose deaths and suicide deaths were on the rise . Amid the horrific trends, the government has decided to take action.
The National Suicide Prevention Lifeline was undergoing a makeover.
As part of the update, the 10-digit phone number has been simplified to a succinct 9-8-8. The lifeline also added texting services, as well as comprehensive mental health services beyond suicide prevention.
The program was supported with $200 million in funding through the Biden administration’s American Rescue Plan.
As chief executive officer of the Emergence Health Network in El Paso, which provides behavioral health, crisis response and other services to nearly 30,000 Texans a year, Daugherty said he’s excited about the developments.
But then, political pressure reached a boiling point and the launch timeline was pushed back by six months, Daugherty told ABC News. For months, EHN has rushed to recruit staff in the face of tight budgets and tighter deadlines, he says, they haven’t seen a cent of the federal support come down from Austin. The Texas Department of Health and Human Services did not respond to ABC News’ request for comment on Daugherty’s claim.
She is not alone in her frustration.
In some critical ways, 988 has strengthened an American mental health system that the Department of Health and Human Services itself has called “long underfunded and under-resourced.”
Since its launch in July 2022, the new hotline has received more than 2 million calls from people in crisis, 45 percent more than the 10-figure hotline over the same period a year earlier, according to data from Vibrant Emotional Health. the organization appointed by the federal government to police the line.
Vibrant says the hotline has also responded to over 1 million chats and messages. Average wait times have dropped from almost 3 minutes to less than a minute. In addition, 988 has implemented variants of the line specifically dedicated to the care of at-risk groups such as veterans, Spanish speakers and LGBTQI+ youth.
Outcome data on emergency responses, referrals to outpatient mental health care services or inpatient stabilization services are not readily available, according to Vibrant. But Tia Dole, the organization’s chief 988 officer, said the service has helped many people who may have nowhere else to turn for help.
In 2021, one American died by suicide every 11 minutes, more than 12 million considered suicide, and suicide was the second leading cause of death in most youth or young adults, according to the CDC. More than 100,000 more Americans have died from drug overdoses, according to data from the National Institute of Health.
But nearly a year after the crisis line was launched and nearly a billion dollars in federal investment, most states are still struggling to ensure that their citizens’ calls are answered locally.
Unanswered calls go to national backup centers, but federal officials acknowledge that these centers are generally less equipped to provide the local services callers may need. In April 2023 alone, the most recent month for which public data is available, more than 11,000 calls were missed overall, according to Vibrant. And as of April 2023, despite federal funding stipulations requiring response rates above 90% by June 2022, only 15 states met that goal. Texas’ call response rate, at 75%, ranked it among the worst performers.
“This thing that we’re doing has never been done,” Dole told ABC News. “Is it perfect? No.”
Widespread staff shortage
Many of these shortcomings may relate to a particularly thorny challenge: staffing.
Crisis call centers depend on behavioral health professionals to man the phones for a workforce that includes psychologists and psychiatrists, nurses and social workers, counselors and coaches. The number of job openings for these types of workers is expanding “much faster than the average for all occupations,” according to the Bureau of Labor Statistics.
The market for mental health counselors, for example, is expected to outpace overall job growth by 4.5 times over the next decade.
In 2020, according to federal data compiled by the Government Accountability Office, the country required more than 1 million more behavioral health workers to meet the mental health needs of Americans. These data also don’t take into account the pandemic, which has taken a toll on the workforce, Dole told ABC News.
“I think the workforce, as far as crisis services is concerned, hasn’t recovered since then [the pandemic]Dole told ABC News.
Workforce shortages have meant that crisis call centers across the country have struggled to staff. According to data reviewed by ABC News from state health departments, in Rhode Island, 52% of positions were empty as of May 2023. In Wisconsin, 30% of positions were empty. According to a 988 job board run by the Substance and Mental Health Services Administration (SAMHSA), nearly every state in the country has vacancies.
For Vince Brancaccio, labor shortages are a daily struggle.
Brancaccio, who is the CEO of the Health Network of Southeast Ohio, one of 988 centers in the state, now spends a significant portion of his days simply trying to find interested candidates. That’s instead of doing the job of stabilizing the crisis and mental health care itself, Brancaccio told ABC News.
Most of the time, his days spent hiring are filled with frustration due to empty Zoom rooms. More often than not, candidates “don’t show up for interviews,” Brancaccio said. Or if they’re hired, he said, “they don’t show up for work the first day.” About half of the 988 chairs at its center are empty, he said.
Inflexible work requirements
Another staffing challenge that call centers face is managing remote versus face-to-face work.
In a post-pandemic world, remote working has become standard, according to a 2021 McKinsey report, especially for computer-based office work, like answering calls. However, many 988 centers, like the one in Brancaccio, do not offer remote work: according to the SAMHSA 988 jobs page, more than 70% of centers are in-person only.
In addition, fewer than 5 percent of the 988 centers currently use Vibrant’s new software platform, the development of which was funded in part by federal funds, to answer calls, Dole told ABC News. Many are still using legacy software whose origins date back to the 2004 launch of pre-988 lifeline software that is too often ill-equipped to handle the complexities of remote work nearly two decades later, Dole said.
These dynamics mean states with already low behavioral health workers are experiencing a brain drain, Joshua Thomas, managing director of the Delaware chapter of the National Alliance on Mental Illness, told ABC News. According to a December 2022 study by the Delaware Department of Health and Human Services, there is a widespread shortage of mental health resources in the state.
Thomas said the lack of flexibility around remote working, combined with “income potential that is significantly lower than it is elsewhere,” presents the risk that states like his will struggle to compete with others that are better resourced. or are they more flexible.
By comparison, states like Massachusetts, which have dedicated $10 million from state coffers to 988, raising wages and providing hybrid job options, have more than doubled their staff since the hotline launched, according to Vibrant. Massachusetts’s call response rate in April was 88%, just below SAMHSA’s 90% response rate threshold, compared to 73% for Delaware, according to data compiled by Vibrant.
Gift box of an empty box
Daugherty fears the accelerated launch timeframe was short-sighted: The rush to announce 988 followed by the rush to get it operational and the ensuing struggles may have undermined confidence in the long-term line.
Upon launching the hotline, HHS Secretary Xavier Becerra said “988 is more than a number, it’s a message: We’re there for you.” Eleven months later, amid the staffing centers’ struggles, Daugherty likens those promises to packing an empty box.
Monica Johnson, SAMHSA’s 988 director, has acknowledged the hotline’s growing problems thus far. But Johnson also pointed to the hotline’s progress to date: More than 3 million contacts answered, wait times reduced, nearly $1 billion invested as signs that things are moving in the right direction.
“I think about, okay, what month is this first year in[and] Have we demonstrated that we have the ability to take calls?” Johnson told ABC News. “The answer, so far, has proven yes.”
However, for people like Molly Jacobson, those growing pains are a matter of life and death.
Jacobson, a Florida native, said she called the line in October 2022 on behalf of a loved one in crisis. A relative had previously attempted suicide and she feared she might do it again. However, when she called 988, she said she was immediately put on hold.
When he finally spoke to someone, after a series of triage questions, the operator seemed resigned, he said. “‘I’m sorry, I don’t know what I can offer,'” Jacobson recalled telling her.
Jacobson said he didn’t know where else to turn.
He said, “For something that’s funded by hundreds of millions of dollars… where is all of this going?”
Jacobson’s experience highlights some of the challenges the state has faced thus far: In April, Florida received more than 10,000 calls, of which only 73% were answered, placing it among the worst performing states. The Florida Department of Children and Families, which oversees the state’s 988 hotline, did not respond to ABC News’ request for comment on the Jacobson case.
Jacobson says her love did well despite her negative experience with the line. But he worries about what might happen next time or, to someone else in a similar situation.
“When any of us are in our darkest hour,” Jacobson said, “what we need is to be heard.”
Despite some of the staffing challenges, if you or a loved one is struggling with a mental health crisis or contemplating suicide, call or text 988.
ABC News is reviewing challenges and successes with the implementation of the 988 Suicide and Crisis Lifeline. If you have had any problems or successes with the line, please contact us here.
Michal Ruprecht, a member of ABC News’ medical unit, contributed to the reporting.
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