Post-COVID-19 society

On Feb. 16, 1968, Rankin Fite, then-Speaker of the Alabama House, placed a historic phone call to U.S. Congressman Tom Bevill. What made the call historic wasn't the caller or recipient, though.

It was the three numbers dialed 911 and what they would come to represent. Before its establishment, frantic callers were forced to dial local 10-digit phone numbers to reach police, fire, or medical services. Since its establishment, an estimated 240m calls are made to 911 in the US each year through 8,900 dispatch centers across the country.

So when President Trump signed into law the National Suicide Hotline Designation Act of 2020, a piece of bipartisan legislation passed to create another three-digit number specifically for mental health emergencies, history had a familiar ring that went largely unheard by most as the news would compete with all things election and pandemic related in media. But, like 911, a new 988 hotline may prove to be the most enduring and pivotal development in 2020, particularly at a time when the consequences of prolonged fear, anxiety, and uncertainty have become the norm, making untreated mental illness arguably easier to live with and harder to identify.

Part of the problem is the fact that mental illness often hides in plain sight. Millions of people in the U.S. are affected by conditions such as addiction, depression, and post-traumatic stress each year. These conditions have been associated with everything from genetic factors to environmental triggers.

Some are less obvious such as social media platforms, like Facebook and Twitter, that contribute to an increased risk for depression, anxiety, and suicidal thoughts. Some people also pay the price for overcoming COVID-19 as survivors have a significantly higher rate of psychiatric disorders, dementia, and insomnia. Other triggers have more obvious consequences, such as heightened feelings of anxiety and depression linked to rampant social unrest.

Given the increasing, indiscriminate prevalence of mental distress across American households today, the 988 hotline offers a couple of important benefits to society. Primarily, it will force us to make a distinction between an emergency and a mental health crisis. Both require the response of competent professionals, with an emphasis on competence.

While firefighters perform many lifesaving functions, they're not ideal in emergencies involving burglaries or domestic disputes. Similarly, a police officer may not be the right professional when a person with bipolar disorder or schizophrenia is having a crisis moment, as seen in the highly publicized police shootings of Laquan McDonald and Ethan Saylor. Calling 988 instead of 911, once adequately socialized and normalized, will increase the likelihood that a first responder is equipped to deal with a situation without unnecessary escalation.

While a 988 option may have always served society well in retrospect, timing is of particular importance because our country's mental health problems are getting worse, not better, at an accelerated rate. Even in "normal" times, more than half of adults with mental illness in our country fail to get treatment when they need it, in large part due to lack of affordability, clinician shortages, fragmented care, and societal stigmas. The longer the pandemic and social tensions persist, the greater the demand for mental health systems that have already hit peak capacity. Additionally, we know a significant number of those who end up in the justice system do so because of untreated trauma and mental illness that get buried beneath rap sheets and long prison sentences. This leaves law enforcement officials and courts to confront a problem that mental health professionals were trained to handle when first responders are facing unprecedented community peacekeeping challenges. The 988 hotlines, in conjunction with more de-escalation tools for crises, as well as options for treatment alternatives to incarceration, will go a long way in solving longstanding problems in our society that are perhaps more based on ignorance than enmity.

That being said, managed expectations are important here as the hotline's success will depend on many factors. Like 911, 988 centers will likely be operated and managed on a local level, which means cities and counties will be responsible for filling gaps in coverage and reducing variability in how they serve their respective communities. But once it's implemented, which is scheduled for some time in the year 2022, the 988 option will represent an inflection point in not just how we approach mental illness-related crises in our country but also a higher likelihood that those who live with mental illness will get connected to the help they need to live, not just survive.