On a Friday afternoon in a call center in southeastern Pennsylvania, Michael Coluccio stirred his hot tea, put on his headphones and turned on his computer. The screen shows calls coming in to the statewide suicide hotline.
Coluccio, 38, said he knows what it’s like to be on the other side of the line.
“I tried to kill myself when I was 10 or 11,” he said. “And now we get calls from people that age, very young, who are going through similar stressful situations.”
For people experiencing a mental health crisis, calling 988 can be a life-saving decision. But what happens after the call depends on where they live. The new 988 system went live in mid-July and according to an early estimate, calls rose by 45% in the first week.
Although calls may increase as the helpline becomes known, some call centers feel that a lack of local resources limits their work.
Coluccio said callers in his area — Bucks County, north of Philadelphia — have access to more services than in other parts of Pennsylvania. Her work at the Bucks County Family Services Association, which runs the local hotline, sometimes involves connecting callers with services such as shelters, therapists or drug and alcohol counselors.
But above all, your job is to listen.
The first call Coluccio made that afternoon was from a woman who seemed panicked. Her partner was on drugs and started threatening her violently.
Coluccio spent more time listening than talking. He assures that it provides comfort, empathy and human connection by listening attentively to the caller.
When he speaks, he asks subtle questions, usually to search for specific types of help. In this case, her questions led her to put the caller in touch with local domestic abuse services and a social worker.
One service he rarely uses is 911 Part of the idea of 988 is to offer an alternative to police or ambulance intervention in a mental health crisis Colluccio said he would only use 911 if someone was an immediate threat to himself or others. Those who have had bad experiences with the mental health system have expressed concern and warned that calls to 988 will result in the police arriving.
After speaking with the woman for half an hour, Coluccio asked his key questions to determine if she was suicidal. It’s an important step to ensure every caller is safe after hanging up, he said.
At the beginning of the call, it appeared that the woman was seeking help for her partner. But when Coluccio asked him directly, on a scale of 1 to 5, how he felt about the possibility of suicide, he said it was a 2 or maybe a 3, and that he had already attempted suicide.
Before hanging up, Coluccio asked him if he wanted to call the next day. He said yes, so he scheduled a call.
Colusio had just enough time to sip his tea before another call came. He is a young college student, overwhelmed with stress. They talked for more than an hour.
It was a fairly normal afternoon, he said.
“Sometimes it’s about making an immediate intervention because there are people who call with pills in hand, clearly thinking about ending their lives,” Coluccio said. “There are people who have called and said, ‘If you don’t answer, I’ll kill myself.’
There are more than two hundred such centers across the country. Calls are tied to area codes. If no one answers the call locally, it is routed elsewhere. The promise is that there will always be someone on the other end of the phone.
Some places, like Bucks County, have additional resources for callers who need more help than they can offer over the phone. Coluccio can send a team of mental health workers to see someone at home. But in Hanover, Pennsylvania, a city a few hours west, the 988 call center doesn’t have that option.
Jane Wildasin runs that center and says workers sometimes have to put down their headsets, get in their cars and go see the caller, who may be an hour away.
“So right now, if there’s a crisis at someone’s house, we have to go there,” Wildasin said.
In another part of the state — rural Center County — the Local 988 call center relies on volunteers, mostly Penn State college students. Denise Herr McCann runs the center and said her team can call on mental health experts, but more are needed.
For decades, suicide prevention call centers have received funding from local, state and federal sources With the switch to 988, they now have to comply with new federal regulations, such as data collection and licensing requirements, said Julie Dees, who oversees Bucks County’s call center. All that costs money.
“Call centers have more responsibility, but there’s no additional funding for it,” Dees added.
This is a problem across the United States, according to a recent analysis by the Pew Charitable Trusts. The polling and research firm noted that states must foot the bill for switching to 988, and that many crisis centers that do this work have gone unfunded over the years. He recommended that state policymakers assess funding needs to ensure 988-connected crisis services are sustainable and efficient.
The Biden administration invested $432 million to build backup and local call center capacity and related services. But the expectation is that states provide the main source of funding.
The 2020 law that enacted the 988 number allows states to pass legislation to add a fee to mobile phone bills as a permanent source of funding for 988 and related mental health services.
Fearing additional calls would flood the system, Pennsylvania decided not to advertise the new 988 number until next year. Counties need more time to build capacity for things like funding, staffing and mobile crisis teams.
This story is part of a coalition that includes NPR, WITF and KHN.
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