Fewer digits, faster help
Jonas Vingegaard (yellow jersey) claimed his first Tour de France Local mental health title Sunday after dueling with defending champion Tadej Pogacar. groups welcome switch to 988 Suicide Hotline
Dialing the National Suicide Prevention Lifeline got seven digit easier last week after the new short er number – 988 – became active last week.
The change from the old number (1-800-273-8255) was initiated by bipartisan legislation co-authored by Sen. Jack Reed (D-RI) and passed in 2020. Although the old number will remain active. Reed championed the National Suicide Hotline Designation Act as a lifesaving measure.
“Trimming the number from 10 digits to 988 will help make it easier for people to remember and ensure those experiencing a mental health crisis or having suicidal thoughts can quickly access the help they need,” Reed said in a statement after the number launched.
Reed and mental health propo-nents still encourage anyone experiencing a life-threatening emergency to call 911 for immediate police, fire and medical assistance. Veterans who dial 988 can press “1” to connect to the Veterans Crisis Lifeline.
Both the Veterans Crisis Lifeline and 988 can also be reached via text or chat, and are accessible for those who are Deaf or hard of hearing via teletypewriter by dialing 711 before dialing 988.
Like the old, 10-digit number, callers will be routed to their local Lifeline-affiliated call center. It is estimated that the lifeline will receive millions of new calls with this new number, Reed said in a statement on the Senate floor on Wednesday.
In Rhode Island, BH Link in East Providence serves as the state’s only Lifeline-affiliated call center. Joseph Ash, co-director of BH Link, said
the organization is working on scaling up staffing to meet the anticipated needs of the new number, and has also been coordinating with other behavioral and mental health groups to talk about staffing and training.
“As much as we can, we’re trying to pull from the expertise of the community,” Ash said.
The center answers calls 24-7, and Ash said the center has consistently improved its answer rate to be one of the highest in the country. Even if a local counselor can’t take the call, the service is set up so that a caller is never put on hold or told to call back. Ash said the center currently uses an internal back-up system that bounces the call to the BH Link triage center, an in-person walk-in facility staffed by clinicians. Other states use the national call center as a backup, which routs the call to the next available center, which could be out-of-state.
Each call is different, depending on what the caller needs, but they generally follow a similar three-stage process.
“Everyone who calls the line is looking for something,” Ash said.
The first stage is stabilization, which may not always be necessary, for example if someone is calling to inquire about available resources. But if the caller is in the midst of a mental health crisis and having trouble communicating, the counselors are trained in techniques to guide the caller into a more stable frame of mind, Ash said.
The second phase in information-gathering, which Ash said is about finding out “what help means to them.” Counselors are also trained during this phase to listen for cues about the safety of the caller. They may ask questions to clarify the risk of the caller or someone else being harmed, “really getting into the weeds and doing a deep dive into what are the factors related to safety in the moment,” Ash said.
If the counselor identifies a call that is “probably more appropriate” for 911, they may coordinate with public safety for a wellness check or crisis intervention.
“We’re talking about situations that are emergent and imminent,” Ash said.
Right now, 988 has the ability to — and does — coordinate with 911 for emergencies when necessary, which was already a procedure in place with the 10-digit number. Ash said in the future, a long-term vision for 988 would also be for that kind of coordination to work both ways; 911 authorities would be able to transfer calls that may be more appropriate for 988 to the Lifeline call center.
Throughout the information gathering process, counselors are also looking for moments of strength and resiliency, Ash said, adding that everyone who initiates a call had the strength to do so.
The final stage is closing out the call, and moving the caller toward a “disposition,” or outcome. This could be connecting the caller to resources, organizing for them to come onsite to BH Link for a clinical assessment and referral, or dispatching a mobile crisis clinician.
“It’s going to make sure that what the caller was looking for in that moment, they got to the best of our ability,” Ash said.
BH Link still operates its own hotline (401-414-5465 or 401-414-LINK), as well as a number for callers under 18 (855-543-5465 or 855-KIDLINK). Several other community organizations also operate hotlines for behavioral or mental health crises or suicide prevention. Ash stressed that there are no wrong numbers to call for someone in crisis.
“No one wants to put someone who’s in crisis through a game of phone-tag,” Ash said.
The effort to designate 988 as the national suicide prevention lifeline number began in 2018 with the National Suicide Hotline Improvement Act, a bipartisan bill co-authored by Reed. The legislation directed the Federal Communications Commission and the Substance Abuse and Mental Health Services Administration to evaluate a three-digit dialing code for the National Suicide Prevention Lifeline, and the FCC recommended 988.
The National Suicide Hotline Designation Act directed the FCC to designate 988 as the National Suicide Prevention Lifeline, a two-year process that required covered phone service and text providers in the U.S. and five major U.S. territories to direct all 988 calls and texts to the National Suicide Prevention Lifeline by July 16, 2022, and to phase out any seven-digit numbers that began with 988.
During these two years, Congress and the Biden Administration invested heavily in the Lifeline to prepare states for the national roll-out. Federal funding increased from $19 million in 2020 to $432 million in 2022, a sum that included $150 million set aside for 988 in the bipartisan gun control bill.
Reed, who sits on the Senate Appropriations Committee, has requested a total of $700 million for 988 in the upcoming 2023 appropriations package, according to his spokesperson.
Although the law allows states to impose a service fee to fund 988, similar to how some states fund 911, Rhode Island designated separate funds in the state budget for 988.
Rep. Mary Ann Shallcross Smith (D-Lincoln) and Sen. Sandra Cano (D-Pawtucket) proposed $1.9 million in federal State Fiscal Recover funds for 988, which was adopted into the most recent budget bill.
“Mental health conditions are disproportionately affecting certain populations, including young adults, communities of color and unpaid caregivers,” Cano said in a statement. “988 is an easy number to remember for those who may be experiencing this crisis in their lives.”
Ash, of BH Link, said the mental health field has been hampered for a long time by a lack of funding.
“Our systems and our programs are only as good as the funding we have,” Ash said. “A stressed system is not going to work as well.”
Ninety-four Rode Islanders died by suicide in 2020, according to the most recent data from the American Foundation for Suicide Prevention. Suicide represents the second leading cause of death for people ages 25-34 in Rhode Island, and claims over 45,000 lives per year nationally, according to the AFSP.
In his floor speech on Wednesday, Reed applauded the roll-out of 988 and highlighted several other bills aimed at suicide prevention and increasing mental health access. Among these are the Suicide Prevention Act, which would fund self-harm and suicide prevention services in hospital emergency departments and expand data collection on self-harm and suicide, and which Reed introduced to the Senate in late June.
Reed also cited the Garrett Lee Smith Memorial Act Reauthorization of 2022, which is named for former Sen. Gordon Smith’s (R-OR) son, who died by suicide in 2004. Reauthorizing the act would continue grant funding for youth suicide prevention in states and on college campuses.
“In meeting the challenge of this mental health crisis, we must be relentless,” Reed said. “We cannot do just one thing or even a few things, because there is no single solution.”
If you or someone you know is experiencing a mental health, suicide or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor.