Reforming our mental health crisis system
One month in, how are we doing with 988?
There are very few options of what you can access if you or a loved one are experiencing a mental health crisis. Sadly, these options usually lead to only more frustration and a further delay in receiving actual help. Up until now, most of our crisis response has meant that people end up in emergency departments, jails, or in some cases die.
It’s obvious that there has needed to be a better way for responding to mental health crises for some time. Enter 988. As I have written about before, 988 is a “Trojan Horse” of sorts for broader mental health reform. It forces us to reconsider who does what, how we pay for care, and even how we can better bring care to where people are. This past July, 988 rolled out nationwide as a new way to give people a person to call, someone to help, and even, in some communities, a place to go. So how are we doing?
Well, we’ve had roughly two months to implement a pretty complex reform to how we respond to suicide prevention and mental health crises. Preliminary data from Health and Human Services released last Friday give us a hint at how things are going. The bottom line? There’s good reason to be optimistic.
The data look at August this year, one month into implementation, with August from last year, which used the old call in number 1 800 273-8255 (a number that still works while we transition to 988). There are a few things that stand out to me from their report.
First, there was a 45% increase in call, chat, and text volume, which does not include the veterans line (press 1 when you dial 988 for this option). This finding is not to be unexpected or at all surprising considering the ongoing demand for help and the ease of a new number. While there has been little to no marketing and/or communication about 988, people are still finding out about it through local media, national outlets, and even one page ad buys.
Second, there were about 300,000 calls this August compared to around 165,000 last August. More people calling in is great - and when you look across calls, chat, and text, an interesting trend that emerges is the huge increase in number of people using text. A whopping 1000% increase in text from last year. I think this says a lot about how people are willing to engage using technology and the ease that text offers a connection to someone who can help.
Third, we saw more engagement with counselors – this is the actual number of people who were able to talk or be connected to a trained professional. This is an important distinction from just calling the number or having your call answered – it’s actually about getting connected to someone beyond the person who answered the phone. These increases were significantly more modest speaking to the ongoing challenge we are going to have finding the right kinds of people who can help and help quickly.
Fourth, the speed in which the calls, chat, and text were answered improved dramatically. As one example, last August the average call response time was 2:30 and this August wait times went down to 42 seconds, a 72% decrease in wait time. I know there was a lot of concern about people hanging up because of wait times, and this data point is indeed encouraging. It will be interesting to see if these trends continue as more people call – and how our workforce helps or hinders this.
While this is only one month, you can see a pretty significant improvement in performance data from the year prior. Again, good news and encouraging.
There are other things that are important to highlight:
1) This is only one month. A great start but there’s a long way to go. We know that there are details to implement 988 that still need to be ironed out.
2) It’s not clear how often we will see new data on how the line is doing. Are there plans for monthly data drops? A public dashboard? All of these would be extremely useful for policy makers and advocates to be able to help assure progress and to know how best to invest resources. Transparency is important!
3) Having state specific data would be extremely useful. We know there are going to be disparities across the states due to some states passing legislation to support 988 and their call centers. Further, some states have done more planning than others. In the aggregate, its impossible to tell who might need help and who’s doing fine. It is fair to say that if we broke down the data, state by state, that everything from wait times to actually connecting with care are going to vary widely.
4) We don’t know what percentage of calls went to 911 (there is a vague reference in the HHS brief that this was only 2%, but that seems hard to believe) – this is likely going to be a longer term issue as more people call.
5) We don’t know what outcomes have been achieved just yet beyond calls answered – not an easy thing to do, but I am sure that states are looking at ways to measure the impact of 988.
6) Workforce remains a major issue and will continue to for the foreseeable future. Almost every state is looking to hire more professionals to staff the over 200 lines across the country. Without a clear recruitment and retention strategy, we are going to see a lot of jobs that need to be filled, which will only increase wait times and availability of help over time.
All in all, I don’t think there’s anything that’s too surprising here. More people are calling and getting help. That was always the intent and goal of 988 - to save lives.
As my data friends always remind me, one data point is not a trend. Let’s hope with ongoing adequate investment in 988 that we see these data continue to improve and show us trends that the line is getting increasingly more efficient and effective at what it does.