Mental health line 988 extends, but not much in rural areas

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

But the United States is a patchwork of crisis support resources, and 988 callers depend on their zip code.

In particular, residents of rural areas, who die by suicide at much higher rates than urban areas, often have difficulty accessing mental health services. While 988 can connect to a call center near their home, personal resources may be far away.

The new system is supposed to give people an alternative to 911, however, those calling from rural areas with mental health crises may still be served by law enforcement personnel instead of mental health specialists.

More than 150 million people nationwide, most of them in rural or semi-rural communities, live in areas designated by the federal Health Resources and Services Administration as mental health professional shortage areas.

This means there are not enough mental health providers, usually psychiatrists, to serve the population in their communities.

The Biden administration distributed about $105 million to states to increase local crisis call center staffing for the new 988 system.

But states are responsible for filling in the gaps to achieve the consistent care that callers believe they need, if they need more than a phone conversation. They also take over most of the staffing and funding of their 988 call centers when federal funding runs out.

The federal Substance Abuse and Mental Health Services Administration, which operates the current 800-273-8255, which has expanded to 988, said a state that operates a successful program must ensure that callers have a health professional to speak with. A mobile crisis. Teams to respond, and places to go, such as a temporary crisis shelter, that provide diagnosis and treatment.

988 desirous of reducing reliance on federal agencies law enforcement, expanding access to mental health care, and reducing pressure on emergency rooms.

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

If there isn’t a mobile crisis team to send to a call center, “you don’t have stability, 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 created Model 988 legislation for states that emphasizes the need for consistent service regardless of where the caller is located.

For the new calling system to be consistent, “you really need that full continuity of care,” Hepburn said.

But when 988 was introduced, most states had not passed legislation to close the mental health care gap.

In South Dakota, which has the eighth-highest suicide rate among states, health officials say responding to mental health crises in rural counties will be challenging. Therefore, they plan to include volunteer emergency medical services and fire department personnel on the ground in emergency response to 988 calls.

More than two-thirds of South Dakotans live in an area with a shortage of mental health professionals.

According to South Dakota Department of Social Services Cabinet Secretary Lori Gill, the state has only one professional mobile crisis team that responds to emergencies in person. The mobile response team is based in Sioux Falls, South Dakota’s largest city, serving 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 answers the state’s 988 calls. “Some of our communities have co-reaction models. Some of our communities will respond directly to the police. So it really varies quite a bit across the state.”

Sioux Falls is 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 has 11 community mental health centers that evaluate patients and provide outpatient treatment. These centers also use law enforcement agencies to respond to mental health crises.

A helpline center counselor can direct a 988 caller to one of those centers.

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

Helpline centers report that their operators handle 80% of calls without deploying a crisis team. But Vibrant Emotional Health, a nonprofit organization that co-operates Lifeline nationally, estimates a fivefold increase in calls for South Dakota in the first year that 988 has been operational. Any increase in calls may increase demand on the crisis team.

Vibrant says 988 will reach at least 2 million people across the country in its first year. Half of them are expected to refer mental health-related calls to 911 and other crisis centers to 988.

Right next to South Dakota, Iowa entered the 988 era with a robust 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 its 99 counties have a mobile crisis provider, but most Iowans live in areas 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 go into a scene and take control,” he said. “People who are in behavioral health crises, who are probably psychotic, sometimes they hear voices, they have hallucinations, they’re in an altered state. They are unlikely to obey orders. That’s where things often get complicated.”

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

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

Adrienne Korbecks, director of community operations, said the mobile crisis team is an excellent option for rural communities where treating mental health can carry a stigma. And with 988, he said, “you can call, text or chat from the privacy of your home; No one needs to know you are accessing the Services”.

To prepare for these introductions, Community has nearly doubled its staff over the past seven months, from 88 employees in January to 175 in July.

But despite preparations for 988 in Iowa and South Dakota, neither state legislature has funded a long-term measure.

In the National Suicide Hotline Designation Act of 2020, Congress gave states the power to cover the costs of 988 hotlines by adding a surcharge on cell phone service, but most have not done so.

But according to the National Alliance on Mental Illness, only 13 states have enacted 988 laws, with varying applications and guarantees of continuity of care.

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

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