“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 has laid bare the stressors facing Americans face. Too often, these stressors lead to suicidal and mental health crises,” said Tom Coderre, acting assistant secretary for mental health and addictions and acting chief of the Substance Abuse and Mental Health Services Administration. (SAMHSA) That’s why the move from the National Suicide Prevention Lifeline (1-800-275-TALK (8255)) to 988 couldn’t come at a more opportune time.
According to the Vibrant Emotional Health website, administrator of the National Suicide Prevention Lifeline, a 3-digit hotline to trained counselors can open the door for millions of Americans to seek the help they need, any sending the message to the country that healing, hope and help are happening every day.
Once the 988 number officially launches 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 for Suicide Prevention (AFSP), about this important and timely change to the National Suicide Prevention Lifeline.
What is the American Foundation for Suicide Prevention (AFSP)?
Gebbia: We have chapters all over the country, in every state and a brand new chapter in Puerto Rico and we have tackled the issue of suicide in a number of ways. We invest in research to better understand what works, how to prevent suicide, why it even happens, and understand the brain and behavioral aspects, as well as the environmental aspects.
We also engage in a lot of advocacy, both at the state and federal level, for policies and laws that can advance suicide prevention, and then we do a lot in the area of education. Much of it is about public education and awareness, from understanding risk factors and warning signs to what to do if someone is in trouble.
We believe in mental health literacy and having a more informed public with the goal of reducing the suicide rate by 20% by 2025. It’s an ambitious goal, but we’ve seen progress in recent years.
How will the change in 988 transform mental health crisis and intervention?
Gebbia: If we look at this in a historical context, I think emergency response services have generally been undervalued and perhaps not seen as part of the health care field, and certainly underfunded. So being undervalued and underfunded is really a moment in time because it indicates that crisis and mental health intervention is important and plays an important role in mental health overall of the nation.
When people are struggling, they need a way to connect to services and care. The 988 is therefore an excellent opportunity. I think it does 3 really important things: the first is that, just like with 911, we now have an easy to remember 3-digit number. We know that if we’re in physical pain, we call 911. Well, when you’re in emotional distress, you call 988, so changing the number makes it easier to remember.
Second, the shift in numbers has provided an opportunity to invest in infrastructure and capacity to care for people in crisis. And third, it gives us a chance to reimagine what an in-person response looks like. Historically, in-person response has been driven more by default by law enforcement, and yet no other part of our healthcare field relies on law enforcement. So it’s a chance to re-imagine that using mobile crisis teams and trained mental health staff when there’s someone who needs an in-person response. It really is an exciting opportunity.
What should clinicians know before 988 goes live?
Gebbia: Granted, they need to know about his availability and what we feel is that he’s not as well-known as one might think at this point. I realize we’re in the pre-launch phase, but I think it’s important that your readers know it’s available and communicate it to their customers so that if anyone struggles and that it’s out of hours, you can’ Reach out to people, there’s a way for patients to connect with someone who can help them through this 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 that link to care that this system could provide means more referrals to clinicians, more follow-up, as well as more use of demonstrably evidence-based interventions for someone in crisis. I think these are really important opportunities, and it’s important for the clinical field to understand.
What worries us a bit is that it could increase demands on an already overstretched mental health workforce. And so, as part of that, we also need to look at how we’re building the workforce of tomorrow. What kind of additional clinicians will be needed with what kind of training? We want to make sure the workforce is there and paid. I think there are still a lot of questions that still need to be answered, but for clinical staff it means there will be more demand for their services.
Which entity actually administers the National Suicide Hotline?
Gebbia: The National Suicide Prevention Lifeline is a federally funded program through SAMHSA that funds Vibrant Emotional Health to operate the lifeline. Calls come into their system and Vibrant has crisis centers across the country that are part of the network. The call is routed to the center closest to the caller, so it will be the same, but Vibrant does a lot of other things – they certify those centers, they make sure they have standards and that they have trained staff who provide all of that kind of system support as well, which is really important.
Will 988 Help Divert 911 Calls?
Gebbia: I think over time it would, and I would also add that it should, as there may be incoming calls to 911 that are better handled by 988 with a sanity response rather than the app of the law or some other response that can be triggered by 911. I think that’s 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 it’s going to take some time to educate the public, but hopefully over time there will be fewer calls when someone one is in emotional distress to 911 since 988 would be better prepared to handle the issue in question.
I would say another thing that we hear, but maybe not uniformly, that at the state level there are ongoing discussions between 911 and local crisis centers about how to better integrate the services. So when is that call that comes in to 911 routed to 988 because it’s better suited to the situation? So we hope there will be good coordination at the state and federal level between 911 and 988.
What was the reasoning behind the move to 988?
Gebbia: This stems in part from the recognition that our crisis system was not up to what it should be and that there has already been an increasing demand on the current system, and the realization that there is has so many people not asking for help and struggling. We know from our own work that about half of the people who die by suicide every year don’t get any kind of mental health treatment, and so we know there’s a gap, and it’s a deadly gap , quite frankly. So I think the growing recognition that we needed to do something to improve the response to the crisis, to make it more accessible to those who are struggling.
The other thing that has changed is the political will. Our politicians are starting to understand that mental health is important, and I think COVID-19 is only exacerbating that because everyone knows that during COVID-19 we’ve seen and continue to see increases in rates depression, increases in levels of anxiety, substance use, and suicidal ideation, so I think that helped move things along. But the conversations about this started before COVID-19, and I think COVID-19 has 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 time was right to make that kind of investment and change, and now we have to make it work. I really think we’re on the right track with that.
What’s next for the helpline?
Gebbia: Now that we have this change, we need to make it work very well and that is going to require sustained and significant funding. The federal government has started this and I think through SAMHSA we’ve seen some good investment in the lifeline itself, but there’s still a lot to do; I say that in the coming year, advocacy efforts are really essential. At the federal level, the President’s proposed budget for next year includes $697 million that would cover expanding local call center capacity, increasing public awareness efforts about 988, and Creation of a Behavioral Health Crises Coordination Office at SAMHSA.
All of that is really important, but it’s not a given. We’re going to have to advocate for this to make sure it passes. And at the state level, the National Suicide Hotline Designation Act included the ability for states to have charges on telecom bills that would support 988, and we think that’s really a game-changer in terms of have a sustainable source of funding to support their local crisis centres. in their condition. So far, 4 states have adopted it. A total of 6 more laws have been passed to support 988 in their state but not with this fee and about 5 or 6 other states are looking at it so we think in the coming year we would like to see more States consider this and pass on this type of support so that their crisis services in their state can be maintained and continue to grow as demand requires.
Obviously, there’s a lot of advocacy work going on to get this legislation passed at the federal and state level, and that’s something I think everyone can be involved in, whether you’re a researcher, a clinician, advocate or someone who has been personally affected by mental health issues. Hope everyone will support this.