It’s expected to be an improvement over the current National Suicide Prevention Lifeline. With fewer numbers to remember and dial in an acute crisis, it will efficiently transfer people directly to the Lifeline, ideally to an in-state call center that provides immediate counseling and, if needed, later in-person assistance.
The program comes at a vital time, for COVID-19’s mental health effects will persist far beyond the transition to the new post-pandemic normal. Many overwhelmed mental health providers aren’t accepting new patients, so for some individuals experiencing a crisis, picking up a phone and calling anonymously to an expert-staffed confidential helpline can be a literal lifesaver. With lines open 24/7, people can make contact whenever they need to, though, as the New York Times has documented, mushrooming demand may lead to slower responses.
For 988 to succeed, it will need more than adequate call center staffing to handle an expected surge in calls above Lifeline’s current 2 million a year. It needs to ensure access to, equity in, and quality of care. And policymakers must increase the number of counselors and therapists as the stigma surrounding mental health issues wanes, reducing constraints on seeking help.
NYC Well, New York City’s mental health crisis program, is a model for doing it right. Abt Associates’ 2020 evaluation of the service found that its call center staffers speak more than 200 languages, in recognition of the city’s ethnic diversity. The staff includes trained counselors plus some with lived experience. Callers can ask to speak to someone who has been there, knows what the caller is going through, and can empathize and help. Their ability to think through their experience together to decide how to address issues is invaluable.
NYC Well also diverted callers from hospital emergency departments and 911, as 988 is intended to do. Twenty percent of people calling for themselves (primary users) and 38 percent of people calling for others said they might have used other emergency services if NYC Well didn’t exist.
Unfortunately, many communities don’t have nearly enough mental health treatment providers. On average, only 28 percent of mental health needs are met. Fortunately, however, policymakers are thinking creatively about ways to increase capacity. A Health Resources and Services Administration apprenticeship and paraprofessional program, for example, aims to increase the supply of students preparing to become behavioral health providers while improving the distribution of such staff across the country. A yearlong apprenticeship can help fill the gap more quickly than can universities that offer a four-year undergrad degree or seven-year Ph.D.
In addition, more states need to adopt waivers that enable providers to offer services, including telemedicine, across state lines. Currently, only 21 states have them.
For 988 to succeed, it also needs to have a communications rollout to reach people most in need where they are, from barber shops to grocery stores. And both the program and the communications strategy require evaluations to determine what’s working, what’s not, and why.
There’s no question that these types of programs can be effective. Roughly two-thirds of NYC Well survey participants reported that their contact with the helpline helped a lot, and nearly 90 percent said it helped at least a little. More than 90 percent reported they were “very” or “somewhat satisfied” with NYC Well services, and 75 percent said they would recommend NYC Well to others.
That’s not all. Primary users’ self-reported psychological distress levels improved during the six months between their initial contact and their later report, an important finding. The percentage of primary users who reported feeling hopeless, depressed, or having serious psychological distress in the previous 30 days dropped 30 percent or more. Assessing longer-term results would be important for 988 because mental health is an issue that people may need to manage for years or decades.
The pandemic has affected the mental health of a generation of students, to say nothing of their parents and grandparents. The 988 service could well be an important first step in improving the lives of those struggling with mental health issues.
Alicia Sparks is a senior associate at Abt Associates specializing in behavioral health.
Governing’s opinion columns reflect the views of their authors and not necessarily those of Governing’s editors or management.
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