Dialing 988 for mental health help: It’s a step forward, but only part of the solution

The technology behind the July 16 switch to the 988 suicide and mental health crisis hotline was not all that revolutionary. It was more a matter of rebranding the existing National Suicide Prevention Lifeline and rerouting calls to an easy-to-remember three-digit number, much like 911.

What happens after someone in need dials 988 will likely vary, however, even if the hotline is a step in the right direction.

Modeled after 911, the new “Suicide & Crisis Hotline” is designed to be a quick way for people in crisis to get connected to an existing network of more than 200 local crisis call centers around the country. People who call or text the number will be connected to a trained counselor at a crisis center closest to them. If a local crisis center is too busy to respond right away, the call gets routed to one of 16 backup centers nationwide.

Is the system leakproof? Not yet, as discovered through a 2021 study by the federal Substance Abuse and Mental Health Services Administration. It found the former suicide hotline received 3.6 million calls, chats, and texts in 2021, but was able to respond to just 85% of calls, 56% of texts, and 30% of chats. With an 18-fold increase in federal dollars recently dedicated to the 988 system, it is predicted calls will double and more will get answered and routed before frustrated callers just hang up.

That’s when it gets trickier. One of the delayed outcomes of the COVID-19 pandemic was more people becoming isolated from friends, family, or just society in general, either aggravating existing mental health conditions or experiencing new anxiety or depression. Scientists have charted that phenomenon, as well as hospital administrators in Wisconsin and elsewhere.

“Hospitals are seeing more emergency department visits for mental health issues after COVID-19 surges, particularly among young adults and racial minority groups,” Modern Healthcare reported in March 2022. In Wisconsin, some hospitals have picked up the slack where county-run mental health facilities have fallen down.

For Dr. Robert Golden, a nationally known psychiatrist and dean of the UW–Madison School of Medicine and Public Health, the advent of 988 is welcome but no panacea.

“I think 988 is an important, albeit relatively small, step in the right direction,” Golden said. “It will save lives, but it’s a Band-Aid. The greater challenge is building up the mental health infrastructure beyond crisis intervention. After you’ve talked someone down from the brink, they need an appointment to start (or restart) treatment, and across the country, we have a growing shortage of mental health professionals, especially for child and adolescent populations.”

Much of society should care if mental health treatment is increasingly less available, including business owners who worry about people wandering in off the street, harassing customers and employees, or worse. Is the epidemic of mass shootings linked to untreated mental health conditions?

Writing recently in Psychology Today, Dr. Fablana Franco noted that 98% of mass shooters are men, usually young men, but added most such shooters don’t meet the diagnostic requirements for mental illness. They’re emotionally disturbed, of course, but that may be rooted in other causes — a pattern of rejection, childhood trauma, bullying, or that hardest-to-define trait, just plain evil.

Whatever the clinical diagnosis, the outcomes also affect community policing. West Allis Police Chief Patrick Mitchell, a recent president of the Wisconsin Chiefs of Police Association, said a large share of trouble calls for most departments involve people in distress. In West Allis, he estimated, it would be about 25% of all calls.

“If 988 can be well publicized, it will be a good thing,” Mitchell said. “But like so many other things in life, it will depend on who’s on the other end answering the phone.”

The 2022 report on “The State of Mental Health in America” confirmed that untreated symptoms, long a problem with many adults, only got worse during the pandemic for adults and youth alike. It also cited 988 taking effect as one factor to help narrow the gap. Perhaps that new three-digit number, over time, will help law enforcement, health systems, businesses, and ordinary people better cope with an often-unseen problem.

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