By Elena Eberwein
As efforts to support mental health and alternative crisis response increase nationwide, individuals in crisis can now call 988 to access suicide prevention services in the hopes of deescalating situations before 911 is called.
Residents in Massachusetts can now call 988 to connect with suicide prevention services. This comes after a federal directive to designate the code for callers seeking support nationwide and is part of Massachusetts larger behavioral health road map.
While each state is utilizing 988 differently, in Massachusetts the 3-digit line directs callers to five call centers that already handle incoming calls from the National Suicide Prevention Lifeline. Samaritans runs four of the centers, and Mass211 runs the fifth center. The call centers have worked to bolster staffing capacity as they prepare for the roll-out in July.
Kacy Maitland, chief clinical officer at Samaritans Boston, said they’re very excited for the roll-out of the line to improve access to care for people.
“There always is the thought of an increase of calls because it’s more accessible,” said Maitland, but they are preparing for the influx. She said for over 50 years, Samaritans has operated “thanks to the good graces of our volunteers.”
While there is federal and state funding available to 988 call centers, Maitland said that like many places across the country there are hiring challenges for staff positions.
National Suicide Prevention Lifeline data shows that their methods have been successful in listening and helping to de-escalate crisis situations. In the U.S. for every one person that dies by suicide, there are 316 who seriously contemplate it.
“Because of their ability to de-escalate a caller, 98 percent of folks that do call these numbers do not require further assistance beyond actually calling the centers to help them with that support,” said Kelly Cunningham, Program Director at the Massachusetts Department of Public Health Suicide Prevention Program, in a Zoom presentation for the community on June 30. She said the two percent of callers that are deemed at risk can be forwarded to 911 for emergency services.
It is a misconception that all calls that come into the call centers are from someone who is actively suicidal. Maitland said, 80 to 90 percent of calls that come in are from individuals hoping to be listened to.
“The core of what we do is called befriending,” said Maitland, “which is really active and engaged non-judgmental listening.”
Maitland said that volunteers participate in 40 hours of training to prepare to take calls. This includes online modules as well as scenario-based training. Volunteers also engage in learning checks where they are paired with a more experienced staff member to both observe and be observed during live calls.
While the 988 line begins in July and will build upon existing infrastructure, a behavioral health line is coming in January of 2023 to Massachusetts as a part of a phased approach to addressing behavioral health challenges in the Commonwealth.
The important distinction is that 988 call centers will be staffed by non-clinicians and volunteers, while the behavioral health line will be staffed by clinicians at a sixth call center. The clinicians will be able to perform assessments and triage to see what the caller may need, whether it be outpatient therapy, immediate intervention, or just someone to talk to.
“Up until now, families like mine would not think to call them when like, my son has schizophrenia, if he was in the throes of a psychotic break,I never would have thought to call a suicide line,” said Monica Luke, a full-time mental health advocate.
By utilizing 988 and the behavioral health line to divert from 911, it could lead to fewer police encounters, hospitalizations, arrests for vulnerable populations. “If we don’t take advantage of this moment, to divert that population from 911, then we have missed a golden opportunity,” said Luke.
The 988 and the behavioral crisis lines are part of a larger plan to create a roadmap to boost behavioral health response and resources, said Jessica Rochelle, co-director for public policy and government relations at the Mass Association for Mental Health. Though it may take time the goal is to “divert people in behavioral health crisis away from a law enforcement approach,” said Rochelle.
The Roadmap as developed after extensive listening sessions with over 700 community members. This included feedback from families, mental health professionals and community stakeholders who helped target need to improve mental health access and treatment.
Mental health crisis response has been a topic of community and legislative discussion for years. Rochelle said the 911 system needs to be reformed. Dispatch is the first place where calls should be redirected.
“The Suicide Prevention Lifeline, they can connect to 911,” said Rochelle, “But it’s not bi-directional, 911 is not connecting the other way.” It will take new training for dispatch statewide to be able to designate when it would be best for a call to be directed towards the 988 or behavioral health line.
Rochelle said her hope and what the Mass Association for Mental Health is advocating for, is that when someone calls 911 with a behavioral health crisis that does not require the presence of law enforcement, they could then be transferred to 988.
“Across the board is well equipped to handle emergencies that are related to medical surgical stuff like your physical health, fire, and ones are potentially criminal in nature,” said Rochelle. “They aren’t across the board, well equipped to handle behavioral health emergencies.”
Rep. Lindsay Sabadosa is sponsoring the ACES bill that would give funding to programs that offer alternative community response to law enforcement in behavioral health crises. She said, “988 does have to be successful, pretty much out of the gate, because people won’t call it otherwise, right?”
Sabadosa said it’s important to make sure that there is a proper response in place when receiving these calls. “And that’s what the ACES bill provides, it provides those teams who are very much in line with what the federal government is telling us to do,” said Sabadosa.
It’s important to get the word out about the shift to 988, but there has been confusion over whether the line is different from what is already in place.
While 988 will not evoke a physical response the way that 911 does, or that the behavioral health line will, the program is part of a larger vision of expanding community behavioral health services.
“I think trying to communicate in a way that lets people know that the service is available, but at the same time, doesn’t over-promise,” said Rochelle. By the summer of 2023, Rochelle said there will be more behavioral health care, urgent care, mobile crisis teams, and other community programs to help address behavioral health crisis needs.
“It’s gonna take time to get there,” said Rochelle.
Elena is a multimedia journalist working to build a career in audio storytelling. After working as a flight attendant for four years, she decided to make a career change during the Covid-19 pandemic. She currently interns at MassINC Polling Group as a podcast production intern on "The Horse Race" and will graduate from Emerson in August 2022.