Mental health hotline 988 expands, but rural areas still face care shortages – InForum

The National Suicide Prevention Lifeline’s 988 phone number, launched on July 16, is designed as a global mental health support tool for callers anytime, anywhere.

But the United States is a patchwork of resources dedicated to crisis assistance, so what comes next is not global. The level of support 988 callers receive depends on their zip code.

In particular, rural Americans, who die by suicide at a much higher rate than urban residents, often have difficulty accessing mental health services. While the 988 can connect them to a call center close to home, they may end up being directed to distant resources.

The new system is supposed to give people an alternative to 911, however, callers from rural areas experiencing a mental health crisis may still be interviewed by law enforcement officials, rather than mental health professionals.

More than 150 million people in the United States—most of them from rural or partly rural communities—live in places identified as areas of mental health professional deficiency by the Federal Health Resources and Services Administration. This means that their communities do not have enough mental health providers – usually psychiatrists – to serve the population.

The Biden administration has distributed about $105 million to states to help increase the number of local crisis call center staff for the new 988 system. But states are responsible for filling any gaps in the chain of care that callers rely on if they need more than one phone conversation. States also take on most of the responsibility for staffing and funding the 988 call centers once federal funding runs out.

The state launching a successful 988 program will ensure callers have a mental health professional to speak to, a crisis team mobile to respond to, the Federal Drug Abuse and Mental Health Services Administration, which administers the current 800-273-8255 lifeline that 988 is expanding to, said the state that launched a successful 988 program. , and a place to go — such as a short-term crisis stabilization housing facility — that offers diagnosis and treatment. The federal agency also intends 988 to reduce reliance on law enforcement, expand access to mental health care, and relieve pressure on emergency rooms.

These goals may not be implemented equally in all states or communities.

Dr. said. Brian Hepburn, executive director of the National Association of State Mental Health Program Managers. The group has evolved

Form 988 state statute

That emphasizes the need for consistent services regardless of the caller’s location.

For the new communication system to be consistent, Hepburn said, “you really need that whole chain of care.” “The expectation is not that it is available now. The expectation is that your condition will eventually get you there.”

But with the launch of 988, most states have not passed legislation to fill the gaps in mental health care.

“You really need that whole gamut of care. The expectation is not that it is available now. The expectation is that your condition will eventually get you there.”

Dr. Brian Hepburn, Executive Director of the National Association of State Mental Health Program Managers

Challenge in South Dakota

In South Dakota, which has the eighth-highest suicide rate among states, health officials said responding to mental health crises in rural counties will be a challenge. So they plan to incorporate volunteer emergency medical services and fire department personnel into emergency response to 988 calls on the ground. More than two-thirds of South Dakota’s residents live in an area with a shortage of mental health professionals.

The state has only one professional mobile crisis team that responds to emergencies in person, according to South Dakota Department of Social Services Cabinet Secretary Lori Gill. The Mobile Response Team is located in Sioux Falls, South Dakota’s largest city, and serves the southeast corner of the state.

“Some of our communities have virtual mobile crisis teams,” said Janet Kittams, executive director of the Helpline Center, a South Dakota nonprofit that will answer the state’s 988 calls. Some of our communities have participant response models. Some of our communities will respond directly with law enforcement. So it really varies a lot across the state.”

Sioux Falls is also home to one of the state’s two short-term crisis facilities. The other is located more than 300 miles away, in Rapid City. South Dakota also has 11 community mental health centers that assess patients and provide outpatient treatment. These centers also use law enforcement agencies to respond to mental health crises.

A help center advisor can direct a 988 caller to one of these centers.

“Sometimes, yes, you will have to drive a few hours to get to a community mental health center, but sometimes you don’t,” Kitams said. “In general, people who live in rural South Dakota understand a lot that they are likely to have to drive to a resource, as this is probably true in other aspects of their lives, not just for mental health care, but for other types of the care or resources they need.”

The Helpline Center reported that its operators de-escalate 80% of calls without deploying a crisis team. But Vibrant Emotional Health, a nonprofit organization involved in managing Lifeline nationwide, predicted a fivefold increase in calls for South Dakota in the first year 988 was established. Any surge in calls is likely to increase demand for crisis teams.

Vibrant said the 988 will reach at least 2 million additional people nationwide in its first year. Half of them are expected to come through diverting mental health calls from 911 and other crisis centers to 988.

Right next door to South Dakota, Iowa entered the 988 era with a more robust mobile crisis response system — “at least on paper,” said Peggy Hubert, executive director of the Iowa chapter of the National Alliance on Mental Illness. 87 of the state’s 99 counties have a mobile crisis provider, but most Iowans live in an area with a shortage of mental health professionals.

Hubert said the remaining 12 counties — all of which are rural — rely on law enforcement and emergency technicians.

“We still have a long way to go with proper training of all first responders, especially law enforcement, because law enforcement is trained to come to the scene and control the scene,” she said. “People who have a behavioral health crisis, and who may be experiencing psychosis, sometimes hear voices, hallucinate, or are in an altered state. They are not as likely to obey commands. This is where things go sideways.”

Officials at the 988 call center for nine counties in eastern and central Iowa operated by CommUnity Crisis Services said their mobile crisis teams would consist only of counselors, but law enforcement agencies may be called in if the team determines it is necessary for its safety.

CommUnity Crisis Services has three mobile crisis service providers who arrive in unmarked vehicles.

Adrian Corbacks, Director of Operations at CommUnity, said mobile crisis teams are a great option in rural communities where the search for mental health treatment can carry stigma. And with the number 988, she said, “You can call, text or chat from the privacy of your home — no one has to know you’re accessing services.”

To prepare for these communications, CommUnity has nearly doubled its number of employees over the past seven months — increasing from 88 in January to 175 in July.

Despite preparations for 988 in Iowa and South Dakota, the state legislature did not fund the system in the long run. In the National Suicide Hotline Identification Act of 2020, Congress gave states the authority to cover 988 expenses by adding a surcharge to mobile phone service, but most did not.

Only 13 states have enacted 988 legislation,

According to the National Alliance on Mental Illness

with different applications and recipes on the continuity of care.

“There is quite a bit of a wait-and-see approach,” Hubert said in Iowa.


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