The ‘988’ mental health hotline is coming. But will Massachusetts be ready?
Patti Donovan answered the phone with a cheerful and reassuring tone.
“Call2Talk, we’re here to listen,” she said.
Donovan volunteers at Call2Talk, one of five centers in Massachusetts that takes calls that reach the National Suicide Prevention Lifeline.
“Are you feeling suicidal today?” she asked the caller. Donovan stopped and listened. “OK, I’m sorry, that’s how you feel,” she said. “Thank you for sharing this with me.”
Donovan and the other volunteers offer what they call “compassionate listening.” The goal is to help prevent suicides by allowing people to share how they feel and what is happening in their lives.
The hotline, 800-273-8255 (TALK), receives millions of calls a year nationwide. And soon it will be much easier for people to remember and call. That’s because a new three-digit number, 988, will be launched on July 16.
In accordance with federal legislation passed in late 2020, 988 will connect callers to suicide prevention services from anywhere in the country. Each state is responsible for strengthening its own system to respond to these calls and building a system that can meet the needs of callers. Massachusetts is busy preparing for launch – just three months away.
The new system is coming, but state officials have yet to decide on a long-term funding plan, staff still need to be beefed up, additional state support services won’t be deployed for years. months and there is at least one major outstanding technical issue. concern at the federal level. Even so, some are just happy to see a service become more readily available to those who need it.
“There’s still a lot to do, frankly, before we’re really up and running and ready for July,” said Kathy Marchi, CEO and President of Samaritans, Inc.. – one of the nonprofit centers answering calls in Massachusetts.
Publicity for the new 988 number, coupled with the ongoing mental and emotional strain of the pandemic, is expected to cause calls to increase. And while the state is set to launch additional behavioral health resources in early 2023, that leaves a six-month gap where compassionate listening services at the five nonprofit centers will be made available. ‘test.
Federal and state funding helps call centers hire more staff, but Marchi said they really need more people to volunteer to help answer an increased number of calls. And she worries that 988 calls will start to include all kinds of mental health emergencies. While her volunteers offer a non-judgmental ear, she says crisis helplines are not set up to provide in-person emergency response or a referral for mental health services.
“It will present us with a great challenge both in terms of volume and capacity, skill, training of people who answer our phones,” she said. “Can this be done by us? It could be, but it’s going to be a different job than what we’re doing right now.”
“We are not dependent on the 911 system,” she continued. “We are not connected to emergency services. We’re not tied to, you know, a statewide system that would help us find a bed or psychiatric resources for someone.
It’s an issue that future training and programs should address, says Massachusetts Health and Human Services Secretary Marylou Sudders.
Sudders said 988 call centers in Massachusetts will be ready to handle all kinds of calls on day one. If call takers hear of someone with an acute emergency that requires an immediate in-person response, they will be able to seamlessly connect with emergency services, Sudders said.
“What we are doing now, by July, is training and coordination between systems to ensure that my phone call, if I were to call 988, and I presented in an urgent crisis that there would have a transfer,” she said.
A larger plan for Massachusetts
In addition to the nationwide rollout of 988, the state is working to expand behavioral health services beginning in January 2023.
The Baker Administration Behavioral Health Reform Roadmap includes opening community behavioral health centers across the state where people can get emergency care and expanding the state’s ability to dispatch mobile crisis teams.
The plan also includes another phone line. This one the state calls a “hotline,” and it would be able to connect callers to mental health services. Once launched in January, Sudders said, 988 callers could be transferred to this new state number, if needed.
“These are trained clinicians, who would then say, you know, ‘We call a mobile crisis team immediately’ or ‘Can we make an appointment tomorrow for a clinical assessment?’ Sudders said.
The state is currently reviewing bids from contractors to run the new helpline.
“The version that comes out in July is not the 988 that is being considered nationally.”
Annabel Lane with the National Alliance on Mental Illness of Massachusetts
When rolled out, this kind of service will help a lot, according to Annabel Lane of the Massachusetts National Alliance on Mental Illness.
“But there’s going to be this weird time slot between July and January, where we’re going to have a 988 number, and people are going to be told it’s a mental health crisis number, but it won’t be not fully equipped necessarily to handle all sorts of things that people might call with,” Lane said.
“The version that drops in July is not the 988 that is being considered nationally,” Lane said. People might call 988 hoping to get a mobile crisis team in an emergency, she said, and end up getting a 911 response. “I think people think of it as an alternative that will be ready immediately, and it will not be ready immediately.”
Some of those who will respond to 988 calls are more certain to be ready to respond immediately.
Eileen Davis, director of Call2Talk, said she was confident her team had the training to assess a caller’s level of risk and respond appropriately.
“Call takers are trained,” Davis said. “They spend a lot of time in their readiness training before answering calls to know how to assess the level of risk a caller may potentially be exposed to, and they know what to do.”
How to finance and build a more “perfect” 988
Legislation that is still pending at the state and federal levels will shape the funding, deployment, and ultimate technical configuration of the system. Massachusetts Congressman Seth Moulton, who authored the 2020 federal report legislation creating 988, expects there to be several bills in the coming years to perfect and refine the federal system.
Beyond federal funding and $10 million in next year’s state budget to implement the new system, Cape Town and Islands Democrat Julian Cyr wants to add charges to the phone bills of the Massachusetts that will fund the hotline, much like the existing fees that support the 911 system. funding for crisis outreach teams and behavioral health providers who would respond to incoming calls.
Cyr, who co-chairs the Legislative Committee on Mental Health, Addiction and Recovery, is pushing for state lawmakers to pass two bills, SB 2572 and SB 1274, which include a range of behavioral health initiatives, including new fees. Federal law explicitly allows states to add charges to phone bills to support 988 – one step at least four states have already taken.
“We’re going to be able to run 988, and $10 million is going to fund 988, probably through the end of the year,” Cyr said. “And then there’s a real question about, how are we going to fund this going forward? I would really say we should use the [funding] tool that the federal government gave us.
It is a measure to which part of the wireless communications industry is partially opposed. In written testimony, the industry trade association CTIA argue any paid funds raised for 988 should be more strictly limited to use for call routing and operational logistics, not to fund teams or crisis centers.
There are also technical issues with 988 that should be resolved at the federal level: primarily, ensuring that a caller will be connected to their state’s services.
“The way the federal government has implemented the  system, if you have a 508 or 617 or 413 number, you’re going to reach someone in Massachusetts,” Cyr said.
But if someone calls 988 with an out-of-state area code, that call will be routed to that other state. This is especially a problem for the large number of students who come from other states to study in Massachusetts, he pointed out. “That’s something that seems pretty darn problematic,” Cyr said.
This is not a problem for the 911 system, which uses the location someone is calling from to route their call to a local dispatcher, regardless of the caller’s area code.
Cyr and Sudders say they are urging the FCC to make the change so callers connect with someone in the state in case they need urgent help.
Moulton, the Democrat for Massachusetts’ Sixth District, acknowledges that there is still work to be done.
“I can’t say I’m 100% satisfied with the progress all states have made to meet this deadline and be truly ready to go in July,” Moulton told GBH News. “But we can’t let the perfect be the enemy of the good.”
Moulton is now co-sponsor of the Implementation Act of 988, which he says will help bring 988 closer to “perfect”. The bill, which was introduced in March, would provide funding for mobile crisis teams and call centers, as well as funds for workforce development and training for those responders. He also supports the creation of community behavioral health clinics, like the ones Massachusetts is setting up as part of its behavioral health reform “roadmap.”
“So it’s about making sure 988 is implemented well,” Moulton said.
“If we were trying to create a perfect system, we probably wouldn’t have this for 50 years,” Moulton said. “We will get a perfect system much faster by launching the imperfect system.”
While it won’t be perfect on day one, this nationwide system will save lives right away, Moulton said, because people going through a crisis will know there’s someone ready to listen to a phone call.