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988 makes it easier to get help in a mental health crisis, but NC needs more providers

Charlotte Observer - 11/25/2022

A new National Suicide Prevention Lifeline — 988 — went into operation in mid-July, replacing the former 10-digit number most states offered. North Carolina saw an immediate increase in calls.

Advocates say that shows two things: the new number is easier to use, and the state still needs more mental healthcare providers, especially for youth.

Here are answers to some common questions about 988.

How does it work?

988 is staffed 24 hours a day by trained counselors who can be reached by call or text. When a call or text comes in to 988 from North Carolina, the counselor who responds is most likely also in North Carolina, though if all N.C counselors are busy, the call will roll to a counselor in another state.

The hearing impaired can reach the Lifeline by calling 711 and then 988. Spanish-speaking counselors are available at 1-888-628-9454. From 3 p.m. to 2 a.m., counselors are available with training to help support LGBTQ callers 25 and younger.

North Carolina’s 988 call center is in Greenville, a partnership with REAL Crisis Intervention, Inc. It was established with $1.8 million in grants from the federal Community Mental Health Block Grant program and the Substance Abuse and Mental Health Services Administration.

Anyone who is in mental health-related distress, or is concerned about a loved one in distress, can call or text the number or use the chat available at The service is free and confidential.

What happens if you call or text 988?

Usually within seconds, a counselor will respond and help determine the best way to help solve the caller’s problem. If the person has harmed themselves and is in need of immediate medical care, or is in imminent danger of harming themselves, the counselor can summon help from EMS or law enforcement through a local dispatcher.

However, according to the Substance Abuse and Mental Health Services Administration (SAMSHA), fewer than 2% of calls require connection to emergency services. Most people need an understanding ear and information about how to find additional services nearby.

Renee Rader, assistant director for policy and programs for the N.C. Department of Health and Human Services, said counselors are trained in de-escalation, and often a conversation is enough to resolve the caller’s immediate crisis.

Counselors may then share the names of providers and agencies that can help support the caller, such as behavioral health care, veterans services and housing.

Calls, chats and texts are not traced. For some people, contact with emergency services can be traumatic and dangerous, and whenever possible the Lifeline recommends alternate options such as collaborating on a safety plan, using mobile crisis teams, collaborating with the individual’s loved ones or professionals, or supporting the individual to get to a Crisis Stabilization Unit, emergency department or urgent care.

What has been the response to the switch to 988?

In the second half of July and in the month of August, the most recent months for which statistics are available, NCDHHS says that calls to the suicide prevention line in North Carolina went from an average of 93 per day under the old 10-digit number to 160 per day using 988.

The biggest increase in users, DHHS said, is among youth, with a noticeable increase in calls from children ages 8 to 12.

Rader of DHHS said that is likely because of the ease of remembering 988 and the text and chat options, which especially appeal to youth.

Rader said the state hopes the availability of the 988 service will help reduce child suicide, which has been on the rise. A report by the Child Fatality Task Force in June showed that suicide is the fourth-leading cause of death among children ages 17 and under in 2020. Among children ages 10 to 14, it was the leading cause of death that year.

Can you get long-term help by calling 988?

Counselors in the call center can’t provide long-term help, but they have a list of services provided in areas where the callers live. The problem is, there aren’t enough providers in North Carolina, and the increase in calls since the switch to 988 has highlighted that problem.

Nationwide, researchers say that in 2019 and 2020, nearly 21 percent of adults — more than 50 million people — experienced a mental illness. More than half were not getting treatment. More than 16% of youth ages 12 to 17 reported experienced at least one major depressive episode during the previous year.

North Carolina ranks 12th in the nation in terms of the prevalence of adult mental illness, but is 38th in the nation in access to mental health care, according to the nationwide nonprofit Mental Health America.

N.C. DHHS said in March that 91 of the state’s 100 counties have a shortage of mental healthcare providers, whether county-wide or just in a particular area or among a specific population. Patients may have to wait weeks or months for a first appointment.

What’s being done to improve access to care in NC?

N.C. DHHS said it continues to increase the use of Certified Peer Support Specialists, with more than 4,000 now available in North Carolina. The state recently awarded a nearly $4 million grant to eight community providers to increase the use of Certified Peers.

The state also has awarded more than $4 million in grants to fund 15 mobile units across the state to provide screening, assessment, treatment, primary care and recovery support services.

The agency also said it is funding addiction medicine fellowships, professional development scholarships, continuing education courses and provider training, and is starting a Mobile Outreach, Response, Engagement and Stabilization (MORES) pilot with funding through Duke Endowment and a Mental Health Block Grant in seven counties.

Some private insurers are trying to help. In July, Blue Cross and Blue Shield of North Carolina said it would invest $2 million to support 11 organizations across the state to improve access to care in rural and marginalized communities and in areas where providers are scarce.

The company said the funding is part of its effort to address racial, health and geographical disparities in North Carolina and supports the company’s goal to improve access to behavioral health care in rural and underserved communities by 25% in five years.

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