A new study published in JAMA Psychiatry looked at changes in specialty crisis services offered before and after the launch of the 988 suicide and crisis lifeline.
“The 988 number is designed to be easier to remember than the previous number, 1-800-273-8255, and it also has a broader scope, focusing on mental health crises rather than just suicide,” study author Jonathan Cantor told us. “The switch to a simpler number aimed to enhance recall and awareness of the suicide lifeline. There has been a noticeable increase in contacts to 988. We aimed to assess whether the crisis support infrastructure changed during this rise in demand.”
The research team anticipated that the availability of crisis services would increase following the introduction of 988. This expectation stemmed from the rise in contacts with 988, leading us to believe that other components of the crisis sector would also expand in response.
“With the increase in contacts to 988, we felt it was important to determine whether the supply of crisis services also increased in tandem,” Cantor told us. “Since 988 is only one part of the crisis care continuum, its success will depend on how effectively it integrates with the broader mental healthcare system.”
The researchers utilized data from RAND’s Mental health and Addiction Treatment Tracking Repository to measure changes in the percentage of mental health treatment facilities offering four specific crisis services before and after the launch of 988.
“The most intriguing results, in my view, is a slight decline in the offering of crisis services from before to after the launch of 988,” Cantor told us. “We observed declines in psychiatric emergency walk-in services, mobile crisis response, and suicide prevention services. We did find an increase in peer support services. But that increase started even before the launch of 988.”
The researchers discovered certified community behavioral health clinics were more likely to offer crisis services. This is encouraging, say the researchers, because these new types of facilities are designed to be more comprehensive in their offerings, and there is an extensive ongoing evaluation to assess these clinics.
“We also found that publicly owned facilities consistently had a higher likelihood of offering each of the four crisis services compared to privately owned facilities,” Cantor told us. “Lastly, we found that facilities accepting Medicaid or private insurance as payment were more likely to offer at least some of these types of crisis services compared to those primarily accepting out-of-pocket payments.”
The researchers felt the decline was most interesting because they expected availability of crisis services to increase over time, rather than decrease.
“I believe the United States continues to struggle with an understaffed and undertrained behavioral health workforce, a challenge that existed even before the launch of 988 and the onset of the COVID-19 pandemic,” Cantor told us. “Both events have highlighted the inadequacies of the current system in meeting existing behavioral healthcare demands or adapting to shifts in demand. I hope that by investing targeted resources to expand the mental health workforce and to improve training, we can alleviate some of these challenges. However, there is a genuine concern that financial investment alone may not suffice to resolve the issue.”
Cantor believes it is crucial for federal, state, and local officials to acknowledge that the mental healthcare workforce is insufficient to handle the demand for services. While additional investments to increase the supply of behavioral healthcare resources are necessary, Cantor believes officials must also develop innovative approaches to address ongoing supply pressures.