At the 988 call center, crisis counselors provide empathy — and Juggle Ltd.

On a Friday evening in a call center in southeastern Pennsylvania, Michael Coluccio stirred his hot tea, put on his headset and turned on his computer. The screen shows the calls coming in to Suicide Prevention Lifeline from around the state.

Coluccio, 38, said he knows what it’s like to be on the other end of one of those calls.

“So, I tried to kill myself when I was 10, 11 years old,” Coluccio said. “And we get callers who are around that age, or quite a bit younger, and they’re going through similar pressures.”

For people experiencing a mental health crisis, calling 988 can be a life-saving decision. But what happens after they call depends on where they are. The new 988 system was launched in mid-July, and an initial estimate said calls rose by 45% in the first week.

While calls are likely to increase as more people learn about the helpline, some call centers say there are limits to what they can do without stretching local resources.

Coluccio said his service area — Bucks County, just north of Philadelphia — has access to more services than other parts of Pennsylvania. Her job with the Family Service Association of Bucks County, which runs the hotline locally, sometimes involves connecting callers with services like homeless shelters, therapists or drug and alcohol counselors.

More than anything, his job is to listen.

Coluccio’s first call of the evening was from a woman who was panicking. Her partner was using drugs and began making violent threats.

Coluccio spent more time listening than talking. She said that by listening closely to what a caller has to say, she offers relief, validation and human connection.

When he talks, he usually asks questions—gently probing for specific ways to help. In this case, her questions led her to connect the caller with local domestic abuse services and a social worker.

One service he rarely does is 911 Part of the idea behind 988 is to offer an alternative to calling the police or an ambulance in a mental health crisis. Colluccio said he would normally only use 911 if someone was an immediate threat to himself or others. Some people who have had bad experiences with the mental health system have expressed concern and warned others about the possibility of a brush with law enforcement if they call 988.

After speaking with the woman for half an hour, Coluccio asked her key questions to determine if she was feeling suicidal. Making sure each collar is secure after hanging up is an important step, he said.

At the beginning of the call, it appeared the woman was asking for help for her partner. But when Coluccio asked her directly on a scale of 1 to 5 how suicidal she was, she said she was a 2 or maybe a 3 — and that she had tried to kill herself before.

Michael Colucci works at his desk.  He wears a red shirt and rectangular glasses.
Michael Coluccio, a specialist at the Family Service Association of Bucks County’s call center, works at his desk. The call center is part of the National Suicide Prevention Lifeline Network. Coluccio’s team answered 988 calls from people whose phones had suburban Philadelphia area codes. If needed, Coluccio can answer calls from other parts of the state or country, part of a system that ensures someone is always available to talk.(Brett Sholtis/WITF)

Before they ended the call, Coluccio asked her if she wanted to call back the next day. He says yes, so he schedules one.

Colusio had just enough time to sip his tea before another call came. It was a young man in college, overwhelmed with stress. They talked for over an hour.

It was a pretty normal evening, he said.

“Sometimes it’s more of an immediate intervention because sometimes people call with pills in hand and are actively considering ending their lives,” Coluccio said. “There are people who have called and said, ‘If you hadn’t taken me, I would have killed myself.’

Nationwide, there are more than 200 such call centers. Calls are tied to area codes. If no one picks up locally, the call goes elsewhere. The promise is that someone will always pick up the phone.

In some places, like Bucks County, additional resources are available for callers who need more help than counselors can offer over the phone. Coluccio can send a mobile crew of mental health workers to visit 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 said workers sometimes have to put down their headsets, get in their cars and meet a caller who may be an hour away.

“So right now, if there’s a crisis at somebody’s house, we can probably 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 operation and said her team can call in mobile mental health specialists, but they need more.

There is also a need for additional mental health professionals who can help when the crisis is over.

“Sometimes those resources are other counseling services, and they don’t have the capacity,” Herr McCann said. “People are calling, and providers are six weeks out if they’re lucky. It is not good.”

For decades, suicide prevention call centers have drawn together funding from local, state and federal sources With the switch to 988, they now have to meet new federal regulations, such as data collection and licensing requirements, said Julie Dees, who oversees the call center in Bucks County. All that costs money.

“Call centers have increased responsibilities, but there’s really no additional funding,” Dees said.

This is a problem in the United States, according to a recent analysis by the Pew Charitable Trusts. The polling and research firm noted that states are largely footing the bill for changes to 988 — and the work of many crisis centers has been underfunded for years. It recommended that state policymakers assess funding needs to ensure that crisis services connected to 988 will be sustainable and seamless.

The Biden administration has invested $432 million to increase the capacity of local and backup call centers and provide related services. But the expectation is that states will come up with the main funding stream.

The 2020 Act that enacted 988 numbers allows states to pass legislation to add a fee to cellphone bills as a permanent source of funding for 988 and related mental health services.

Pennsylvania’s outgoing Democratic governor has proposed a funding fee model, but it has yet to gain traction in the Republican-controlled Legislature. The lack of a funding mechanism worries Kevin Buzzell, who heads the Pennsylvania County Commissioners Association.

“It’s life or death,” Buzzell said. “And you can’t do it halfway.”

Fearing that too many calls could overwhelm the system, Pennsylvania decided to put the new 988 number on hold until next year. Counties need more time to set up funding, staff and build capacity for things like mobile crisis teams.

This story is from a partnership that includes NPR, WITF and KHN.

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