Big changes are coming for crisis line call takers as the date nears for the July 16 debut of the 988 suicide prevention hotline number. By some federal estimates, call centers may see the number of calls increase by 14% as the new number gets publicized.
At the Kansas Suicide Prevention HQ call center in Lawrence, the projection is even higher.
“I would say that internally we’re really preparing for our call volume to double within the first year of the launch of that program,” said Monica Kurz, vice president for policy and prevention programs.
If there’s any panicking about that, it’s hard to tell. The call center, at an out-of-the-way section of nondescript offices, is designed for calm.
The overhead fluorescent lights are turned off. Volunteers and staff work by lamp light, surrounded by stuffed animals, homey tchotchkes, gentle white board reminders and picture walls of volunteer training classes. Conversations take place in hushed voices.
While there may be an influx of calls, it likely won’t happen all at once, said Kristin Vernon, vice president of internal programming. In the meantime, empty swaths of floor space augur plans to double the 7,000-square-foot space in anticipation of adding more staff, volunteers and training.
If there’s any anxiety, it’s in the color-coded Kansas map taped to a wall, with pages of goals, timetables and performance metrics for the changeover below. Vernon points it out, joking that the wall is the way one staff member is dealing with the stress of the coming change.
The big idea
Basically, 988 is a rebranding — but one that is expected to have a huge impact. The national crisis counseling number is currently 1-800-273-TALK (8255) and it connects callers with the National Suicide Prevention Lifeline, a network of call centers across the country. That is the number that’s been regularly displayed during broadcasts and news stories about suicide.
But it’s hard to remember. Changing it to 988 is intended to make the number as easy to remember and dial as 911. It may also separate the less acute mental health calls — ones that don’t need an ambulance or law enforcement officer for safety — from a police response, since the calls won’t go through a police dispatcher.
The separation is not total. Calls into 911 may still turn out to involve a person having a mental health crisis, and those calls will require collaboration with mental health responders.
The calls to 988 will come in on Lifeline’s infrastructure and the old TALK number will still be usable. In Kansas, the Lawrence center has handled calls for 103 counties, even as far west as the Colorado border. The Wichita area has a call center, as does Johnson County. The Lawrence center also provides backup when there are too many calls to the other centers.
ComCARE takes calls for northwest Missouri, with the bulk of them coming from the Kansas City area, said Michelle Watson, the call center director.
The biggest change expected from the easier-to-remember number may be a big surge in calls. The Kansas Suicide Prevention HQ gets about 24,000 crisis contacts each year. Kurz said the call volume will pick up and could eventually double as the public becomes more aware of the new number.
Watson said the 14% increase predicted by the federal Substance Abuse and Mental Health Services Administration could increase the call volumes at ComCARE to 12,000 a year.
Johnson County has had a crisis line of its own for over 30 years that covers all sorts of mental health calls. It joined the national Lifeline last August in part to increase the chances local calls wouldn’t get bumped to the backup line outside of the area, said Rob MacDougall, director of emergency services at the Johnson County Mental Health Center. Lifeline calls have since averaged 110 to 120 a month, he said.
Most centers are in the process of bulking up their staffing. Kurz said the Lawrence center has already been able to add around a dozen staff members after it received $3 million in state funding to prepare for 988. Some 85 to 90 staff and volunteers work at the center, although most not for a full 40-hour week because of the taxing nature of the work.
At ComCARE, Watson expects to increase the 20-member pool of paid staff by 24 to 40%. The Johnson County crisis line is also in the process of shifting and eventually expects to hire more people, MacDougall said.
Pandemic effects
The white board in the heart of the Lawrence call center features reminders about how to approach and validate their callers — things like “You did the right thing calling” and “It takes a lot of courage to pick up the phone and call a stranger when you need help.”
“DON’T SAY 'Thank you for calling,'” is the advice at the top.
Mental health and suicide were growing public concerns even before the pandemic, as people became more willing to talk about their personal struggles and family members became more open about the suicides of loved ones. And there was an increasingly successful effort to get media to display the national Lifeline number prominently in stories, Vernon said.
Although busy times for crisis calls are hard to predict, there are often spikes in call volume after a high-profile suicide, she said. Comedian and actor Robin Williams was a case in point. There were 8,000 calls to centers across the country after he took his life in 2014, Vernon said, and calls to the Lawrence call center rose.
The months of COVID-19, with its accompanying isolation, conflicts over masks and other uncertainties, only made things worse, in the view of national experts. Late last year, for example, U.S. Surgeon General Dr. Vivek H. Murthy issued a report saying young people face a mental health crisis that has been exacerbated by the pandemic.
Locally, the experience of call center workers was often difficult. Rachel Strothkamp said her first days answering calls occurred during the pandemic’s early months, when she and other call takers worked their shifts alone, instead of with two or three others as they do now.
“Working an eight-to-midnight alone could feel really overwhelming, at least for me, because I was just starting out,” she said.
Call center managers noticed a difference during that time. It wasn’t so much that there were a lot more calls then as that the calls coming in seemed to be more acute, they said.
“”You can definitely look at a correlation with the pandemic, because people’s suicidal thoughts were definitely increased and more intense. That’s been reflected in the amount of time our crisis counselors have been on the phone with people to have them get to a place where they’re safe,” Watson said.
Kurz agreed.
“Certainly the severity of the crisis that people are calling in with has increased,” she said. “It seems we are talking to people who are in greater distress more often than we have ever before.”
Law enforcement’s role
The calls that involve injury or immediate danger will still get a response from ambulance and police when the new number comes online. But the hope among mental health professionals is that a 988 number will weed out non-emergency calls and help direct them to crisis teams and away from a potentially violent police response.
In fact, addressing the proper police response to mental health calls is a trend that is already in progress in some jurisdictions. After a potentially suicidal Overland Park teenager, John Albers, was fatally shot in 2018 by an officer checking on his welfare, his mother, Sheila, demanded changes in the department. The city council answered with a special mental health task force, and later the creation of a new behavioral health unit in the police department.
The Overland Park Crisis Action team — OPCAT for short — is just getting started, hiring 12 officers from its existing police force who will specialize in crisis training.
OPCAT responders are toned down in appearance from the rest of the police force. They’re still police, but without the word emblazoned prominently across their car doors and shirts.
The less aggressive approach is important, mental health and law enforcement officials agree. Capt. Jeff Burvee of OPCAT said people tend to relax a little more and relate better without the trappings of police gear.
“I think people really want to get past that barrier,” he said.
All officers will be trained as such, but people tend to request officers in non-traditional garb for certain things.
In fact, the majority of calls to the Lawrence center can be handled without calling an ambulance or other first responder.
“Every call is different,” said Rebecca Bachmuth, a volunteer there. “It’s mostly just providing emotional support. In the vast majority of calls we can talk them down to a level of safety where we don’t need to dispatch emergency services.”
The future
For police departments that haven’t set up first responders or crisis teams, some collaboration will be required with 988. When the Lawrence center gets a call from Goodland, Kansas, for instance, appropriate help will come with consultation with the police or sheriff’s department there.
Some of the features advocates want for 988 may not happen for a while. Ideally, the call takers will be able to send out mobile crisis teams to meet some of the needs. But getting the funding and infrastructure for that may be a ways down the road.
Another wish list item is geolocation. The 911 system has it, but the 988 system does not.
The 988 calls will be routed to centers based on area code and prefixes. But a student living temporarily in Lawrence, for instance, might have a cell number from home in a different state. In that case, the call would go to a center in the home state.
That’s not an insurmountable problem, because crisis line workers are trained to deal with the caller’s issues, no matter where the call comes from, Kurz said. A lot depends on good collaboration to learn the local resources.
At least for now, 988’s biggest plus may be that it makes it easier for people in crisis to find help.
“I think that more access is always a good thing,” Kurz said, noting that it’s not easy, for someone who is struggling, to negotiate a long and hard-to-remember number.
“A more ubiquitous mental health hotline just helps people not have to be experts in the system to find the help when they need it,” Kurz said. “I think that’s what’s really, really powerful.”
