Christy Daugherty remembers the announcement like it was yesterday.
March 11, 2021 marks one year since the World Health Organization declared novel coronavirus disease (COVID-19) a global pandemic, and in the past 12 months, no new cases have been identified by the Centers for Disease Control and Prevention. Published data showed significant reductions in previous mental illness, overdose mortality, and mortality. Suicides soared. In a frightening trend, the government has decided to take action.
The National Suicide Prevention Lifeline was being revamped.
As part of the revamp, 10-digit phone numbers have been simplified to a simple 9-8-8. The lifeline now includes a comprehensive mental health service beyond suicide prevention, plus a text messaging service.
The program was supported with $200 million in funding through the Biden administration’s American Rescue Plan.
Daugherty said he is excited about the development as CEO of El Paso’s Emergence Health Network, which provides behavioral health, crisis response and other services to approximately 30,000 Texans annually. rice field.
But then political pressure reached a boiling point and the launch schedule was pushed forward by half a year, Daugherty told ABC News. Faced with tight budgets and tight deadlines, EHN spent months ramping up staff, she said, not seeing a penny of federal aid flowing out of Austin. The Texas Department of Health and Human Services did not respond to ABC News’ request for comment on Daugherty’s allegations.
She’s not the only one who’s frustrated.
In several key ways, 988 strengthened America’s mental health system, which the Department of Health and Human Services itself called “for years underfunded and underresourced.”
Since opening in July 2022, the new hotline has responded to more than 2 million calls from people in crisis. Data from the organization’s appointed Vibrant Emotional Health showed that there were 45 percent more hotlines than the 10-figure hotline in the same period last year. The federal government oversees this route.
Vibrant says the hotline has also responded to over a million chats and text messages. The average wait time he reduced from 3 minutes to less than 1 minute. In addition, 988 has rolled out line variations dedicated to caring for at-risk groups, including veterans, Spanish-speaking people and LGBTQI+ youth.
Outcome data for emergency response, outpatient psychiatric referrals, or inpatient stabilization services are not readily available, Vibrant said. But Tia Doll, the organization’s 988 chief executive, said the service has helped many people who could not ask for help elsewhere.
According to the CDC, one American will die by suicide every 11 minutes in 2021, with more than 12 million suicidal thoughts, making it the second leading cause of death for most adolescents and young adults. More than 100,000 more Americans died from drug overdoses, according to data from the National Institutes of Health.
But nearly a year after the rollout of the Crisis Line, and nearly $1 billion in federal investment, the majority of states still struggle to ensure that their residents’ calls are answered locally. .
Unanswered calls are carried over to national backup centers, but federal officials acknowledge that these centers are generally less equipped to provide the local services callers need. increase. In total, states missed more than 11,000 calls in April 2023 alone, the most recent month for which public data is available, according to Vibrant. And in April 2023, only 15 states met that goal, despite federal funding mandating a 90% or higher response rate by June 2022. With a 75% call response rate, Texas ranked as one of the worst performing regions.
“This thing we’re doing has never been done before,” Dole told ABC News. “Perfect? No”
Widespread talent shortage
Many of these shortcomings can be related to the particularly thorny challenge of staffing.
Crisis call centers rely on behavioral health workers to answer calls. This workforce includes psychologists, psychiatrists, nurses, social workers, counselors and coaches. Job openings for these types of workers are growing “at a much faster rate than the average for all occupations,” according to the Bureau of Labor Statistics.
For example, the market for mental health counselors is expected to be: outpacing overall employment growth It will increase 4.5 times over the next 10 years.
In 2020, the country needed more than 1 million more behavioral health workers to meet the mental health needs of Americans. according to federal data Collected by the Government Accountability Office. Dole told ABC News that the data doesn’t take into account the pandemic that has hit its workforce hard.
“Regarding crisis response, I don’t think the workforce has recovered since then. [the pandemic]’” Dole told ABC News.
Crisis call centers across the country are struggling to fill staff due to labor shortages. In Rhode Island, 52% of positions were vacant as of May 2023, according to data surveyed by ABC News from state health departments. In Wisconsin, 30% of the positions were vacant. Nearly every state in the country has job vacancies, according to 988 job boards run by the Mental Health Services Authority (SAMHSA).
For Vince Brancaccio, labor shortages are a daily struggle.
Brancaccio, chief executive of Ohio’s Southeast Health Network, one of 988 centers in the state, now spends a good portion of his day finding interested candidates. . Brancaccio told ABC News that instead of working on crisis stabilization or mental health care itself.
For the most part, his recruiting days are frustrating with empty Zoom rooms. Candidates often “don’t show up for interviews,” Brancaccio said. Or, even if hired, “they don’t show up on the first day,” he said. About half of the 988 chairs in his center are empty.
inflexible labor requirements
Another challenge call centers face when it comes to staffing relates to managing remote and in-person work.
Remote work has become the norm in the post-pandemic world, according to one company. 2021 McKinsey Report, especially for computer-based office work such as answering phones. However, many 988 centers like Brancaccio do not offer remote work. More than 70% of the centers are face-to-face only, according to the SAMHSA 988 job page.
Additionally, fewer than 5% of the 988 centers are currently using Vibrant’s new software platform, partly funded by federal funds, to answer calls, Dole said. he told ABC News. According to Dole, many people are still using legacy software that dates back to 2004, when the pre-988 Lifeline was launched, and that software, nearly 20 years later, still adds to the complexity of remote work. Too often we are ill-equipped to deal with it, Dole said.
The move means a brain drain is happening in states with already inadequate behavioral health workers, said Joshua Thomas, chief executive of the Delaware National Psychiatric Alliance, ABC News. told to According to his December 2022 study by the Delaware Department of Health and Social Services: widespread shortages Lack of mental health resources in the state.
Thomas said the lack of flexibility around remote work combined with “significantly lower income potential compared to other regions” meant states like him could compete with other states with greater resources and flexibility. said there was a risk of struggling with
By contrast, states such as Massachusetts, which has pumped $10 million from the Treasury into 988, raised wages and offered hybrid work options, have more than doubled their workforce since the introduction of the hotline, according to analysts. Brant reports. Data compiled by Vibrant showed Massachusetts’ call response rate was 88% in April, just below the SAMHSA response rate of 90%, while Delaware’s was 73%. .
gift wrapping with empty boxes
Daugherty worries that the accelerated rollout was short-sighted. The rush to announce the 988, the ensuing scramble to enter service, and the accompanying struggle may have undermined confidence in the line in the long run.
“The number 988 is not just a number, it is a message that we are there for you,” said Health Minister Xavier Becerra when the hotline opened. Eleven months later, as the center struggles to staff, Mr. Daugherty compared the promise to gift-wrapping an empty box.
SAMHSA 988 Director Monica Johnson acknowledged the pain associated with the hotline’s growth to date. But Johnson also cites the hotline’s progress so far — more than 3 million contacts answered, waiting times reduced, and almost $1 billion invested — as a sign that things are going in the right direction. ) pointed out.
“I’m thinking about what month this first year falls into—[and] “So far, the answer has proven to be yes,” Johnson told ABC News.
Still, for people like Molly Jacobson, growing pains are a matter of life and death.
Jacobson, from Florida, said he made the call in October 2022 on behalf of a loved one in crisis. Her relatives had attempted suicide before, and she was worried they might try to kill her again. But she said she called 988 and she was immediately put on hold.
When she finally spoke to someone after a series of triage questions, the operator seemed to give up, she said. “‘Sorry, I don’t know what I can offer,'” Jacobson recalls telling her.
Jacobson said he didn’t know where else to turn.
She said, “Hundreds of millions of dollars are being invested in… where is it going?”
Jacobson’s experience highlights some of the challenges Florida has had in the past. Florida received more than 10,000 calls in April, but only 73% of them were answered, making Florida one of the worst performing states. The Florida Department of Children and Families, which oversees the administration of 988 hotlines in the state, did not respond to ABC News’ request for comment on Jacobson’s case.
Jacobson said despite the bad experience on the line, his loved ones made it through. But she worries about what will happen next, or what will happen to others in a similar situation.
“When all of us are in our darkest times, all we need is to be heard,” Jacobson said.
There are some challenges with staffing, but if you or a loved one is struggling with a mental health crisis or are considering suicide, call or text 988.
ABC News examines the challenges and successes in implementing the 988 Suicide and Crisis Lifeline. If you have any problems or successes with the line, please contact us here.
Michal Ruprecht, member of the ABC News medical unit, contributed to the report.
