On Saturday, amid hope and trepidation, a national experiment in mental health care begins.
That’s when a new three-digit phone number will activate, so people who are contemplating suicide or are otherwise in crisis can connect to a person trained to listen and help. The new code is intended to replace the 10-digit National Suicide Prevention Lifeline — 800-273-8255 — but that number will continue to function.
Just as everyone can remember to call 911 for police or fire, it is hoped that 988 will also be as easy to remember in an emergency, and may even ease the stigma of seeking help.
“A number like 988 makes that call so much easier for an individual in crisis,” said Kathleen C. Marchi, chief executive officer and president of the Boston-based Samaritans Inc., a suicide-prevention agency that provides a help line and other services.
Switching from 10 digits to three might not seem like a big deal, but the 988 line, created by a 2020 federal law, has required states to up their game on call centers, which now must be open around the clock. And questions remain, in Massachusetts and elsewhere, whether the already overstressed mental health system can accommodate the expected increase in people seeking help.
“This crisis line is really one small piece and one small step in reforming the system as a whole,” said Jacqueline Hubbard, policy director for NAMI Massachusetts, an advocacy group. “There needs to be somewhere to call. That’s not the only thing that needs to happen.” People also need better access to care before they reach a crisis point, she added, as well as somewhere to go once they’re in crisis.
Representative Seth Moulton, a Massachusetts Democrat and the lead sponsor of the legislation that created 988, cautioned against letting the perfect be the enemy of the good. “The day this goes live, even if it’s not perfect, it’s going to save lives,” he said. “There are too many people who don’t get any help.”
Although 988 was established by federal law, each state must set up its own system. A survey by the RAND Corporation, published in June, found that many state officials around the country don’t feel ready for the 988 launch, although the report didn’t provide state-specific information. In Massachusetts, the Executive Office of Health and Human Services, which is overseeing the 988 effort here, declined to make anyone available for an interview.
But three leaders of the private agencies that will answer the calls expressed confidence they are ready for an influx.
“We feel very well prepared and very well supported by the state,” Marchi said.
Massachusetts starts with an advantage: It already has five suicide call-in centers. In addition to Marchi’s agency, Call2Talk in Framingham, Samaritans on Cape Cod and the Islands, Samaritans of Merrimack Valley, and Samaritans Southcoast will be answering 988 calls.
But until now, only two have operated 24-7, and all have relied heavily on volunteers. In preparation for 988, the centers plan a mix of volunteers and paid employees, working around the clock. The agencies have spent the past few months hiring and training staff — a challenge at a time when the health care industry faces a staffing crisis.
While training differs from center to center, it typically involves dozens of hours of instruction, followed by shadowing a call center worker, and then taking calls under supervision.
The National Suicide Prevention Lifeline, established in 2005, received fewer than 50,000 calls in its first year, but by 2020, that number had soared to more than 2.6 million. The 988 line is expected to draw even more callers, although no one in the industry really knows how many more, leaving agencies to guess at their staffing needs.
“It’s a crystal ball situation,” said Deborah Helms, director of Samaritans of Merrimack Valley. “We are gearing up to be overstaffed if possible.”
Eileen Davis, director of Call2Talk, said it would be foolish not to expect an increase in callers. “With anything new, there will be a significant demand,” she said. “We have not only people that really need it, we have the curiosity factor — people trying to figure out exactly what it is.”
Additionally there’s an increased need for mental health care. “I don’t think you can go a day any more without people talking about mental health and what we’re enduring in this country right now,” Davis said.
Because the 988 line isn’t working now, no advance advertising is planned. But when it’s activated on July 16, all existing references to the National Suicide Prevention Lifeline will change to 988 on websites, social media, and billboards.
If any local agency is overwhelmed, calls will be routed to the national line, but callers may have to wait for someone to pick up.
Danna Mauch, chief executive of the Massachusetts Association for Mental Health, has heard the agencies are struggling to staff up. Still, she feels “optimistic but realistic” about the launch.
“It takes time to implement things and get it right,” she said. “We’ll see in the first months what demand looks like. Everyone has pledged to make the necessary adjustments once we have more data.”
In Massachusetts, the 988 launch is being funded by $11.7 million in state money and $2.5 million in federal funding. But it’s unclear how the state will continue to fund it long term. The RAND survey on readiness for 988 found that few states had passed legislation imposing a 988 surcharge on phone bills, similar to the surcharge some states use to finance 911 call systems. Only 16 percent of respondents said they had a budget to support 988.
When someone dials 988, the call will be routed to the nearest call center based on the caller’s area code, just as happens now with the National Suicide Prevention Lifeline. People calling from cellphones with out-of-state area codes will be routed to a call center in that area code, where they will receive listening and support. If they seek additional care, the center will refer them to resources in their community.
“Most callers are calling for what we provide — free, compassionate, nonjudgmental listening and validation,” Davis said. “Most callers do not ask for or need resources.”
If someone is in immediate risk, the call center will contact 911 dispatchers, as they do currently. The call centers will also be able to connect with the state’s Emergency Services Program for those who need support but are not at imminent risk of suicide. A counselor will meet the person at home, or wherever they are, to assess their situation and connect them with appropriate services.
Starting next year, the centers are hopeful they can connect callers with a broader array of services through the state’s new network of community-based behavioral health organizations. On Thursday, the Baker administration announced that 25 agencies had been designated to fulfill this role by expanding access to routine, urgent, and crisis treatment for mental health and substance use disorders.
All the Massachusetts call centers have translation services for more than 100 languages, and some have bilingual staffers who may be available to take calls from people who don’t speak English. The National Suicide Prevention Lifeline also has a Spanish line.
People who are deaf or hard of hearing may use their preferred relay service or dial 711, then 1-800-273-8255.
For people who prefer to text, the National Suicide Prevention Lifeline offers an online chat function, but it requires pausing to fill out a survey. Some of the crisis centers have their own chat services as well.
Helms said most people want to hear a voice.
“That’s why a lot of people call us,” she said. “They’re overwhelmed and may not have anyone to talk to. Hearing that warm voice on the other end does a lot itself.”