July marks the first anniversary of the nationwide implementation of the 988 lifeline number for those experiencing a mental health crisis.
And while there were initial challenges in Illinois, Andy Wade, executive director of the National Alliance on Mental Illness’ Illinois branch, recently told Health News Illinois that the first year of 988 has been a “solid work in progress.”
Data released last year by Vibrant Emotional Health, the administrator of the National Suicide Prevention Lifeline, found just one in five calls in Illinois were answered by in-state call centers in the first three months of 2022
But after what Wade called considerable efforts to bolster the system, including $70 million in last year’s state budget to implement the 988 call center and increase staffing at six call centers across Illinois, those receiving in-state help has grown.
A recent analysis by KFF found about 86 percent of the roughly 23,000 calls made to 988 in April and May were answered by in-state call centers.
Wade also spoke on what challenges remain in implementing 988, as well as a working group established by the General Assembly to review the state’s progress in implementing 988 operations.
Edited excerpts below:
HNI: How was the first year of 988 in Illinois?
AW: It’s a solid work in progress. I would say there have been some very important successes, especially in states like Illinois, that may have been behind when all of this started, just in terms of catching up. The complexity of the crisis response system is pretty big. We still have a long way to go, but I would say the fact that 988 is up and running is a pretty significant accomplishment in and of itself. 988 probably would have been a couple of years farther down the road if it hadn’t been for the COVID-19 pandemic. And I would say that in Illinois, the most significant change is that the in-state response rate has dramatically turned around in about a year. So that’s pretty impressive. That doesn’t tell the whole story, but that’s probably the biggest single achievement. It’s important for calls to be answered locally, because generally once people are through a crisis, they’re still going to need some support. And if the person on the other end of the line doesn’t know where you live and doesn’t know what’s around there and can’t point you to where you need to go, it can kind of leave it hanging.
The other thing in Illinois is that we’re a little bit unique in terms of how our crisis response legislation is structured. The mobile response teams exist in Illinois. We have separate legislation that created them, which means that we actually have a very strong focus on safe and appropriate mobile response. But since it’s a different area of law, connecting the dots is a little bit more complicated. So those are the two that are sort of most immediately in front of everybody right now, the need for more crisis stabilization centers and places to go. That’s going to be something that you hear more and more about.
HNI: How was Illinois able to improve its in-state response capacity?
AW: It’s fairly straightforward. We put money into a system that had long been underfunded. Illinois had six in-state call centers, and I think the response rate … was lowest in the nation. And so just by increasing funding to the existing centers, but then more significantly, creating a statewide call center that operates out of Bloomington that is framed as an overflow center, that right there is what significantly increased the people power right here in Illinois to answer those calls. So that’s the most immediate driver of that. I would say though, as that is begun, there’s an emphasis on depth and quality now that I think is going to be an ongoing thing. Lifeline centers are one kind of call center. There are also warmlines. And not all call centers are the same. So really, the more you invest in a crisis response center, the better services you’re going to get.
HNI: What challenges remain?
AW: One thing to keep in mind is that a mental health crisis is something that happens very locally. And if you are in a rural area, for example and it takes 15 minutes for a mobile responder to reach you, that’s an issue. So I think you’re going to see in rural communities issues of capacity related to geography. If the response system is slow, in a mental health situation, moments can count. So that’s one. I think the other thing that you will see is that there’s just a shortage of places for people to go and get care. Right now, if you are in an emergency room with a mental health crisis right now, you could sit there for three, four or five days before a placement can be found, and they may not find a placement. Not everybody needs an inpatient placement. There are drop-in centers or outpatient care, but there’s a shortage. We were in shortage mode well before the pandemic, and now you have rising demand. The good news is that people know about 988 and they know that crisis systems exist and more people are calling, so more people are asking for help, and the number is growing.
This is a nuts-and-bolts kind of thing. It took 30 years for 911 to get to be where it is. So you have different systems that are similar and that I think most people assume are connected. But they’re not, and the articulation between all of the different mental health crisis lines or resources and points of entry really needs to be clarified and consolidated. I remember that I started this job three weeks into the pandemic, and one of the first things we did was just cut and paste a list of all of the different support lines onto a handout, because there were so many. And so what 988 really does, it begins moving us down the path where there truly is no wrong door. You can walk in one place and get services. But right now, 988 is not fully articulated with 911. If it’s not fully articulated with things like the Illinois warmline, which is when you’re not in crisis, but need support. If it’s not fully articulated with the multiple response teams, people will lose confidence and then they’ll stop asking for help. And so I think that’s actually one of the bigger dangers.
HNI: Where is public awareness of 988?
AW: It’s not very high. I think that, in a way, some of that was a little bit purposeful because when it was initially rolling out, there was some thoughtful concern about not wanting to raise awareness for a system that was still getting off the ground. A year later, we’re in a different place. A year later, this is something and it’s time for people to know about this. I think that the (public relations) aspect of this will grow. But, again, the risk is if we’re going to raise the bar for public awareness, we have to guarantee that people get a good response and the right experience. There’s no easy way to get one thing right at a time. The connection between 988, the mobile response and then the traditional legacy emergency responder system, that’s kind of the immediate focus.
HNI: What will the working group established by the Assembly be considering?
The idea was just to create more visibility across all parts of the behavioral health system and all parts of government to connect the dots. But the immediate focus is on the depth and quality of the 988 experience. And so the working group is going to be drawn from across different stakeholders. You’ll have some 988 call centers, some other kind of call centers, groups like NAMI — we hope — will be appointed and leaders in government. It’ll be doing that year one gut check to clarify what the priorities are. I also think it’s going to elevate the political importance of 988 as a priority in the state of Illinois. That’s a positive thing. What the working group will be doing is looking at the data, looking at performance against the (Substance Abuse and Mental Health Services Administration) metrics, and, I hope, looking pretty closely at the articulation with the other parts of the system. The 988 legislation and the emergency responder legislation, because they’re separate pieces of law, it’s going to be incumbent on all of us to make sure these connect. Because if you have similar efforts on parallel paths, that’s fine. But if they’re not articulating soon, it’s not great.