Dan Gorenstein: Hey, it’s Dan.

We’re releasing this episode on July 16, 2022, the day that 988, the country’s new mental health crisis line, goes live.

To mark this historic day, we’re sharing a conversation I had earlier this week with Alana Casanova-Burgess on The Takeaway, a public radio show and podcast produced by WNYC Studios and PRX.

It was a great conversation that touched on many of the challenges and opportunities facing 988 that we’ve reported on all year long.

So we wanted to share it with all of you.

Here it is.

Alana Casanova-Burgess: Hi, everyone. This is The Takeaway. I’m Alana Casanova-Burgess from WNYC, host of the Le Brega podcast, in for Melissa Harris-Perry. And just a heads up, we’re going to be talking about some difficult mental health issues today. Difficult but essential.

Clip: 911, where’s your emergency?

ACB: Since the late 1960s, nine, one one has been the all encompassing number, we’re told, to call in an emergency, an easy to remember code that was also easy to dial on a rotary phone.

911 calls typically dispatch law enforcement, paramedics or firefighters. But a study put out earlier this year by the criminal justice reform nonprofit Vera looked at nine major cities over two years and found that nearly 20% of 911 calls were related to mental health. Experts have long said that these types of calls do not require a police response. An estimated 52 million Americans are thought to be living with some form of mental illness. That’s about one-fifth of all U.S. adults. Since 2005, the National Suicide Prevention Lifeline has been one option for people in crisis. The number 800 273-TALK has connected callers to a network of 200 local call centers. But it’s a long number. It’s clunky, it’s hard to remember. And it’s specifically tied to suicide prevention. In 2020, Congress unanimously passed legislation to mandate a new three digit number: 988. A nationwide lifeline to provide support for people struggling with mental health, substance abuse and suicidal crisis. Here’s former U.S. House representative and current Montana Gov. Greg Gianforte, who was part of a bipartisan group which introduced the legislation to create nine, eight, eight.

Rep. Greg Gianforte: No matter where you are in the country. Just like when you call 911, when you call 988, you’ll be connected to mental health resources.

ACB: And now, two years later, 988 is about to come online. On July 16th, this Saturday, it’ll go live.

Hannah Wesolowski: When somebody is experiencing a mental health crisis, they’re feeling paranoia, they are conducting self-harm, they are experiencing suicidal ideation, or they’re in any range of emotional distress, 988 is going to be a resource for them.

ACB: Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness, says the number will be key.

HW: When someone dials 988, they will be connected to trained crisis counselors who are there to listen, to provide support, to de-escalate the situation.

Tonja Myles: I’m a three time to suicide attempt survivor.

ACB: Tonja Myles, a peer support specialist and community activist, testified before the House of Representatives in 2021.

TM: Over 28 years, I’ve been blessed to wake up every day on a mission to push hope for those who suffer from addiction, mental illness, individuals incarcerated and formerly incarcerated.

ACB: So we reached out to Tanja. She told us that she had dealt firsthand with police coming to the scene in response to a mental health concern.

TM: When I had my crisis, the only choice that my family had was to call 911. And there were two law enforcement officers that came on the scene. One treated me like I was in crisis, the other treated me like I was a criminal.

ACB: Her own experience underlines the risks of sending officers with little training to deal with someone in crisis.

TM: They’re already confused and they’re concerned and in a place of trauma. And so when someone who is not trained to know how to de-escalate, to talk to someone that’s in a crisis, then that crisis can become something that nobody wants to see. It can become, now, that person who’s in crisis is now handcuffs, maybe going to jail. So we want to avoid that.

ACB: Here’s the vision for 988. Calls and texts will be routed to local crisis centers or to the National Suicide Prevention Lifeline to provide immediate access to trained professionals. Here’s Hannah Wesolowski again.

HW: It’s trained crisis counselors answering the phone. And they can help anywhere from 80 to 95% of people that call and resolve that crisis on the phone. Anyone, no matter where they live, can dial 988, and they will be connected to the National 988 Suicide and Crisis Lifeline Network. That’s about 200 call centers across the country. Ideally, those calls will be answered locally, but if the local call center doesn’t have capacity, there are national backup centers that can pick up that excess demand. So no matter where you call from and what your state may have available, you will be able to talk to a trained crisis counselor.

Anna Sale: Can you talk me through when you’re answering calls? What what is the experience of the caller and then when do they connect with you and what do you see?

ACB: Anna Sale, the host of Death, Sex and Money, which is also produced by WNYC Studios, recently visited a call center in Wyoming and spoke with one of the trained crisis counselors on the other end of these calls.

Crisis counselor: If a call comes in, there’ll be a little flag here. I will click, pick up the phone. And then I will hear, “Press one to accept this Lifeline call.” We press one and then we’re connected. And then here we have the suicide risk assessment section.

AS: There’s this little dial on the side of the screen that guides with the Lifeline staff do next.

Crisis counselor: When it gets to the red, then we have somebody who is at risk, at immediate risk.

ACB: In March, call center hours went to seven days a week in anticipation of the launch of 988. By June, they had set a monthly record for total calls.

TM: We have to make a difference so we can change lives.

ACB: Tonja Myles, who we heard from earlier, emphasized to Congress the need for states to build up the mental health resources and infrastructure to handle crisis response needs. In addition to her spoken testimony, she submitted a statement that read, “It will do little good to have a fully staffed regional crisis call center to accept 988 calls without a fully functioning, comprehensive crisis system. With the launch just two days away, there are fears that many states do not have the infrastructure fully in place.

For more on all of this, I spoke with Dan Gorenstein, the executive editor and host of the health policy podcast Tradeoffs. Dan’s show has produced a series reporting on the 988 rollout. Here’s a clip from the podcast.

DG: In 2020, the current suicide lifeline got roughly 3 million calls and texts. As many as 12 million may come through this wider 988 door starting in July. As mental health advocates see it, that’s 12 million opportunities to greet people with better, safer crisis services than they’ve had before.

ACB: So that sounds great, but as one mental health care professional in Iowa told you:

Emily Blomme: Brilliant idea, logistical nightmare.

ACB: So, Dan, talk about the potential of 988.

DG: The potential is awesome, right? It really is. On paper, this front door to all kinds of mental health and behavioral health services, people who are struggling with things like suicide, addictions, schizophrenia, depression. And it’s a way to get these essential services, right? 988 represents this opportunity to, like, make it a three digit phone call away from getting those services.

ACB: And yet there’s the logistical nightmare part of it. How is it going to work and what makes it a nightmare?

DG: I wonder if nightmare is too strong, honestly. But at the same time, there are very real questions, and I think the real questions are simple: Who’s going to answer the call? Are there going to be people who can show up to your home if you need services? And if you need services beyond someone showing up at your home and you actually need to like go somewhere to some sort of inpatient treatment facility or you even need like weekly counseling, are those services available and accessible to you?

ACB: Yeah. I mean, if we’re thinking that this is going to expand the availability of trained counselors who can help people, where are those trained counselors coming from?

DG: It’s really clear from the reporting that we’ve done and we’ve talked to, you know, a dozen call centers, crisis call centers around the country, most centers are not fully staffed up. This line goes live on July 16th, and there just aren’t going to be enough people to answer these calls. And you’ve got these call center operators who are literally having the nightmares, pulling their hair out, whatever sort of cliche you want to use. But they’re really all trying to figure out how do we staff up? And they’re limited by a couple of big things. One of the big things is money. I talked with one Iowa call center who was saying to me just yesterday, she was telling me that they can pay their starting salaries $17.50 an hour. She’s competing with the Targets and the Wal-Marts, and this job answering call after call after call of people who are potentially in crisis. I mean, literally, sometimes people who are standing on a bridge or people who have a gun across their lap, like you’re going to get paid $17.50 an hour to answer a call like that compared to working a cash register or restocking a shelf. And how do you convince people to take this job?

ACB: But it’s not like there isn’t a hotline now. What’s new is this simpler 988 number that people can remember instead of the old ten digit number. So what exactly is different that makes the demand for trained counselors greater now?

DG: Right, that’s that’s an excellent question. And I think this has been a bit confusing on some level because 988 is replacing the National Suicide Prevention Lifeline, which is a ten digit number. And as that name suggests, it really is a call predominantly for people who are thinking about harming themselves in some way. 988 is bigger than that. It is broader. It is more than just people who are struggling with suicide. It is in fact, people who are struggling with all sorts of mental health crises, whether that is schizophrenia, depression. Rates of depression in the pandemic have gone way up in the United States. And then, of course, there are all the behavioral health crises that people experience struggling with addiction in one form or another, whether that’s alcohol or substance use, opioid use. So this is really a way for people not just who are thinking about suicide, but people in crisis.

ACB: There’s polling from the National Alliance on Mental Illness that shows that the public doesn’t really know about the number 988 yet. One poll showed that around 77% of those surveyed had never heard of it. What are the issues as far as making people aware of the 988 number leading up to its launch?

DG: Everybody knows 988’s just not ready for primetime. The infrastructure is not there. You don’t have enough people to answer the calls. There’s not necessarily the great protocols for how people should show up at someone’s home. The coordination between law enforcement and social service providers is just in its early, nascent stage. They’re not necessarily facilities and treatment beds and places to take people if they need more serious help. So the question is, how do you both promote this new service and also knowing that it’s not quite ready for primetime. People want folks to start calling 988, but they’re afraid that demand is going to overwhelm supply and that will somehow be ruinous and kind of taint the reputation of 988. Like 988 is a joke, like I’m not going to call 988, I’m not going to get any service from there. So it’s really this difficult balance. A lot of that folks are really trying to hold and they’re just know there are no easy answers. The line is going live whether people are ready for it or not. And so there’s going to be collateral damage. And I think anybody who’s reported on this and anybody who’s working in this field understands collateral damage can be a matter of life and death.

ACB: We have to take a quick break. More on the rollout of 988 right when we come back on The Takeaway.

BREAK

ACB: I’m Alana Casanova Burgess in for Melissa Harris-Perry. We’ve been speaking about 988, a new federally mandated mental health and substance abuse crisis hotline number set to go live in just a couple of days on July 16th. It’s also seen as a way to get trained professionals to handle these crisis situations instead of law enforcement. According to a stat from The Washington Post, nearly one in four people killed by police suffer from mental illness. That’s 1,500 in the past six years. I asked Dan Gorenstein, the executive editor and host of the podcast Tradeoffs, the ways in which 988 tries to address the issues of that other three digit number, 911.

DG: 988, truly, in theory, represents a genuine alternative to law enforcement showing up. And we know that when law enforcement shows up, it can be deadly, particularly for people of color, in a mental health crisis. So the fact that this is an alternative is something that is one reason why there’s so much enthusiasm behind this new line. And one of the reasons why there’s so much sort of gnashing of teeth and nervousness is because it doesn’t seem like it’s ready for primetime and people might call 988 and law enforcement shows up anyway. And then that’s kind of almost a poison pill. Like, wait a minute. I thought this was an alternative. It’s not. The cops are still at my door. What’s up with this?

ACB: So what are the lessons that 988 could learn from 911?

DG: The first is that it took 911, which I think came out in the late ’60s, a while to find its footing. It’s going to take 988 some time, there’s no question about that. I think we need to be honest about that in trying to set expectations. I also think that 911 over time ultimately figured out how to come up with a sustainable source of funding. Most places have some kind of fee tacked on to our cell phone bills. And the question, when Congress adopted and passed this law creating 988, it gave states the authority to do that. There are a small handful of states that have done that, 4 so far. But will we see more states begin to adopt a steady, reliable, sustainable stream of funding for 988? And looking to 911’s history can perhaps be instructive there. Third, I think we need to think about the 911 workforce itself, and the 911 workforce, and based on the best evidence we have, can be in pretty rough shape. I mean, it’s been a staff long, overworked. The average call-taker makes about $47,000 a year. People were working 8 to 12 hour shifts at a desk listening to people describe shootings, suicides, child abuse. And one of the stats that really sort of like jumped out at me was that nearly a quarter of the call-takers suffer from PTSD symptoms like nightmares and distracting thoughts. And that makes it hard for them to work and live. And so this is another way of thinking about the stress and the toll that’s going to be wrought upon these people who are taking 988 calls. So like we are asking a lot of this 988 workforce and can the 988 service providers really look to the challenges 911 workforce has faced and try to make sure this staff is taken care of and supported, both in terms of how much they’re paid, the services they have, the time off they get, you know, all of those sorts of things.

ACB: In your series, you do focus on a number of different states and municipalities around the country that are experimenting with other alternatives to providing mental health care. Do you want to just shine a spotlight on one example that you really learned something from?

DG: Yeah. So in Texas, for example, we talked with one woman who runs 988 services there, and she has worked with state officials to change the educational requirements. So anyone with a bachelor’s degree could work there instead of that person needing a degree in psychology, sociology or social work. We’ve talked to people in different states who are offering bonuses, increasing pay. The woman in Texas has managed to increase starting salary from $42,000 a year to $51,000 a year. I was talking with somebody in Iowa who was saying one of the ways they’re trying to sell the job is by focusing on benefits, including pet benefits and a good insurance plan. And I think one of the things that you see also is in this sort of post-pandemic era, if you want to call it post-pandemic, you see a lot more people saying you don’t have to work in the office, you can be virtual. In fact, there’s one crisis center we talked to based in Washington state that hired someone in Virginia to actually answer calls for them. So I think more of this is going to be remote work.

ACB: Even in this conversation with you, I’m thinking, wow, I really want listeners to the Takeaway to know about 988 whether they’re in a crisis themselves or they see someone in a crisis, a loved one, someone in their household. And at the same time, I want to make sure that we are thinking about this rollout. And I don’t want to give people the impression that they shouldn’t call because it won’t work and they won’t get help. You know, there’s a tension there as well.

DG: Absolutely. That’s really well said, I think. And, you know, the clichéd expression, don’t let perfect be the enemy of the good comes to mind. And I think we need to acknowledge that something is better than nothing. And I think the folks who are doing this work, 988, understand what is at stake. That’s why they want it to be so good from day one. Unfortunately, in most instances, that’s not going to be the case. But there will be some people who call 988, and instead of having law enforcement answer that, instead of having a 911 call-taker answer that, it will be somebody from 988. It will be somebody trained in helping people deal with a behavioral health crisis or a mental health crisis. And that is progress. It’s inadequate. It’s incomplete. There’s so much more that could be done, but it’s still progress.

ACB: Dan Gorenstein is executive editor and host of the health policy podcast Tradeoffs. They have a series, it’s great, on this 988 rollout. Dan, thank you so much for your time today.

DG: Alana, thank you so much. Really glad you’re doing a story about something so critical as us.

ACB: For much more on the rollout of 988, check out Death, Sex and Money and Tradeoffs. They’re both available now wherever you get your podcasts. And if you or someone you know is in need of help, call the National Suicide Prevention Lifeline at 800-273-8255. It’s available 24/7. 988 will begin its rollout this weekend.

DG: Thanks so much to everyone at The Takeaway for having us on this week.

The Takeaway is a public radio show and podcast produced by WNYC Studios and PRX. 

Check them out at thetakeaway.org or wherever you get your podcasts.

If you want more of our reporting on 988, you can find it in our feed or online at tradeoffs.org/answeringthecall.

I’m Dan Gorenstein, this is Tradeoffs.