US mental health hotline network expands, but rural areas still face shortage of care

The National Suicide Prevention Lifeline 988, which launched on July 16, is designed as a universal mental health support tool for callers anytime, anywhere.

But the US is a patchwork of crisis relief resources, so what follows is not universal. The level of support that 988 callers receive depends on their postcode.

In particular, rural Americans, who die by suicide at a much higher rate than urban residents, often have trouble accessing mental health services. Although 988 may connect them to a call center close to home, they may find themselves directed to distant resources.

The new system is supposed to give people an alternative to 911, but rural callers experiencing a mental health crisis may still be met by law enforcement officers rather than mental health professionals.

More than 150 million people in the U.S. — most from rural or semi-rural communities — live in places designated as mental health professional shortage areas by the federal Health Resources and Services Administration. That means their communities don’t have enough mental health providers — usually psychiatrists — to serve the population.

The Biden administration allocated about $105 million to states to help increase staffing of local crisis centers for the new 988 system. But states are responsible for filling any gaps in the continuity of care that callers rely on if they need more than a phone call. States also assume most of the responsibility for staffing and funding their 988 call centers after federal funding runs out.

The federal Substance Abuse and Mental Health Services Administration, which operates the existing 800-273-8255 helpline that 988 is expanding, said a state that launches a successful 988 program will ensure that callers have a mental health professional with whom to talk to, a mobile crisis team to respond to them, and a place to go—like a short-term residential crisis stabilization facility—that offers diagnosis and treatment. The federal agency also intends for 988 to reduce reliance on law enforcement, expand access to mental health care and ease pressure on emergency rooms.

These objectives may not be met equally in all countries or communities.

If the call center doesn’t have a mobile crisis team to send, “you don’t have the stabilization, then you’re basically going from the call center — if they can’t meet your needs — to the emergency room,” said Dr. Brian Hepburn, executive director of the National Association of State Directors of Mental Health Programs. The group has developed model 988 legislation for states that emphasizes the need for consistent service regardless of the caller’s location.

For the new call system to be consistent, “you really need that full continuum of care,” Hepburn said. “The expectation is not that it’s available now. The expectation is, he said, that your state will eventually take you there.

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