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'People are calling': More Californians are reaching out to 988 mental health hotline

Those who are in a mental health crisis can start calling 988, the number for the national suicide hotline.
Those who are in a mental health crisis can start calling 988, the number for the national suicide hotline.

For Amanda Wood, the first counselor hired to service the new 988 mental health hotline at the Crisis Support Services of Alameda County, one story sticks out.

She was working an overnight shift when a young man called, and told her he was thinking of killing himself and others.

“His and his family's safety was at high risk,” she said. “From the beginning of the call, I knew how important it was to take my time.”

Wood had a supervisor jump on the call with her to listen and give suggestions on how to walk the tightrope of validation and de-escalation. She asked him to role-play out conversations he could have with family, and, after realizing he would benefit from in-person help, connected him with a crisis stabilization center in the area.

Wood’s one-hour call was one of 280,637 contacts — including calls, texts and chats — that were made to the 988 number in California between its rollout in July 2022 and May 2023. Aggregated data from California’s crisis response centers show calls are up 28% since the easy-to-remember number went into operation.

Interacting with 988 counselors does seem to be lowering suicidality among contacts. According to officials with Didi Hirsch Mental Health Services, the state’s largest crisis response center, only 2% of calls require intervention like Wood’s case did. The majority, 98%, are resolved on the phone by trained counselors.

During a press conference held to recognize the one year anniversary of 988, Wood said she was grateful the young man she spoke with called in a time of “dire need” and collaborated with her “on an effective safety plan.”

Health leaders on the local and national level say that for the 2% who do require intervention, the stage is set for a more robust crisis response that could lean more heavily on trained workers like Amanda, and less on police.

‘Someone to talk to, someone to respond, a safe place to go’

During a press conference Thursday to introduce the new 988 Spanish text and chat options, U.S. Health and Human Services Secretary Xavier Becerra shared that calls to the hotline are up nationally. Five million contacts were made across the country in the last year, 2 million more than the year previously.

“People are calling, which is great. But it’s not so great because so many people are calling; so many people are hurting,” he said. “We know we have work to do.”

Becerra added that the priority now is to build on the follow-up services of the lifeline.

Prompted by videos and stories of poorly handled crisis intervention by police, activists have pushed for alternatives to calling law enforcement during crises. There’s also been growing recognition that emergency rooms and jails are not the best places for people to get mental health treatment. Grassroots initiatives like ‘MH First’ — a project launched by the Anti Police Terror Project in January 2020 — have deployed mobile crisis units to scenes of distress and been an alternative to police in Sacramento.

Jonathan Porteus is the CEO of WellSpace Health, which serves as the crisis hotline for 26 counties, including Sacramento. He pointed to a crisis care model that is also touted by the National Alliance on Mental Illness: “Someone to talk to, someone to respond, a safe place to go.”

Porteus said the 988 program fulfills the first step of someone to talk to, and the priority now is to build out and invest in mobile crisis teams and crisis stabilization locations.

“The challenge and the opportunity is to create an appropriate conveyer, an appropriate continuum to receive those calls and do the right thing with them,” he said.

In 2020, WellSpace opened the Crisis Receiving for Behavioral Health location downtown. Referred to as the “Crib” program, it receives people who are experiencing a mental health crisis or substance intoxication and allows them to stay for 24 hours and be connected to other services. The center, which opened in 2020, has capacity for 25 people, and 5 staff members are on site at all times.

More funding for mobile crisis teams and spaces like Crib may be coming down the line in California. AB 988, passed last fall, created a surcharge on phone lines of 8 cents per month to help raise money for the operation of crisis response centers and the operation of mobile crisis response teams. That amount could be raised to up to 30 cents per month, starting in 2025.

WellSpace is anticipating the number of contacts to 988 will triple in the coming years, an estimate in line with other projections.

I’m interested in how health care policy impacts Sacramento and California, who gets access to care and the issues facing health care providers.
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