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New 988 hotline is 'the front door' to help. But what's next for Washingtonians in need?

caption: A Crisis Connections phone worker answers a call.
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A Crisis Connections phone worker answers a call.
KUOW Photo / Noel Gasca

For the past month, people experiencing mental health crises have been able to dial 988 for help.

The 988 hotline is available nationwide 24 hours a day, seven days a week.

Congress approved the universal hotline in 2020, in part, because it's easier to remember than the former 10-digit National Suicide Prevention Lifeline, which is still active.

If you or someone you know is experiencing a mental health crisis or considering self-harm, call or text 988 for help. You can also contact the National Suicide Prevention Lifeline at 1-800-273-8255.

Michelle McDaniel is the CEO of Crisis Connections, which operates the 988 line in King County. She said the organization has received about 25% more calls since the new hotline went live.

That's been harder to keep up with in some parts of the state, but overall, McDaniel said Washington state took steps to ensure operators were ready.

Congress did not provide funding for the states to roll out the 988 line, she explained. Washington was one of just four states that adopted legislation to fund the effort. Lawmakers approved a 24-cent monthly tax on phone and internet lines; that fee will increase to 40 cents per month starting next year, according to The Seattle Times.

That fee allowed crisis call centers, like Crisis Connections, to staff up for the anticipated increase in calls. Now, she says 90% of calls or more are answered within 30 seconds.

"There are very few places anywhere where you're able to pick up a phone and get that kind of [timely] support," McDaniel said. "We're really trained to be able to meet people where they're at and navigate any type of crisis."

That's not limited to people experiencing dire crises, either.

While the hotline's official name is the 988 Suicide and Crisis Lifeline, McDaniel said anyone is welcome to call for help, whether they're experiencing mild anxiety or trying to get help for a loved one.

"It's common for us to have callers who simply are feeling isolated, feeling alone, having a difficult time," she said. "About 30% of our calls are about someone else, someone worried about a family member who they think may have relapsed or concerned even about a person who is outside their home, who may be unhoused, and they want to have a conversation about how they can support them. Those are not uncommon types of calls."

The staff at Crisis Connections and hotline operators across the country are trained to help people in a variety of situations, who have a variety of needs. Sometimes people just need to talk. But others need more immediate, potentially life-saving interventions.

"People call crisis lines because they want to live," McDaniel said. "We want to make sure that people don't say, 'Oh well, it's not so bad. I'm not feeling suicidal, or I don't feel that depressed.' Any issue, we are available to navigate that with you. It doesn't have to get to the point where it's a severe crisis."

Of course, the 988 line is there for people in crisis, too.

If you or someone you know is experiencing a mental health crisis or considering self-harm, call or text 988 for help. You can also contact the National Suicide Prevention Lifeline at 1-800-273-8255.

While the rollout of the 988 line seems to have successfully reached more people in need, it has not been without its hiccups.

Some mental health advocates have publicly expressed concerns that calling 988 could lead to police involvement in mental health crises or even involuntary treatment.

Like 911, the 988 line is intended to be easy to remember and dial in a crisis. But also like 911, 988 is seen by some as a potential connection to law enforcement officers who may not be trained to handle those crises, as NPR recently reported.

Emily Krebs is a suicide researcher. She told NPR involuntary treatment is seen as a necessary part of suicide prevention in the U.S. but not in other countries. She took to Twitter to warn potential 988 callers that their cases could be referred to police.

McDaniel said some crisis line calls do become "active rescues" involving law enforcement.

There's more to it than that, though.

And McDaniel hopes concerns about police involvement, among other things, won't stop people from getting help through the 988 line.

She spoke with KUOW's Angela King about some of those concerns and what Washington state should do next to hep the people who call.

This interview has been edited for clarity.

Angela King: If someone has a Florida phone number, and they call 988: Would they be directed to somebody in Florida first?

Michelle McDaniel: One of the components of the 988 hotline is that you will be routed to the call center with which your area code is associated. So, for example, if I have a 206 number, but I am calling from Florida, I'm going to get routed to my call center, to Crisis Connections (in Washington), even though I may be in Florida. And of course, the opposite is true; somebody with a Dallas phone number could be in Federal Way, so they're actually going to be routed to the Dallas call center. Over time, nationally, we're hoping to address that with geolocation. The idea is that wherever you are physically, you will be routed to the closest call center. That's down the road, another phase to help folks get connected to their local crisis center.

Part of this also has created some misinformation in the community. There's this idea that when somebody calls 988, that crisis call centers like ours are able to actually locate where you're at. That is not correct. We are not able to trace anyone. And actually, our interest is not to be able to find someone — we want these folks to be anonymous. We want this to be a safe place for people to call. So in the future, even when we have geolocation, the point will be just to make sure that people get connected to the call center that's closest to them, the people who know the resources in the community they're in.

Some mental health advocates have warned people about using the 988 line, because there are concerns that law enforcement could get involved or callers could be treated involuntarily. Your take on those concerns?

To be honest, there's just clear misinformation or misunderstanding. As I mentioned before, Crisis Connections is one of the oldest crisis lines in the United States. We've been providing anonymous and non-judgmental crisis intervention since 1964. There is no way that we are able to trace a call — we don't have that capacity, nor do we have any interest to do so.

But I will tell you that there are very rare occasions where somebody calls a crisis line like ours, and for some reason, they're actually not participating in trying to reduce their lethality; they are actively suicidal or homicidal. Our staff and volunteers are trained to work with someone, to help them navigate through that crisis. There are very rare times where somebody is not participating in in de-escalating that situation. So, nationally about 2% of calls to crisis lines end up becoming an active rescue where we do have to get 911 involved; at Crisis Connections, my organization, it's actually less than 1%. In those cases, we are concerned that someone is going to harm themselves or others.

When that happens, crisis lines like ours are not able to trace that call. Instead, we will have a staff member contact 911 and say, "here's everything we know about the situation." At that point, it is law enforcement that would try to figure out if they can locate that person. What has been portrayed, and primarily portrayed on social media is, if you call 988, they could actually target where you're at and come get you and involuntarily detain you. Completely untrue. Our job is to not try to take away your rights. Our job is to help you navigate through a crisis.

But are concerns about police involvement legit, in your opinion? Some folks are worried that getting law enforcement involved could lead to another case like that of Charleena Lyles, a pregnant mother of four who relatives say was suffering a mental health crisis when she called 911 to report a suspected break-in.

Police wound up shooting her to death after they said she came at them with a knife. Mind you, she called 911 in the first place, not a crisis help line. But this case seems to be an example to some people about how these calls can go wrong.

Absolutely. There's the category, I say, of misinformation that 988 is going to dispatch police and it's not a safe place to call. That's the misinformation part. But there is a valid concern out there, which is around what happens in a mental health crisis if police are dispatched and do get involved.

The reality is that police showing up ... even for the most well-trained officer, that alone can escalate a situation. Compare that with trained mental health professionals in an unmarked car, not in uniform, not carrying any weapons; they are trained, specifically, to deescalate a situation. We have to be very clear that we want to have the right resources and the right trained people for the situation.

If this is a situation where someone is in danger of harming themselves or others, we have to make sure that that is contained by officers who are trained in how to deescalate that situation. But if it's a behavioral health crisis, we want to make sure that we have behavioral health professionals that are showing up to that scene.

This is where working together with law enforcement to provide better training, provide clarity is going to be really critical. We are talking with law enforcement, we are working with 911 to be able to have clarity on what we can do to make sure that another situation like Charleena Lyles doesn't happen. That is unacceptable. That is a situation where somebody was in a mental health crisis. We want to make sure that that is deescalated and that someone does not die because they had a mental health crisis.

What next steps would you like to see the state take to strengthen this effort and get closer to the promise of creating an entirely integrated system across the state?

Really, that's the larger promise of 988. What we're focused on in Washington state, particularly, is that this is an opportunity to reform the behavioral health crisis system. I personally have been working in health and human services in western Washington for over 30 years. It is an antiquated system. There are not enough resources. Far too many people are taken to jail or are put in a hospital. We need a whole array of services that are available 24/7 for people who are in emotional or chemical dependency crisis. The 988 hotline is that front door to the behavioral health system.

When Congress passed the legislation for the national hotline back in 2020, they said the 988 line would be live in July 2022. What would have been really helpful, to be honest, is so much more time to actually build out the whole array of mental health services that are needed. The 988 call centers, again, are the front door. We've been focusing on that area to make sure that there's capacity, because we're inviting people in. No issue is too big or too small. You don't have to be in a situation where you're contemplating suicide to call 988. You could be calling about anxiety, depression, difficulties being a parent of a teenager. You can also call about other people that you care about in your life. That's an open door.

If you or someone you know is experiencing a mental health crisis or considering self-harm, call or text 988 for help. You can also contact the National Suicide Prevention Lifeline at 1-800-273-8255.

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