Some states are struggling to prepare for calls to the 988 mental health crisis line


Staff at Memorial Behavioral Health in Springfield, Illinois are available around the clock to speak to people struggling with suicidal thoughts, addiction, or other mental health crises.

They offer a listening ear and help connect people to resources or crisis support, if needed.

Until recently, the hospital’s call center was managed by nurses on call and other clinical staff. But at times when everyone was tied to the patients, calls went unanswered, diverting the caller to the nearest available call center, often in another state or a national rescue center.

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

Statewide, Illinois-based call centers responded only 1 in 5 calls in the state to the lifeline in the first three months of 2022. The remaining 80% were redirected to other states. Illinois has the lowest response rate in the country, far behind the others. The state with the second-lowest rate, Texas, answered 40% of its calls during the same period.

Leaving so many calls 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 strengthen their call center. It’s part of the rollout of a new national mental health crisis number, 988, which promoters say will make it easier to connect more people with the National Suicide Prevention Lifeline when it launches on July 16.

Knaebe said the new funding allowed Memorial to transition to staffing the crisis line with dedicated employees instead of on-call hospital staff. Although they still have several vacancies they are trying to fill, she said they have already seen big improvements in their response rate.

“In [April] where we did that, we were able to answer 80% of calls compared to 20% in previous months,” Knaebe said.

According to national trends, 3 in 10 adults in Illinois reported feeling anxious and depressed at the end of last year, according to a survey conducted by the US Census Bureau and analyzed by the Kaiser Family Foundation. Of this group, 24% did not receive counseling or therapy.

Before the pandemic, 17% of adolescents and 8% of adults in Illinois had a major depressive episode Last year. Nationally, this percentage was 16% and 8%, respectively.

How Underinvestment Hinders Deployment

Preparations for the deployment of 988 are in full swing across the country, but call centers are scramble to hire people by mid-July, and some states have a lot of catching up to do. A study of RAND Company published earlier this month surveyed 180 behavioral health program directors and found that half had not been involved in any planning related to 988. A large majority of respondents said they had not helped develop a budget to support the lifeline.

In Illinois, underinvestment has plagued call centers for years. In the first three months of 2022, a quarter of callers — approximately 5,500 calls – filed before anyone answered.

The new crisis line should send call volume skyrocketand 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 place to start,” Wade said. “But it’s been underfunded in Illinois for so long that just increasing that alone is nowhere near enough.”

While other states have committed funds to the lifeline, Illinois has not followed suit, leaving call centers to rely on private donors and grants.

It’s important because the National Suicide Prevention Lifeline automatically directs calls to the nearest call centers, and if no one answers, people can wait on hold while being transferred, said Rachel Bhagwat, director of policy at NAMI in Chicago.

“And that’s really concerning for mental health advocates. I mean, when you’re talking about someone who’s in crisis or contemplating suicide,” she said.

Bhagwat is also concerned that call center employees in other states are unaware of local resources.

If someone in Illinois ends up being put in touch with a crisis counselor from Missouri or another state, “How could that person… really understand what the crisis system is like or the mental health infrastructure locally? said Bhagwat.

John Draper, head of the National Suicide Prevention Lifeline, agrees that calls are ideally answered in the state. But he specifies that the national center is ready to manage the overflows.

“I can’t promise no one will wait at all,” Draper said. “I can definitely say that if you hang in there you’ll get an answer and you’ll get an answer from a counselor who cares about your situation.”

Draper says that while preparation for 988 varies by state, he is encouraged by the progress.

Call centers rush to increase capacity

With 988 nationally rolling out just weeks away, 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 the majority of lifeline calls, has hired more than 100 staff.

But call centers across the country still have plenty of openings available, according to a list of 988 jobs compiled by the US Substance Abuse and Mental Health Services Administration. Vacancies include both crisis advisers and mobile response unit staff, who distribute mental health professionals and paramedics instead of the police to help people in crisis.

More … than 129 million in the United States, people live in an area where there are not enough psychiatrists to adequately 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 is often no placement available in mental health facilities. So mental health experts say addressing mental health needs must go far beyond call center staffing to also include longer-term treatment options.

Federal funding to help increase call center staffing includes $282 million of the US bailout, although only $105 million is specifically dedicated to this hiring.

But some worry about sustainability: much of the funding provided so far will expire in a few years.

Mental health advocates in Illinois say they would like to see the state step up and invest more in preparations for 988, and they need lawmakers to take ownership of a consistent, long-term funding The source. But so far this has not happened.

To help with hiring, Memorial Behavioral Health negotiated hiring bonuses and offered to hire people who are still in the process of getting their degree or certification.

“The state really hasn’t invested in the call center at all,” said Knaebe, who headed the mental health division of the Illinois Department of Human Services. “Everything was done by the individual vendors, feeling they wanted to be part of it. That’s why we did it on the fly.”

Illinois Department of Social Services 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 in the over the next two years. Additional state funding from cannabis tax revenues and other federal sources results in approximately $7.5 million in annual expenditures for call centers. Additionally, the state has a “$71 million obligation for the continuum of crisis care, which includes mobile crisis response support.”

Kollias also explained that the reason for the current low response rate in the state is “because the majority of our counties do not have a primary call center that covers them.” Only 37 of Illinois’ 102 counties have a call center under contract with Lifeline to answer calls in the state. The goal is to have a 90% response rate in the state within the first year of operation.

If you or someone you know is considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (Spanish: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or Crisis text line by texting HOME to 741741.


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