June 21, 2022

Some states aren’t ready for the launch of the mental health crisis line, 988


Article origination Side Effects Public Media
Barbara Wheatley takes phone calls as part of the National Suicide Prevention Lifeline Network. Wheatley is an alcohol and substance abuse counselor and the lead clinician for mobile crisis response for Memorial Behavioral Health in Springfield, Illinois. - Photo by Bobbi Wiseman / Memorial Health

Barbara Wheatley takes phone calls as part of the National Suicide Prevention Lifeline Network. Wheatley is an alcohol and substance abuse counselor and the lead clinician for mobile crisis response for Memorial Behavioral Health in Springfield, Illinois.

Photo by Bobbi Wiseman / Memorial Health

If you or someone you know is struggling with suicidal thoughts, help is available. Contact the National Suicide Prevention Hotline at 800-273-8255 or the Crisis Text Line by texting HOME to 741741.

Updated June 16 at 2 p.m.

Staff at Memorial Behavioral Health in Springfield, Illinois, are on call around the clock to talk with people struggling with suicidal thoughts, drug addiction or other mental health crises. They provide a listening ear and help connect people to resources or crisis support, if needed.

Until recently, the hospital’s call center was operated 24/7 by on-call nurses and other clinical staff. But at times when everyone was tied up with patients, calls would go unanswered, bumping the caller to the nearest available call center.

“Staff would answer the phone 24/7, but if they were busy with intakes or with residents … then they wouldn't be available to take the call,” said Diana Knaebe, president and system administrator of Memorial Behavioral Health.

Across the state, Illinois-based call centers answered just 1 in 5 in-state calls to the lifeline in the first three months of 2022. The other 80 percent were redirected to other states. Illinois has the lowest in-state answer rate in the nation, lagging far behind others. The state with the second-lowest rate, Texas, answered 40 percent of its calls during that same time period.

Letting so many calls go unanswered wasn’t ideal, but without state or federal support, Knaebe said it was the best they could do.

The center has since received federal funding to beef up their call center. It’s part of the rollout of a new national mental health crisis number, 988, that proponents hope will make it easier for more people to connect with the National Suicide Prevention Lifeline for help starting July 16.

Knaebe said the new funding enabled Memorial to switch to staffing the crisis line with dedicated employees instead of on-call hospital staff. Even though they’ve still got several open positions they’re trying to fill, she said they’ve already seen big improvements in their answer rate.

“In the first month where we did that we were able to answer 80 percent of the calls versus 20 percent in previous months,” Knaebe said.

Following national trends, 3 in 10 people in Illinois reported feeling anxious and depressed late last year, according to a survey conducted by the U.S. Census Bureau and analyzed by the Kaiser Family Foundation. Among these adults, 23 percent did not receive counseling or therapy.

Prior to the pandemic, 15 percent of adolescents and 7 percent of adults in Illinois, and nationwide, reported having had a major depressive episode in the past year.

 

How underinvestment hinders the rollout

Preparations for the rollout of 988 are in full swing across the country, yet call centers are scrambling to hire people by mid-July, and some states have a lot of catching up to do. A study by the RAND corporation released earlier this month interviewed 180 behavioral health program directors and found half had not been involved in any planning related to 988. A vast majority of respondents reported they had not helped develop a budget to support 988.

In Illinois, underinvestment has plagued call centers for years. During the first three months of 2022, a quarter of callers – about 5,500 calls – dropped off before anyone answered.

An analysis of Suicide Prevention Lifeline data reveals that nationwide during the same time period, 18 percent of all calls were abandoned before the caller got help. States including Minnesota, Alabama and Georgia join Illinois in having above-average rates of abandoned calls.

The new crisis line is expected to send call volume soaring, and that means states like Illinois have a tough hill to climb, said Andy Wade, executive director of the Illinois chapter of the National Alliance on Mental Illness.

“You're building on the platform of the suicide prevention line, which is a logical starting point,” Wade said. “But that's been under-resourced in Illinois for so long that just ramping that up alone is far from sufficient.”

While other states dedicated funding to the lifeline, Illinois hasn’t followed suit, leaving call centers to rely on private donors and grant funding.

It matters because the National Suicide Prevention Lifeline automatically directs calls to the nearest call centers, and if no one answers, people may wait on hold while they’re transferred to a different call center, said NAMI’s Chicago Director of Policy Rachel Bhagwat.

“And that's really concerning for mental health advocates. I mean, when you're talking about somebody who is in crisis or considering suicide,” she said.

Bhagwat also worries people staffing call centers in other states aren’t familiar with local resources.

If someone in Illinois ends up getting connected with a crisis counselor in Missouri or some other state, “how would that person … really be able to understand what the crisis system or mental health infrastructure looks like locally?” Bhagwat said.

Call centers rush to increase capacity

With only a few weeks until the national 988 rollout, Illinois-based call centers are trying to ramp up call center capacity as quickly as possible. A center in Bloomington, Illinois, which has contracted with the state to handle a majority of calls to the lifeline, has hired over 100 employees.

But call centers across the state still have many openings available, according to a listing of 988 jobs compiled by the U.S. Substance Abuse and Mental Health Services Administration. Open positions include both crisis counselors and staff for mobile crisis response units, which dispatch mental health professionals and paramedics instead of police to help people in crisis.

More than 129 million people in the U.S. live in an area that lacks enough psychiatrists to appropriately cover the population. And the concern goes beyond psychiatrists. It can take months to get an appointment with a counselor or therapist. For people who need more intensive interventions, there’s often no available placements in mental health facilities. So mental health experts say the need for increased capacity goes far beyond call center staffing to also include crisis response teams and long-term treatment options.

Federal funding to help scale up staffing at call centers includes $282 million from the American Rescue Plan, though only $105 million is specifically dedicated to hiring at local crisis call centers across the country.

But some worry about sustainability: Much of the funding dedicated so far is short-term and will expire in a few years.

Mental health advocates in Illinois say they’d like to see the state step up and invest more in 988 preparations, and they need lawmakers to appropriate a consistent, long-term funding source. But so far that hasn’t happened.

To help with hiring, Memorial Behavioral Health in Illinois has negotiated sign-on bonuses and offered to hire people who are still in the process of working toward their degree or certification.

“The state really didn't invest in the call center piece at all,” said Knaebe, who used to lead the Illinois Department of Human Services Division of Mental Health. “It was all done by the individual providers, feeling that they wanted to be a part of it. That's why we kind of did it makeshift.”

Side Effects reached out to the Illinois Department of Human Services for comment on 988 preparations, but the agency did not respond. After this story was published, spokeswoman Marisa Kollias said in an email that the state has distributed nearly $4.5 million in federal funding to be used by call centers over the next two years. Additional state funding from cannabis tax revenue and other federal sources results in about $7.5 million in annual spending on call centers. In addition, the state has a “$71 million obligation for crisis care continuum, which includes support of mobile crisis response.”

Kollias also explained the reason for the current low in-state answer rate is “because the majority of our counties do not have a primary call center covering them.” Only 37 of Illinois’ 102 counties have a call center contracted with the Lifeline to respond to calls within the state.

“We have been working on a remedy for this since last fall, and have funded PATH, Inc., in Bloomington, to establish a statewide call center in advance of the 988 roll out,” Kollias said. “They are currently in the process of establishing primary coverage responsibility for all counties that don’t have it, as well as back-up coverage for counties that do have a primary call center, with the goal of improving to a 90% in-state response rate within the first year of operation.”

Clarification: This story has been updated to include information provided by the Illinois Department of Human Services after publication. A previous version of this story stated “Federal funding to help scale up staffing at local call centers includes $282 million from the American Rescue Plan.” That was incorrect. While $282 million has been made available to support 988 efforts nationwide, only $105 million is specifically dedicated to hiring at local crisis call centers.

This story comes from Side Effects Public Media — a public health news initiative based at WFYI. Follow Carter on Twitter: @carter_barrett.

Side Effects is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering challenges and solutions to accessing mental health care in the U.S., with a focus on Arizona, California, Georgia, Illinois, Pennsylvania and Texas. Partners on this project include The Carter Center and The Center for Public Integrity.

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