988 suicide hotline launches, despite concerns about staffing

PITTSBURGH – The new national mental health crisis phone line, 988, was launched on Saturday, but many fear states and their lifeline call centers may be understaffed and unready to absorb the influx of new callers.

The number is intended to be easy to remember, in the hope that it will enable more people to connect with the National Suicide Prevention Lifeline, which has relied on people dialing a 10-digit phone number, 800-273-8255.

Since its adoption in 2005, the National Suicide Prevention Lifeline has received over 20 million calls from distressed people looking for support.

The National Suicide Hotline Improvement Act of 2018 required the Federal Communications Commission (FCC) to coordinate with the Substance Abuse and Mental Health Services Administration (SAMHSA) to examine the feasibility of a three-digit hotline. Congress authorized the 988 code in 2020.

States were given a deadline of Saturday to adopt the new number. The old 10-digit number will remain operational.

“The 988 number is much more memorable and accessible and is a big step forward in the long strategic destigmatization and expansion of the emergency mental health services in the country,” said Dr. Jack Rozel, medical director for Resolve Crisis Services at UPMC Western Psychiatric Hospital.

Resolve, the only lifeline call center in Pennsylvania’s Allegheny County, receives around 200 daily calls, Rozel said.

Only around 10% of calls stem from the National Suicide Prevention Lifeline with the other 90% being from their 1-888-796-8226 number, according to Rozel, who previously served as the president of the American Association for Emergency Psychiatry and was involved in the adoption of 988.

“I was just sort of awestruck that I could sit there on the phone and, over the course of 20 minutes, save lives by saying stuff that was frankly not much more substantive than ‘uh-huh’ and ‘tell me more about that,’” Rozel said.

With the adoption of the new and easier hotline, many call centers around the country are afraid wait times will increase and the efficiency of the crisis hotline will decrease. The Biden administration has invested nearly $105 million into strengthening crisis call center services nationwide in advance of the transition.

“There are staffing shortages everywhere … the great resignation did not spare emergency mental health services,” said Rozel. “Given our small share of calls coming from the hotline, I would say we are prepared for the influx of callers.”

“Is everything in perfect working order for Saturday, though? No, it isn’t.”

Kristen Houser, deputy secretary for the Office of Mental Health and Substance Abuse Services at the state Department of Human Services, said Pennsylvania has received a $3.2 million grant from the federal government to provide additional funding to the state’s 13 call centers and help them with workforce recruitment and retention.

She said the Department of Human Services will not be investing in publicizing the number until after it analyzes the impact word of mouth, social media and advocacy groups have in increasing the number’s visibility.

Critics have raised concerns about the service’s limited location detection features.

According to Rozel, it is “always best to have a local call center reply to local calls, especially when it comes to dispatching mobile teams and understanding local resources.”

States have adopted measures to ensure that calls get transferred to local clinics as often as possible. If all state call centers are busy, the call would be transferred to the national bank of call centers. In 2020, only 66% of Lifeline’s calls in Pennsylvania were answered in-state. The number could be lower in 2022.

The hotline has no geolocation features apart from telephone area codes. A person with an Alaska area code calling from Pennsylvania would be routed to an Alaskan call center. Dr. Rozel said that in such cases, call centers try to build trust with the caller and ask them to share their location and then communicate and coordinate with local centers.

Resolve has received calls “from every state and continent” and around 10% of its calls require mobile teams to arrive on scene. The center also runs a walk-in and residential program for people who need more than 24 hours support. All services are free.

“I encourage people who are looking for a new career and who want to help others to look into incredible opportunities in the field of crisis work … we’d love to meet them and find the right niche and role for them, as would crisis centers across the country,” said Rozel.

Those looking for local job opportunities can search for “crisis services” at careers.upmc.com/ or go to samhsa.gov/find-help/988/jobs for national job opportunities.

“This number and service does save lives,” Houser said. “It is a beacon of hope for many, many people.”