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3-digit mental health crisis number goes live next week, but experts say gaps remain
The phone number for the National Suicide Prevention Lifeline will be cut to three digits — 988 — starting July 16, an important step in making mental health care more accessible but one that highlights gaps in rural areas, Iowa experts say.
“It’s a big deal, and the reason it’s a big deal is because it’s an opportunity for someone to call a three-digit number and get immediate help from a trained professional who can provide crisis response via the phone or text, which does not happen when you call 911,” said Peggy Huppert, executive director of the National Alliance of Mental Illness Iowa.
To enable the change to the three-digit number, Iowans with a 319 or 515 area code have to dial all 10 digits when making other calls.
When a person with an Iowa area code calls or texts 988, the phone likely will be answered by someone working at Foundation 2, a Cedar Rapids-based nonprofit, or at CommUnity Crisis Services, an Iowa City-based nonprofit. Both employ legally accredited mental health counselors and have been working with the National Suicide Prevention Lifeline since its inception in the 1970s.
“Ultimately, when you call the line, it’s a direct connection to a compassionate and accessible support to a phone counselor who will work with the individual calling to support them and their needs,” said Drew Martel, director of crisis services for Foundation 2.
The state has set a goal to respond to all 988 calls and texts within 30 seconds, with 90 percent of those responses being from Iowans. If an Iowan is unable to answer the call or text within 30 seconds, it will roll over to a backup center in another part of the country, according to Huppert.
The majority of calls made to the suicide prevention lifeline are able to be resolved over the phone, Martel said, often with referrals or recommendations for further care.
“A lot of the work is the de-escalation on the phone, supporting the person, listening to them, trying to understand what their needs are, and then providing that direct support,” Martel said. “To be honest, some people call and they don't want anything else. They want to talk to a counselor and then they want to go about their day and their life. Other folks want referrals or maybe a service on the continuum of care, like mobile crisis outreach.”
Gaps in service
Sarah Nelson, executive director at CommUnity Crisis Services, said in the cases where someone does need more help than what can be offered over the phone there are options — but it varies from county to county in Iowa.
Most of the counties contract with a mobile crisis outreach team, meaning trained mental health professionals are available to respond in-person. But there are 11 counties without mobile crisis teams — Kossuth, Winnebago, Worth, Adair, Adams, Union, Taylor, Henry, Van Buren, Des Moines and Lee — according to the website of Iowa’s Area Education Agencies.
Seven counties — Linn, Johnson, Black Hawk, Polk, Dallas, Wapello and Clarke — have walk-in mental health access centers, according to Iowa’s Department of Health Services. An access center is a place someone in crisis can go to receive immediate support and services when they don’t need psychiatric hospital treatment.
Ideally, every county in Iowa should have both a mobile crisis team and an access center, according to Huppert.
“I don't know what's going to happen. It's a concern,” she said. “There's a wide variance in practice and procedure, depending on where you live in the state. From my perspective, that's a problem, because it shouldn't matter where you live in the state. If you call 988 and the person you're talking with determines that you need an in-person response, then there should be an in-person response.”
Sometimes law enforcement could respond to 988 lifeline calls, but that is only in cases of immediate danger, according to Nelson.
“It either reaches the level of law enforcement or not … so just because mobile crisis isn’t available does not necessarily mean law enforcement would be appropriate. It just means that, unfortunately, they don’t have that access to in-person counselors coming out,” Nelson said.
Instead, the phone counselor in those cases will recommend other community resources or work with callers to identify their own support systems.
“We talk with them about, what supports do you have? Is there a person that you could reach out to that might be able to come and visit with you this evening? We go through all of the various things that they might have within their support system, as well as the community resources,” Nelson said.
Nelson said she believes Iowa is moving in the right direction with mental health care and hopes in a few years there will be mobile crisis teams in each county with access centers close behind.
“There are a lot of regions that have gotten a mobile crisis team up and running that didn’t have them a year ago. There are a lot of regions that now have an access center or an access hub that didn’t have one a year ago. There has been a lot of work, and so it’s changing and evolving very quickly,” Nelson said.
Staffing and funding
Both CommUnity and Foundation 2 anticipate an increase in calls after the three-digit number goes live.
Martel said in Iowa, the national lifeline has been receiving about 12,000 calls each year. But it could receive up to 71,000 calls between this July and July 2023, according to an estimate by Vibrant, the organization that contracts with the Substance Abuse and Mental Health Services Administration to run the national line.
Vibrant has also estimated a significant increase in texts sent to the lifeline, as well as chats from the national suicide prevention website, because of the increase in marketing and awareness that will come with the 988 rollout, according to Nelson.
Based on this expected increase, CommUnity and Foundation 2 have been working to hire more staff. CommUnity has almost doubled its staff since January, going from 88 employees to 173.
“It’s not just about adding crisis counselors. We have to add supervisors and coordinators and quality assurance folks to make sure that we have that high quality intervention and really robust training,” Nelson said.
Increasing staff costs money, and the new line will include some new and upgraded technology that will need to be funded as well, according to Martel. The federal government supplies a very small amount of funding, and the state government contributes some as well, but it’s not yet clear where the additional money to support the line will come from if calls increase as much as predicted.
“Right now a sustainable funding source hasn’t been identified. That is true in the vast majority of states. I think a piece of anxiety for all of us that do this work is what that will look like,” Martel said.
One of the technological changes that could need funding is adding geolocation capabilities, like those used by 911, Martel said.
Currently calls to the suicide lifeline are directed based on area code, meaning a person living in Iowa who has an area code from another state and calls 988 will likely reach a provider from the other state. But counselors can easily transfer the calls.
To get help
Over the phone: Call The National Suicide Prevention Lifeline at 800-273-8255, or 988 starting July 16.
Online: Visit suicidepreventionlifeline.org
In-person: Go to your nearest mental health access center, found at this link
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