It’s been two months since the 988 Suicide and Crisis Lifeline was launched nationally, and call volume is starting to level out. A rebranding of the previous crisis numbers — 615-244-7444 locally and 1-800-273-8255 nationally — 988 saw a spike in calls in the days following the launch, up to more than 1,000 statewide in the first week, according to state data. Before the launch, the weekly call volume was averaging around 725, and in recent weeks counts have settled around 811 on average.
In Tennessee, about 43 percent of concerns related to calls were resolved through counseling over the phone, while 25 percent received nonemergency health referrals. Eleven percent received community referrals not related to mental health, and 11 percent received coordination of care. Five percent of calls resulted in a face-to-face mobile crisis evaluation, whereas 2 percent were directed to an emergency department.
“A message that we’ve tried to say is, if you’re having a suicide or a mental health or substance use crisis, call 988,” says Becky Stoll, senior vice president of crisis services at Centerstone. “Don’t call the police, don’t call EMS unless there’s a medical reason to do so, and don’t go to an emergency department unless there’s a reason to do so. Because oftentimes those are not good places for people to end up. They don’t get what they need, and sometimes they incur bills.”
Tennessee has six call centers, and two are in Nashville — Family and Children’s Services, which serves as the Davidson County lead, and Centerstone, which serves a few surrounding counties. The national standard is to have 90 percent of the calls answered locally without relying on a national backup. Tennessee is reaching that rate based on August data, according to a spokesperson for the Tennessee Department of Mental Health and Substance Abuse Services. The department did not supply statistics on texts and chats, which are also available 24/7 through 988 or 988hotline.org.
For the caller, the experience is mostly the same as before the rebranding, except there are fewer numbers to dial. From the provider perspective, the funding is much better — that’s thanks to the Lifeline Improvement Act of 2021 and American Rescue Plan dollars, says Stoll. Before the number change, the hotline was an underfunded and mission-driven voluntary initiative. She says her organization got a stipend of just $1,500 dollars for participating.
“The volume really was increasing year over year, and we really realized at the top of this body, it’s pretty large and heavy, and it’s balancing on these really small spindly legs, and it’s not going to be sustainable,” Stoll says. “At some point, something was going to have to give.”
At first, some organizations hesitated to even publicize the hotline because they feared there wouldn’t be enough capacity, Stoll says.
Federal funding allowed Family and Children’s Services to add four full-time crisis line staff members, as well as a coordinator to help with the well-being of the staff in an attempt to reduce burnout and high turnover rates.
“I hate to say, but that’s one of the wins of the pandemic,” Stoll says. “Mental health is being paid attention to in, I think, unprecedented ways — rightfully so. Behind that has come funding, so you really do have money to hire people to be on the other end of those calls and chats and texts, and be able to help people. Especially given what this pandemic is showing it’s leaving in its wake in terms of mental health.”
Stoll says another important aspect is the capacity to follow up with users of the line.
“The mental health system is rough to navigate,” Stoll says. “Until they are connected, we’re going to try to keep following up.”
While the line is most closely associated with suicidal ideation and suicide attempts, those at the call centers emphasize that it’s there for any mental health or substance abuse crisis.
“988’s national promotion is targeted to people in ‘emotional distress,’ which includes callers that are suffering from anxiety, depression, isolation, bereavement, relationship and family issues, job loss and other significant life events, to name but a few of the reasons why people call,” says Shannon Huffman, director of crisis services at Family and Children’s Services.
“There’s not this guardrailed definition of what a crisis is,” Stoll adds. “If the person themselves experiencing it or the people that care about them define it as a crisis, call or chat or text. Then it’s a crisis. I think that allows for the flexibility of people getting what it is they need when you allow it to be self-defined.”
