For states, the rollout of 988 still faces some challenges

Just over a year ago, the nation launched the 988 Suicide and Crisis Lifeline, an easy-to-remember number similar to 911 that people in crisis could call for help. Since then, states have been ramping up those call centers, and that has meant different experiences for people in need all across the country.

In Alabama, for instance, callers had to wait 46 seconds for someone to answer the phone when the new hotline launched in July 2022. About a quarter of the callers gave up before they spoke to a counselor, according to data compiled by the Substance Abuse and Mental Health Services Administration, or SAMHSA.

Alabama had not yet fully staffed the line, and although the state has since added more mental health providers and cut the wait to 29 seconds as of June, it’s still among the longer wait times in the nation. In Mississippi or Rhode Island, it only took an average of two seconds to talk to a counselor. As a result, just seven of the 1,082 people that called 988 in Mississippi in June gave up before they were able to reach someone.

But Brian Hepburn, executive director of the National Association of State Mental Health Program Directors, cautions that there is no need for alarm yet. The fact that some states are having a harder time than others has much to do with the fact that the effort is brand new.

“It's the first year,” he said, noting that wait times have since improved. Indeed, SAMHSA data show that the average wait time nationally has decreased from an average of two minutes and 20 seconds to 35 seconds in the past year. “I think we're off to a good start.”

Still, the wait times vary widely, according to the most recent data in June. Pennsylvania now has the longest wait of any state, at 38 seconds, and 16% of the callers hang up before a mental health counselor has time to answer.

The Secret Behind Some States' Successful Rollout

One explanation for why some states have seen more success during the rollout than others is that those states already had mental health crisis centers.

In California, Santa Clara County, for example, had a mental health hotline before 988 and would send counselors out in person to talk to the people who called, said Bruce Copley, the county’s director for access and unplanned services. After 988 launched, the county hotline received 1,916 calls, 500 more than the previous month. By adding staff to its existing call center, Santa Clara was able to reduce the wait time from 20 seconds in July 2022 to just 8 seconds this year.

In Rhode Island, the state tapped a local nonprofit to oversee its 988 call centers. The state had worked with this group to start a behavioral health center a few years earlier in East Providence that gives people with mental health issues “a safe place to stay for up to 24 hours that’s not a chaotic hospital-like setting,” said Cliff Cabral, CEO of Horizon Health Partners.

Cabral says that the health center has helped the state handle the rise in the number of people looking for help after 988 began. “If our 988 operators are occupied,” he said, “we just reroute that call to our behavioral health emergency facility, and it can be answered by a nurse or a clinician.”

Many states that have struggled to staff their call centers, like Alabama, have had to reroute calls to counselors in other states, prolonging the wait for people who are already in a fragile state. In some of these states, less than two-thirds of calls remain there. But in Rhode Island, only 2% of the calls in June had to be rerouted to a call center in another state.

Keeping a call in-state is important, Cabral said, because the people who answer the phones know better than someone in another state where to send people for help. In the case of California and Rhode Island, keeping the call in state also means that a counselor can send a team out to someone in need.

That has been a real challenge for Alabama. A year ago, the state had to reroute about half of the calls it received to a center in another state to handle the overload. It has made some progress. But with only about 59% of calls answered by a counselor in Alabama, it still has the lowest rate in the nation. 

“We're still building out our infrastructure,” said Beverly Johnson, director of prevention at the Alabama Department of Mental Health. “We do understand that we are well below what those expectations are. We're currently putting things in place to be able to address that,” such as analyzing what times workers are most needed. 

But Johnson says that the state needs more federal funding to help staff the 988 call centers. 

Staffing Shortages Plague 988 Call Centers

One of the biggest challenges states are facing in ramping up their 988 call centers includes problems recruiting workers. Even in areas where calls are being answered quickly like Rhode Island, mental health officials say they are dealing with a shortage of workers to field the calls.

Rhode Island only has about 60% to 70% of the counselors they need, Cabral said. It helps that the East Providence behavioral health center is handling the excess calls, he said, but continuing to be understaffed could lead to burnout. 

“We've seen an exodus from the health care and behavioral health care fields since COVID,”  he said. “A lot of that is because the economy has shifted and so you see wage growth in a lot of other industries. So oftentimes it's difficult for behavioral health organizations to compete with larger corporations who simply offer better compensation.”

Texas, meanwhile, has had success in dealing with its workforce issues. In June 2022, only 55% of calls from people seeking help in Texas were answered by a counselor in the state. But this past June, that percentage had risen to 80%.

In a statement, the state’s Department of Health and Human Services said that initially the 988 centers “had difficulty in filling weekend and overnight shifts and was experiencing turnover due to the challenging nature of the work and competition with the private sector.”

However, mental health providers have been able to increase staffing by offering sign-on bonuses, raising pay and allowing more employees to work remotely, the statement said.

The People Who Need 988 Don’t Know About it

In addition to workforce issues, researchers say there’s another problem that could reduce the 988 lifeline’s impact. Not many people who need help know about it.

A recent survey by the Pew Charitable Trusts found that only 13% of adults polled knew what 988 was. One reason for that is that states have held back on publicizing the hotline until they feel like they can handle all the calls.

“Providers all around the country were sort of given instructions to take the first year to build the program up and not spend so much time marketing,” Cabral said.

Cabral, though, predicted agencies will make a “big marketing boost” in the coming year.

The lack of marketing, though, has led to a disparity in who uses the lifeline. Whites are more likely to know about it, whereas only 7% of Blacks and 9% of Hispanics said they knew about 988, the Pew survey found.

Another common “failure” of the 988 system that has kept people in crisis from reaching a counselor in their state are cellphone numbers with out-of-state area codes. Under the technology 988 uses, calls are routed to counselors based on the area code of the caller. So if a person in California with a 202 area code calls 988, they would be sent to a counselor across the country in Washington, D.C.

The Federal Communications Commission, however, is working to begin using geolocation to track where a person is actually calling from.