Suicide is the leading cause of death in the United States and according to the Centers for Disease Control (CDC), nearly 46,000 people died by suicide in 2020 in the U.S. This is about one death every 11 minutes.

Starting 16 July, the U.S. will roll out an official mental-health hotline. Similar to 911, the 988 hotline will act as an emergency number and route callers to trained counsellors that are part of the existing National Suicide Prevention Lifeline network, which in the past required dialling ten digits. The Lifeline, which debuted in 2005 and saw 50,000 callers that year saw a stark increase at the height of the pandemic, clocking over 2 million calls in 2020 alone.

In 2020, the U.S. passed the National Suicide Hotline Designation Act which designated 988 as the universal telephone number for a national suicide prevention and mental health crisis hotline. Additionally, the Act required that the hotline include a strategy to provide specialised services for LGBTQ youth, who are 4 times more likely to contemplate suicide than their non-LGBTQ peers.

While the legislation enacted nearly two years ago has been lauded, others are cautiously optimistic when it comes to ensuring that the hotline will be properly implemented. “Having a universal 988 hotline is a great idea and can potentially be a wonderful, easy to remember, much-needed resource for the many people in the U.S. suffering from mental illness or in need of crisis intervention,” notes Hanna Tessema Palladium Health Monitoring and Evaluation Advisor. “But I worry about the implementation in practice,” she adds.

Though the Act may have mandated the 988 launch, it left much of the funding and infrastructure decisions up to the individual states. The U.S. Department of Health and Human Services has allocated upwards of US$400 million to assist with the rollout and several federal grants are allowing centres to hire more counsellors to meet what’s expected to be an increased influx of calls and texts.

“It will be particularly important to provide additional resources that support the 988 hotline,” adds Tessema. “If the staff aren’t trained appropriately, they run the risk of re-traumatising people or triggering survivors of trauma, effectively making the situation far worse.”

Part of a wider push to increase access to mental health and substance use disorder support and resources, the launch of the hotline marks a push in the U.S. to move away from relying upon law enforcement to handle these often delicate situations. Several cities around the U.S. are piloting programs that avoid sending police as first responders to mental health calls and instead sending unarmed trained behavioural health professionals to provide appropriate support. But as Tessema adds, providing that support requires critical training.

“My immediate thoughts are when you provide an opportunity for people to share such serious concerns on a hotline, you really want to make sure that the people picking up the call are well trained and equipped to address the issues, that there are culturally, and linguistically appropriate communications and resources provided, and of course, that there are enough staff to answer the calls,” Tessema explains.

Her concerns aren’t entirely unfounded. A recent survey of public health officials rolling out the 988 line found that in jurisdictions with hotlines, 55% had staff trained to interact with children and adolescents and only 45% had training to interact with other populations like people experiencing homelessness or LGBTQ individuals.

Awareness and Support for Mental Health

Despite the concerns around implementation, Tessema adds that it’s very timely to be having this discussion during National Minority Mental Health Awareness Month, a time intended to bring awareness to the distinct struggles of racial and ethnic minorities in the U.S. around mental health. “It is especially important that high-quality support services are provided to communities of colour, who are often underserved, misdiagnosed, and tend not to seek help around mental health issues,” she notes.

“People of colour in the U.S. also experience subtle and overt traumas caused by racism and there are not enough Black or African American behavioural health providers to offer support.” She’s hopeful that the hotline may help bridge the gap and provide appropriate support services around mental health to those who can most benefit from it.

In the U.S. where nearly one in five people are living with a mental health condition, the 988 hotline is an important step forward, and one part of a broader, much-needed mental health strategy for the U.S.

For more information, contact info@thepalladiumgroup.com.