(TNS) — Mental health professionals across Missouri and Kansas are preparing for Saturday’s launch of 988, a 24-hour call and text line they expect will change how mental health crises are handled.
They hope 988, which will replace the 10-digit National Suicide Prevention Lifeline, can help callers more easily access local help at any hour.
“I’m someone who lives with mental illness and so it’s like, ‘Oh my gosh we finally have a resource that we can use,” said Holly Miles, board vice president for the National Alliance on Mental Illness Missouri. “So you’re gonna see this huge flock of people, especially individuals who are in crisis, that finally have this lifeline, this raft, that they can grasp onto.”
HOW IT WORKS
Like 911, the line will be staffed 24/7, with local operators at call centers handling the majority of calls and national entities taking over if those centers become overwhelmed. Anyone can call or text 988 to talk with a trained mental health professional and receive support if they or someone else is in emotional distress, having suicidal thoughts or experiencing other crises.
Six centers will handle calls in Missouri and four will take calls in Kansas. Kansas City callers will be forwarded to a call center at CommCARE in Missouri or the Johnson County Crisis Line in Kansas.
Lauren Moyer, who heads the 988 task force in Missouri, said 90% of callers can be triaged over the phone. The other 10% may need in-person care, which will come through mobile crisis centers and behavioral health crisis centers, an alternative to hospitals and emergency rooms.
Patients can walk in and stay in the behavioral crisis centers for up to 24 hours and are then assigned to a case manager who can help them receive longer term support.
Calls for mental health crisis lines average about 20 minutes, said Tim DeWeese, director of the Johnson County Mental Health Center. Operators are trained to create a repertoire with callers so they can learn what’s going on, connect them to resources and ensure they’ll have follow up care, a key difference that separates 988 from other emergency response.
“We’ll develop a plan with them as far as next steps and that may be to come out to the mental health center, that may be to have the mental health center reach out to them the following day or that night, if we need to,” he said. “Whatever is needed to help that person manage that crisis situation, that’s what we’re going to try to do.”
MEETING THE INCREASED NEED
With a shorter and easier number to remember, call centers are expected to see a rise in calls. But mental health professionals in Missouri and Kansas said they felt ready to meet that challenge.
When 988 was first announced, Michelle Watson, the director of call center services at CommCARE, said the center had wanted to increase staffing, but didn’t have the money or resources. Grants allowed CommCARE to increase its call staff to have at least one more operator per shift, Watson said. On average, that means three to four people will answer calls each shift compared to two to three operators that worked a shift before staffing increases.
CommCARE and other call centers have combated staffing challenges by opening up more part-time positions. Some jobs in Kansas and Missouri have also been opened up to bachelor’s level candidates or professionals working toward their license, rather than requiring a master’s degree or completed license.
The hiring increases will help meet the expected influx of callers, said Moyer. Missouri received just over 40,000 National Suicide Prevention Lifeline calls in 2020. That number is estimated to increase six times to more than 250,000 callers a year once the number goes live and a national media campaign advertising 988 goes out around December, she said.
Moyer said call center response rates have improved across the state’s six call centers in preparation. When the task force formed in July 2021, she said the state had around a 40% in-state call answer rate with just two call centers. The in-state answer rate has risen to around 85%, just five percentage points shy of the national goal for 988 call centers by next July, Moyer said.
Early state funding, grants and staffing increases helped Missouri call centers make improvements, while some states haven’t begun discussions for funding, she said. Making those plans in advance also meant that call center staff could make it through the training process in time for 988 to launch.
The hiring focus now is on mobile crisis centers, which Moyer hopes to have fully staffed by late October, as well as behavioral crisis centers. The state currently has nine open behavioral crisis centers and expects to have 15 by the start of 2023.
“Our work isn’t over, but I do feel like we’re in a strong position to pretty much provide well-supported crisis services,” Moyer said.
Kansas mental health facilities have seen similar improvements, according to Monica Kurz, director of the Kansas Suicide Prevention HQ. Kurz said with funding from the Kansas Legislature in the past two years, including $10 million recently approved for the call line, the state has seen its in-state response rates increase from 60% to over 80%.
She said call centers have increased their staffing and should meet the goal of having enough people to answer phones when 988 goes live. At her center, KSPHQ, Kurz said there are currently around 80 staffers and volunteers, more than at any time since she started in 2005.
DIVERTING FROM 911
Experts also hope a standardized number will help people in crisis get in touch with mental health professionals rather than law enforcement when they call 911.
Sometimes those interactions end in tragedy, said Sherrie Vaughn, executive director of the National Alliance on Mental Illness Kansas. One in four people killed by police have a severe and untreated mental illness, and people with untreated mental illness are 16 times more likely to be killed by law enforcement, according to a report by the Treatment Advocacy Center.
Oftentimes, Vaughn said, people call police for help, but officers don’t have the training or resources available to properly assist them. That’s also why she said about two million people experiencing a behavioral health crisis are booked into jails across the country each year, according to a 2020 report from the National Association of State Mental Health Program Directors.
By implementing 988 and other mental health resources, Vaughn said those numbers will drop.
“I believe that,” she said, “because people are going to get the help they need early, and they’re going to get the best care possible and they’re going to get diverted from the justice system as a result of that.”
The standardized number will also help send people in crisis to behavioral health centers rather than hospital emergency rooms where they’ll likely wait longer for care from people with less training in mental health, said Dr. Greg Nawalanic, a clinical psychologist with the University of Kansas Health System.
Diverting mental health-related calls will take pressure off of emergency room personnel as well as 911 operators and law enforcement officers, Nawalanic said.
“If you go to an emergency department, you’re going to get a very well-intended, likely psychiatrically trained nurse,” he said, “but you’re not going to get a qualified, licensed mental health professional until likely the next day.”
ROOM TO GROW
While mental health professionals and activists agree that 988 is a much-needed resource, they also know there will be room for improvement after the crisis line goes into effect.
Both Moyer and Kurz said staffing and resources will need to be increased at mobile crisis centers and behavioral crisis centers. Moyer is also working to create a centralized database that shows availability at centers across Missouri.
Vaughn said she hopes mental health resources and call centers will continue to receive funding from states. One way to create consistent funding, she said, is to add a monthly fee to cellphone bills, like the fees required to fund 911.
She also thinks more attention can be placed on existing programs in Kansas, some through NAMI Kansas, that look to decrease the number of people with mental illness who end up in jails. She hopes to see more resources like mental health courts across the state.
If 988 operators can help connect people to these programs and resources in addition to mental health clinics and behavioral centers, they should also be expanded across the state, Vaughn said.
“Part of 988 is to connect them with those local resources, those community-based services that can come alongside and help them along with the community mental health centers,” Vaughn said. “It takes everybody to come alongside and help.”
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