“988 is more than a number, it is a message: we’re there for you. Through this and other actions, we are treating mental health as a priority and putting crisis care in reach for more Americans.” — HHS Secretary Xavier Becerra
Only July 16, 2022, the Federal government launched 988, a crisis line devoted to increasing outreach for people struggling with serious mental health problems including suicidality:
“The 988 Suicide & Crisis Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week in the United States.”
A mental health crisis has been ballooning over the last decade. It has caught critical attention in light of its interaction with the pandemic, punctuated by the impacts of grief and loss. A workforce long plagued by licensing variation, lopsided pay structures and cultural incompetence is buckling under this public health emergency. It’s clear we need to make improvements where gaps create the greatest risk. There’s a lot of work to do to invest in a healthier society, and our leaders have started with this urgent need: increasing emergency services.
A shocking number of 911 calls are made because of mental health crises. Police are dispatched. The risk of harm increases. A quarter of all people killed by the police have documented mental health problems; the risk for violence increases substantially for Black men who have mental health concerns. One piece of this problem — one that has more widespread support than addressing police brutality — is to reduce the calls made to 911 for mental health issues in the first place.
988 will route callers to local crisis centers where folx answering calls can offer immediate live support and also make recommendations for follow-up and wrap-around services. Texting and online chat are available, as well as services for Spanish speakers, the deaf and hard of hearing — and a dedicated Veterans Crisis Line.
The approaches and quality of care will depend largely on what is available locally. However, the 988’s architects are making two important commitments: 1) a substantial amount of Federal dollars are being devoted to increasing capacity in local crisis centers and 2) if you get a busy signal at your local center, your call gets rerouted to another center so you don’t wait to speak to someone.
This initiative will be most effective if it begins a domino effect. State governments need to follow suit and properly support local efforts. There are a multitude of ways that private and public industry can partner to make mental health a priority. As it stands, 988 does not create new infrastructure. So there are a lot of open questions around what common patterns of response will be. In many places, depending on the nature of the crisis, problems related to overpolicing and overmedicalization of mental health emergencies will be replicated, even exacerbated. In areas with strategic investment and a commitment to inclusion, new approaches can flourish.
Research on the efficacy of crisis lines demonstrates promise but also caution. We only know that crisis lines make short-term impacts; people who call are often high-risk, describe immediate relief and reduced suicidal ideation, and especially benefit from person-to-person chat. We know very little about the long-term and broader impacts of crisis lines as intervention.
This conversation is a decidedly Jewish one as well. Black and indigenous scholars have long called for community-care models as critical to mental wellness. Our Jewish communities offer opportunities for mental wellness within relationships that decrease isolation and increase interdependence. While 988 joins intervention models focused on individualized self-care strategies, the attention raised is an overall call to action.
Crisis lines serve a single purpose at a single time point. However, our best shared intervention strategy, backed by decades of research, is to invest in relationships and community care. Below are research-backed strategies to help us care for each other and reduce suicidality. These are not failsafe strategies. Mental health is complicated. But if our BHG (big hairy goal) is to eradicate suicidality and not just respond once crisis presents, these are steps we can all take toward a healthier future.
- Call trans kids by their chosen names. And generally normalize love is love.
- Reduce oppressive structures and practices in your work, school and home.
- Discuss race, class, gender and other elements of structural oppression in your home.
- Talk about mental health, risk taking behaviors and suicidality with care.
- Invest in relationships.
- Practice optimistic, future thinking in community.
- Make mental health a practice and not a crisis.