One year, 4 million conversations: the 988 suicide & crisis helpline

July 24, 2023

By Don Sapatkin

In other mental health news: Younger people may be driving a surge in texts to the 988 crisis lifeline. State-run psychiatric hospitals can cost a bundle, and the collection agency can be the attorney general. How do you treat loneliness? Teens’ mental health may actually have improved early in the pandemic (before getting worse). And legalizing recreational pot is linked to a decline in mental health treatment admissions.

---

One year on, calls to the 988 suicide and crisis hotline are up — and texts for help are up far more

The revamped 988 Suicide & Crisis Lifeline is one year old this week – a good time for status reports. Before its revamp, teens largely ignored it. Now they’re reaching out in droves – not so much by phone but by text, the Washington Post reports. Answered texts were up 938% in May 2023, compared with May 2022, two months before the expanded service launched, while calls increased by 45% and chats by 52%, according to federal data. The average time to answer across all contacts decreased from 140 seconds to 35 seconds.

Still, progress on the unwieldy network of local call centers has been slow. The addition of Spanish-language text and chat services, a full year after the lifeline went live, was the big news touted by a government press release It was also publicized in a brief statement by HHS Secretary Xavier Becerra, who said that “988 is more than just a number — it’s a person to listen, a person to care.”

A Kaiser Family Foundation issue brief highlighted performance differences among states, which oversee and fund most local call centers. Answer rates ranged widely, from 55% in Alabama to 98% in Mississippi (14 states had answer rates of 90% or higher), which the analysis said may reflect differences in states’ investments in crisis services and whether their funding is ongoing.

“Especially in some states without long-term funding strategies, it is unclear whether local Lifeline call centers can maintain their pace as federal funding decreases and demand increases,” the brief said. It noted that much better state and federal metrics are needed for policymakers and researchers to evaluate 988’s effectiveness, identify problems and propose solutions.

---

State AGs intervene on unpaid surprise medical bills – on the hospitals’ side

Bridget Narsh had tried for years to find affordable preventive care near her Chapel Hill,  North Carolina, home for her teenage son, Mason, who has autism and ADHD. The need became urgent when he started destroying furniture and running away from home, causing her to worry for his safety and that of the rest of the family.

When she was offered a bed at Central Regional Hospital, a state-run mental health facility at a discounted rate of $60 a day – instead of the standard $1,338, which the family could not afford – her husband signed a contract. Mason, now 17, ultimately stayed more than 100 days over two stays in 2020. Bills for $101,546 – 15 times the $6,700 the Narshes expected to pay under their agreement with the hospital – began arriving from the state attorney general’s office the following year.

Attorneys general are charged with contradictory roles: protecting consumers from harmful debt collection services while also serving taxpayers’ interests and funding services. Across the nation, KFF Health News reported, “states seize money or assets, file lawsuits, or take other steps to collect debts from people who stay at state-run hospitals and other institutions, and their efforts can disproportionately affect racial and ethnic minorities and the poor.

The Narshes contacted an attorney, who negotiated with the state to allow the family to pay $100 a month in exchange for a 96% reduction in the total charges, although in the event of a default the family would be obligated to pay the full amount. Bridget Narsh told the news service that the experience was particularly frustrating because she had tried so hard over the years to find behavioral health care services for her son – a shortage acknowledged in a state report last year that proposed a “coordinated effort” to improve services.

---

“If loneliness is an epidemic, how do you treat it?”

“Given its myriad health consequences, some experts argue it’s time to consider new remedies,” journalists Eleanor Cummins and Andrew Zaleski write in a guest essay for the New York Times. They don’t mean a pill, although a growing body of research has found that loneliness is, in large part, a biological phenomenon: The same brain signals that should cause someone to seek social connection can, in different situations, “turn people defensive and vigilant – more apt to hunker down instead of reach out.”

“Under this rubric,” they write, “loneliness isn’t simply a symptom of societal failure to foster deep relationships but rather a wariness that takes root, steadily snowballs and reshapes the brain. Loneliness may be a communal problem, but healing begins with the individual.” This is a lot to take in, and it’s not clear what the medical system can or should do about what Surgeon General Vivek Murthy declared an “epidemic of loneliness” two months ago.

Even someone surrounded by people on a dance floor can be lonely, the authors say. While health care providers, friends, family and communities all have a role in treating loneliness, experts they quote say the individual has the most power. “It’s a choice to remain lonely or not lonely,” says Stephanie Cacioppo, a behavioral neuroscientist who was devastated by the loss of her husband and went on to research and write about her experience in a memoir “Wired for Love: A Neuroscientist’s Journey Through Romance, Loss, and the Essence of Human Connection.” The Times writers’ translation: “Loneliness doesn’t have to be a permanent state. With the right support and a lot of determination, the brain can learn to connect again.”

---

In other news…

Both youth suicide deaths and ER mental health visits dropped early in the pandemic. Most reports on COVID’s impact on young people’s mental health have   emphasized that it significantly worsened. But two new studies describe an important nuance: Emergency department visits and hospitalizations for suicide attempts or ideation had been rising for years among youths 10 to 18 but declined significantly in spring 2020, when the pandemic began and schools closed, Forbes reported, resuming their rise the following year. Youth suicide rates typically go down during summer vacation, and the authors of a JAMA Network Open study speculated that having less stress at home than in school might have played a role in the spring decrease, especially among children and adolescents.

An unrelated study found that mental health-related emergency department visits declined 17% during the first 12 months of the pandemic among children 5 to 17 who had at least one previous visit in the same period the year before the pandemic, according to a press release from the National Institute of Mental Health. Visits during COVID’s second 12 months then increased 7% above the pre-pandemic baseline, according to the JAMA Psychiatry research article.

Some 19% of employed adults say their workplace is somewhat or very toxic, and that group is more than three times as likely to report having experienced mental health harm at work compared with those who say their workplaces are healthy, according to an American Psychological Association survey focused on work. The APA summarized key findings in a recent press release.

Twelve states were ordered to pause Medicaid terminations for certain beneficiaries and temporarily restore their coverage, CNN reported. The April expiration of a pandemic-era pause on eligibility redeterminations is projected to result in more than 15 million people losing coverage. But the Centers for Medicare and Medicaid Services is concerned that most of the more than 3 million disenrollments to date have been for so-called procedural reasons, meaning that enrollees did not complete the renewal process – often because they didn’t receive the forms or didn’t understand the instructions.

---

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

---