Improving Mental Health Crisis Services Since 988 Launch
In July 2022, 988 emerged as the national mental health crisis hotline, intended to serve as a vital lifeline for individuals navigating turbulent mental health waters. However, new research unveiled a concerning trend – despite the surge in calls to 988, essential crisis services have not seen a parallel increase in availability. This revelation comes as a blow to the overarching goal of bolstering an underfunded and disjointed mental health care system that often left vulnerable individuals stranded during moments of crisis.
A recent study, published in JAMA Psychiatry, highlighted a distressing decline in emergency psychiatric walk-in services, mobile crisis response units, and suicide prevention services across psychiatric facilities nationwide. Hannah Wesolowski, the chief advocacy officer at the National Alliance on Mental Illness, candidly remarked that the true potential of 988 remains untapped until a comprehensive network of crisis services is seamlessly integrated into every community.
The data, meticulously analyzed by researchers at RAND, shed light on the disheartening reality within psychiatric facilities. From November 2021 to June 2023, the proportion of facilities offering emergency psychiatric walk-in services plummeted from 32% to 29%, marking the most substantial decrease among the tracked services. Despite this alarming trend, variations in service availability persisted across states, underscoring the inconsistency within the mental health care landscape.
It is imperative to note that the RAND study solely focused on psychiatric facilities, thus excluding services provided in medical emergency departments, schools, community health centers, or other healthcare settings. Polina Krass, a pediatrician and researcher at the Center for Violence Prevention, emphasized the self-reported nature of the data, which may introduce inherent biases.
Publicly funded facilities and those accommodating Medicaid or private insurance beneficiaries displayed a higher likelihood of offering crisis services than their counterparts. Certified community behavioral health clinics (CCBHCs), mandated to deliver crisis services, emerged as a beacon of hope amidst the prevailing challenges. With only a limited number of CCBHCs nationwide, the study’s lead researcher, Jonathan Cantor, envisioned them as a pioneering model for future providers.
The implications of the federal funding freeze cast a shadow of uncertainty over mental health care providers. While 988 was inaugurated during the Biden administration, it was the Trump administration that enacted the legislation. Although the initial rollout of 988 witnessed a surge in federal funding for crisis services, the long-term sustainability remains a pressing concern. States have been urged to explore alternative revenue streams, such as wireless service fees, to ensure the continuity of mental health crisis services.
As the study authors underscored the necessity for more nuanced data analysis at the county level, the lack of transparency surrounding 988 call data emerged as a prominent issue. While SAMHSA publishes overall performance metrics for 988, detailed insights into call logs and referral outcomes remain inaccessible to the public. This limited visibility hampers efforts to optimize crisis services and ensure equitable access for all individuals in need.
In 2024, 988 counselors fielded over 5.7 million calls, answering 89% of them, a slight dip from the previous year. Dr. Ashwini Nadkarni, the associate medical director of psychiatry at Brigham and Women’s Hospital, emphasized the crucial link between enhancing access to care and realizing the full potential of mental health crisis services. The ongoing effort to bridge the gap between demand and availability remains paramount in the quest to support individuals grappling with mental health challenges.
For those grappling with suicidal thoughts or in need of immediate assistance, the 988 Suicide & Crisis Lifeline stands as a beacon of hope. By calling or texting 988 or visiting the 988lifeline.org website, individuals can access a supportive network of professionals dedicated to providing compassionate care during moments of crisis. For TTY users, utilizing relay services or dialing 711 followed by 988 ensures seamless access to critical support services.
