988 mental health hotline is expanding, but rural areas still face care shortages – InForum

The National Suicide Prevention Lifeline’s 988 telephone number, which launched on July 16, was designed as a universal mental health support tool for callers anytime, anywhere.

But the US is a patchwork of crisis relief resources, so what follows is not universal. 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 residents of urban areas, often have trouble accessing mental health services. While 988 can connect them to a call center close to home, they could end up being directed to resources far away.

The new system is supposed to give people an alternative to 911, however, callers from rural areas who are experiencing a mental health crisis may still be served by law enforcement personnel, rather than mental health specialists.

More than 150 million people in the US, mostly rural or partially rural communities, live in places designated as mental health professional shortage areas by the federal Health Resources and Services Administration. That means their communities don’t have enough mental health providers, usually psychiatrists, to serve the population.

The Biden administration distributed about $105 million to states to help increase local crisis call center staffing for the new 988 system. But states are responsible for filling the gaps in ongoing care they rely on. callers if they need more than a phone conversation. States also bear most of the responsibility for staffing and funding their 988 call centers once federal funds run out.

The federal Substance Abuse and Mental Health Services Administration, which manages the current 800-273-8255, which expands to 988, has said that a state that launches a successful 988 program will ensure that callers have a professional mental health to talk to, a mobile crisis team to respond to them, and a place to go, such as a short-term residential crisis stabilization center, that offers diagnosis and treatment. The federal agency also intends for 988 to reduce reliance on law enforcement, expand access to mental health care and ease pressure on emergency rooms.

Those goals may not be developed equally in all states or communities.

If a call center doesn’t have a mobile crisis team to dispatch, “you don’t have the stabilization, then you basically go from the call center, if they can’t meet your needs, to the emergency room,” said Dr. Brian Hepburn, executive director of the National Association of Directors of State Mental Health Programs. The group developed

988 model legislation for the states

which emphasizes the need for consistent services regardless of the location of the caller.

For the new calling system to be consistent, “you really need that complete continuity of care,” Hepburn said. “The expectation is not that it will be available now. The expectation is that his status will eventually get him there.”

But when 988 launched, most states hadn’t passed laws to fill gaps in mental health care.

“You really need that complete continuity of care. The expectation is not that it will be available now. The expectation is that his status will eventually get him there.”

Dr. Brian Hepburn, Executive Director of the National Association of Directors of State Mental Health Programs

A 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 challenging. Therefore, they plan to incorporate volunteer emergency medical services and fire department personnel in the emergency response to 988 calls on the ground. More than two-thirds of South Dakotans 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 Laurie Gill. The mobile response team is based in South Dakota’s largest city, Sioux Falls, serving the southeastern corner of the state.

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

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

A Helpline Center counselor could direct a 988 caller to one of those centers.

“Sometimes, yes, you’ll have to drive a couple of hours to get to a community mental health center, but sometimes you won’t,” Kittams said. “Generally speaking, people who live in rural South Dakota understand very well that they will potentially have to drive to a resource, because that is probably true in other aspects of their lives, not just for mental health care. , but for other types of care or resources they need.”

Helpline Center reported that their operators reduce 80% of calls without deploying a crisis team. But Vibrant Emotional Health, a nonprofit organization that co-manages the lifeline nationally, has projected a fivefold increase in calls for South Dakota in the first year that 988 is up and running. Any increase in calls is likely to increase the demand for crisis teams.

Vibrant has said that 988 will reach at least 2 million more people across the country in its first year. Half of them are expected to come from diverting mental health-related calls from 911 and other crisis centers to 988.

Right next to South Dakota, Iowa entered the 988 era with a stronger mobile crisis response system, “at least on paper,” said Peggy Huppert, executive director of the Iowa chapter of the National Alliance on Mental Illness. . Eighty-seven 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.

The remaining 12 counties, all rural, rely on law enforcement and EMTs, Huppert said.

“We still have a long way to go to properly train all first responders, especially law enforcement, because law enforcement is trained to get to a scene and take control of the scene,” he said. “People who are in a behavioral health crisis, who are perhaps psychotic, sometimes they hear voices, they have hallucinations, they are in an altered state. They are not likely to obey orders. That’s where things often go awry.”

Officials at a nine-county 988 call center in east-central Iowa operated by CommUnity Crisis Services said its mobile crisis teams will be comprised of counselors only, but law enforcement agencies can be called if a team determines that it is necessary for your safety.

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

Adrianne Korbakes, director of operations for CommUnity, said mobile crisis teams are an excellent option in rural communities where seeking mental health treatment can carry stigma. And with 988, she said, “you can call, text or chat from the privacy of your home; nobody has to know that you are accessing the services”.

To prepare for those contacts, CommUnity has nearly doubled its staff over the past seven months, from 88 employees in January to 175 in July.

Despite preparations for 988 in Iowa and South Dakota, neither state’s Legislature has funded the system long-term. In the National Suicide Hotline Designation Act of 2020, Congress gave states the authority to cover 988 expenses by adding a surcharge to cell phone service, but most have not done so.

Only 13 states have enacted the 988 legislation,

according to the National Alliance on Mental Illness

with various applications and prescriptions in the continuity of care.

In Iowa, Huppert said, “there’s a wait-and-see approach.”


(Kaiser Health News) is a national newsroom that produces detailed journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the top three operating programs in


(Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information on health issues to the nation.

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