Calls are on the rise, but many 988 call centers lack the resources to offer in-person help: Gunshots
On a Friday night at a call center in southeastern Pennsylvania, Michael Colluccio stirs his hot tea, puts on his headset and boots up his computer. On the screen, calls are coming in for the lifeline for suicide prevention from across the state.
Colluccio, 38, says he knows what it’s like to be on the other end of one of those calls.
“So I attempted suicide when I was about 10, 11,” Colluccio says. “And we get callers who are around that age, or quite young, and they go through similar stressors.”
For people in mental health crisis, calling 988 can be a life-saving decision. But what happens after your call depends on where you are. The new 988 system was launched in mid-July and an initial estimate indicates that calls nationwide increased by 45% in the first week.
With calls expected to increase further as people learn about the helpline, some call centers say there are limits to what they can accomplish without more local resources.
Colluccio says callers in this area — Bucks County, a suburb of Philadelphia — have access to more services than in many parts of the state. Her work with the Family Service Association, which runs the hotline, sometimes involves connecting them to services such as homeless shelters, therapists or drug and alcohol counsellors.
More than anything, his job is to listen.
“If you hadn’t picked up, I would have committed suicide”
Colluccio’s first call of the evening comes from a woman who seems panicked. Her partner is using drugs and has started making violent threats.
He spends a lot more time listening than talking. He says that by listening carefully to what she has to say, he provides relief, validation and human connection.
When he speaks, he usually asks questions – gently seeking specific ways to help. In this case, her questions lead her to put the caller in touch with local domestic violence services and a social worker.
One service he rarely turns to is 911. Part of the idea behind 988 is that it provides an alternative to police or ambulance response to a mental health crisis. He generally only called 911 if someone posed an immediate threat to himself or others.
After talking with the woman for half an hour, Colluccio asks her some key questions to determine if she feels suicidal. Colluccio says it’s an important step to ensure every caller is safe after hanging up.
What happens next is surprisingly common. At the start of the call, it sounded like the woman wanted help for her partner. But when he asks her directly on a scale of one to five how suicidal she is, she says it’s a two or maybe a three – and that she’s tried to kill herself before.
Before ending the call, Colluccio asks her if she would like to be called back tomorrow. She says yes, so he schedules one.
Colluccio barely has time to take a sip of tea when another call comes in. He’s a young man in college, overwhelmed with stress. They talk for over an hour.
It’s a pretty typical evening.
“Sometimes it’s more of an immediate response because sometimes people call in with pills in their hands and are actively considering ending their lives,” Colluccio said. “There are people who called and said, if you hadn’t picked up, I would have committed suicide.”
He says that’s why having a national network of call centers works so well. There are over 200 call centers like this across the country. Calls are tied to area codes. If no one picks up locally, the call is forwarded elsewhere.
The promise is to always have someone to pick up the phone.
Limited resources for in-person assistance
In some places, like Bucks County, there are options for callers who need more help than counselors can offer over the phone. Colluccio says he can even send a mobile team of mental health workers to visit someone in their home.
But this is not the case everywhere. In Hannover, a small town a few hours to the west, the 988 call center does not have this option.
Jayne Wildasin runs this center and says workers sometimes have to drop off their helmets, get in their cars and go out to meet people sometimes up to an hour away.
“So right now if there’s a crisis in somebody, we could potentially go there,” Wildasin said.
In rural Center County, the local 988 call center relies on volunteers – mostly Penn State University students. Denise Herr McCann is leading the operation and says her team can bring in mobile mental health experts, but more is needed.
Additionally, there is a dire need for other mental health professionals to continue helping people after the crisis has passed.
“Sometimes those resources are other consulting services, and they don’t have the capacity,” says Herr McCann. “People call and suppliers are out for six weeks if they’re lucky. That’s not good.”
For decades, suicide prevention call centers have had to raise funds from local, state and federal sources. Now, with the move to 988, they must meet new federal regulations, such as data collection and authorization requirements, says Julie Dees, who oversees the Bucks County call center. All of this costs money.
“There are increased responsibilities being given to call centers, but there really isn’t additional funding for that,” Dees said.
It’s a problem around the United States, according to a recent analysis by The Pew Charitable Trusts. The group notes that states largely have to foot the bill for switching to 988 — and many call centers doing the actual work have been underfunded for years. He recommends that state policymakers assess funding needs to ensure that 988-connected crisis services will be sustainable.
The Biden administration has dedicated $432 million to building the capacity of local and emergency call centers and providing related services. But states are expected to provide the main streams of funding.
The 2020 law enacting the 988 number also allows states to pass legislation to add a small fee to cell phone bills as a permanent source of funds for 988 and related mental health services. So far, only four states have done so and only two more have proposed legislation.
Pennsylvania is not one of these states and has not implemented any other funding plans. This worries Kevin Boozel, who heads the County Commissioners Association of Pennsylvania.
“It’s life or death,” says Boozel. “And you can’t do it halfway.”
He pointed out that Pennsylvania has decided not to release the new 988 number until next year. The fear is that too many calls will flood the system, and counties need more time to set up funding, hire workers and build capacity for things like these mobile crisis teams.
Challenges aside, in Center County, Herr McCann points out that the hotline call is working. In most cases, talking with someone is enough to defuse a crisis.
“When they have someone who is empathetic and listens, that connection helps them,” she said. It lets people know that “it’s not hopeless. There’s hope out there. There’s help out there.”