New federal funding also announced for mobile crisis-response teams
Almost a year after the launch of the 988 Suicide and Crisis Lifeline, only 13% of U.S. residents know the line exists and what it’s for – and many of those who do know are afraid that calling it will summon the police, according to a new survey.
Even with the relatively low levels of awareness, the number of calls, on-line chats, and texts to the lifeline each increased considerably in April 2023 compared to the year before and, if this rate of increase continues, is on pace to roughly double the 2.4 million calls received annually from 2017 to 2021.
The 988 service was launched in mid-July 2022 to connect those going through a substance use or mental health crisis with a trained call-taker skilled in handling mental health emergencies. But it also is intended to be the base of a larger project, providing a place to call that, when needed, can summon help in the form of crisis responders other than police who can assist someone in the grips of a mental health emergency.
This second piece – which is now happening only in scattered places for some fraction of emergency calls – got a boost yesterday when the Biden administration awarded $10 million to communities in 13 states to create and expand mobile crisis response teams that work “in coordination with local law enforcement.” In total, the administration has awarded $27 million to 25 communities to support development of crisis systems.
The demand for non-police crisis response units has been building as a result of a string of highly publicized incidents in which mental health-related 911 calls have led to violent, sometimes fatal, police responses to a person in the midst of a psychiatric crisis.
Without models that provide alternative response teams, police are often the only available in-person response to these crisis calls. The new survey by Pew Charitable Trusts shows that fears of what might happen after dialing 988 have made people apprehensive about using the Lifeline.
This week, Mad in America, a mental health news organization that pushes for “rethinking psychiatric care,” reported that growing use of the 988 line is leading to a rise in police interventions, call tracings, and psychiatric detentions.
Public unawareness
The low levels of public awareness about the 988 line is largely a reflection of a slow ramp-up of publicity campaigns about it, said Hannah Wesolowski, chief advocacy officer for NAMI, the National Alliance on Mental Illness.
She said part of the delay in spreading public awareness has been intentional – a way to give states and communities time to build out their continuum of care and the services that extend beyond calling a hotline. Once advertising of 988 services begins, people start asking what kind of response they can expect when they call, she said.
“It takes time to develop trust because if you’re calling, texting, or chatting 988 – and you need more help than can be provided over the phone – people have an expectation that that’s available already,” Wesolowski said. “We know in many communities that’s not available so in some areas of the country mental health authorities are purposely not promoting 988.”
The Pew researchers surveyed 5,000 people across the country to gain insights into public awareness and perceptions of the 988 line. They found that those with the greatest awareness about 988 were white, wealthier and more educated.
The more people know about 988 and what it’s for, the more they’ll call it
Tracy Velázquez, pew charitable trusts
Sixteen percent of white, non-Hispanic adults knew of the number and its purpose, compared to just 7% of Black, non-Hispanic adults surveyed and 9% of Hispanic adults surveyed. The people most likely to know about the hotline were those who had been diagnosed with a mental health issue and those who identify as LGBTQ+, according to the survey.
Even among those who had heard of the Lifeline, a fourth of them were unsure when they should contact the service, according to the survey. After being provided information explaining 988, about one in four respondents expressed fear they would end up in jail after calling 988, according to the study.
“Obviously the more people know about 988 and know what it’s for and trust it, the more they’ll call it,” Tracy Velázquez, the Pew researcher who led the study, told MindSite News. “There’s a lot of competing information out there, but it takes a long time for people to get used to new things. I think it’s a good place to start from.”
Call centers should partner with local grassroots groups
Organizations operating call centers in cities and states need to be thinking: “How do you reach these groups that we already know have heard less about 988?” Velázquez said. She added that they should look to partner with grassroots organizations and local businesses.
The survey responses show police involvement in response is a “significant consideration” for people in using 988, Wesolowski said.
“I think it’s a valid concern that a lot of people have,” she said. “We want to make sure law enforcement is not the default response. But if you call 911 that’s what you’re going to get. So 988 does provide that alternative option of over the phone or text intervention.”
The LGBTQ+ community, in particular, voiced concerns that law enforcement would be sent, that they may be forced to go to a hospital, or that the person responding might not be able to handle the issue they were contacted about, Velázquez said.
“While that community has sought higher awareness of 988, they also had somewhat higher concerns,” she said, adding the service has rolled out a 24/7 chat service specialized for LGBTQ+ youth and young adults. “Hopefully, this pilot will continue to push forward this idea that folks need to know that the person they’re talking to is going to be non judgmental and understand their situation.”
When 988 Turns to 911
According to SAMHSA, the federal Substance Abuse and Mental Health Services Administration, about 2% of 988 calls are transferred to 911 and lead to emergency services being dispatched. This occurs, according to SAMHSA spokeswoman Dani Bennett, only “in cases where the risk of harm to self or others is imminent or in progress.”
Mad in America’s article takes that 2%, applies it to the increased rates of call, and concludes that “a staggering 81,000 Americans who’ve reached out to 988 for confidential conversations have ended up being coercively taken to psychiatric hospitals.”
While many of those people may have been taken to emergency hospitals, crisis stabilization centers or even jails, there is no national data on what occurs when 911 is looped in and emergency services are summoned. But the relative lack of mobile crisis units means that most of those calls are likely to be handled by law enforcement or emergency medical teams.
SAMHSA’s Bennett says that more than half of emergency dispatches occur with the caller’s consent. “We recognize that, for some individuals, having contact with emergency services can be traumatic and dangerous, and therefore it is only used when other interventions cannot be used,” she said.
The Mad in America article also raises the issue of people who call 988 for confidential assistance being subjected to geo-location technology. Bennett says the 988 system does not have geo-location capability and that technology – which can identify the precise location of a caller – only occurs for the 2% of calls that are transferred to 911.
Lifeline counselors work with those contacting the Lifeline on the least invasive safety plan using the mental health resources available including mobile crisis teams, community centers, and family and friends, she said.
Wesolowski said the availability of non-police mobile crisis teams is still limited and she hopes their numbers will increase. But that, she said, will take significantly more investment and commitments by both government and private insurers to provide coverage of mobile crisis response.
“There needs to be a standard set so we can improve insurance coverage so they’re paying for these healthcare interventions for individuals just as they would pay for an ambulance, hospital stay, or urgent care visit,” she said. “Right now, there’s a significant burden on the government to fund it.”
So far, five states have been approved to fund mobile crisis care through their state Medicaid program: Wisconsin, Ohio, North Carolina, Arizona, and Oregon. In addition, 20 states have been awarded $15 million in planning grants to develop mobile crisis-care efforts through their state Medicaid program.
