Getting ready for the era of 988: The new local — and national — crisis hotline increase has launched

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The 988 hotline launched July 16, and Santa Cruz County mental health officials say they have noticed a slight increase in calls. The hotline is one part of a larger, yearslong effort to reshape the response to mental health crises. 

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There’s a new number to remember: 988.

That’s the number to call in Santa Cruz County — and nationwide — for anyone experiencing a mental health crisis and needing support. The new line became operational July 16 after years of planning.

In Santa Cruz, it’s the Family Service Agency of the Central Coast that has taken on the responsibility for responding to the calls — and it has staffed up significantly to do that. A program within the agency has been responding to calls for suicide prevention since the National Suicide Prevention Lifeline was first launched in 2005.

FSA and agencies across the country have spent the past several months hiring and training more responders to meet an expected increase in calls. In Santa Cruz, that has meant hiring 12 new full-time responders to augment a substantial volunteer call response group of 60.

As people get to know about 988, agencies expect an influx of calls, given the weight of COVID and other stress factors on the overall population, adding to ongoing mental health needs.

“We saw a little bit of an uptick in calls,” said Andrea Tolaio, program director for Suicide Prevention Service of the Family Service Agency of the Central Coast, told Lookout last week. “Not as many as we thought.” FSA is a private nonprofit, founded in 1957, that provides counseling and supportive services to those in Monterey, Santa Cruz and San Benito counties.

The launch of the national 988 hotline is part of a larger movement to address growing mental health needs and to improve the response to people in crisis. Over the past two decades, the national suicide rate has increased almost 30%, and experts say the pandemic exacerbated those challenges.

To further improve the response to mental health calls, California lawmakers have proposed Assembly Bill 988, currently in the Senate Appropriations Committee, as the first step to outline a program of alternative response teams of mental health professionals to be deployed in some crises as an alternative to law enforcement response. The CAHOOTS program, pioneered in Eugene, Oregon, is one model for such a mobile crisis response team program.

The transition to a new system won’t happen overnight, and county officials say there’s still a lot left to do — including seeking significant input from community members — before a framework for a local system is created.

“It is going to be a process,” said Andrea Turnbull, behavioral health program manager for the county’s Health Services Agency. “It’s not something we just flip a switch, and we have everything ready to go.”

In the meantime, the 988 hotline will continue to develop its services, including potentially adding a text/chat system and doing prevention education and outreach.

To meet the expected increase in calls, Tolaio and the center’s six other staff members have seen their numbers grow. Tolaio said paid and volunteer responders alike receive the same training to provide callers with both a supportive voice and to inform them of their resources.

For fiscal year 2020-21, the program received a total of 3,465 calls from the three counties. Prior to the 988 hotline implementation, calls to the centers were expected to increase by 30% post launch.

Some of the callers simply wanted to learn about the hotline, according to Tolaio. Responders, most of whom work remotely, directed those callers to the Substance Abuse and Mental Health Services Administration (SAMSA) website. Tolaio said callers can call about anything from depression to relationship challenges.

Partly out of the way is Tolaio’s biggest challenge: hiring paid responders. But as time goes on and call volume stabilizes, she said the center will continue evaluating its staffing needs. Another challenge will be funding. She said the money received from the federal government so far for the implementation “wasn’t enough,” but the call center will receive funding through SAMSA and eventually through the state.

There is a lot of work left to be done over the span of several years for the full implementation of the hotline and the alternative mental health response system. Legislation sets Jan. 1, 2027, for full operability of both the 988 hotline and the mobile crisis response system.

Turnbull emphasized this point, saying the bill will need to be passed before the county can move forward with significant changes.

She oversees the county’s crisis response team, including the Mobile Emergency Response Team (MERT) and the mental health clinicians team. The mental health clinicians are Health Services Agency employees who assist on mental health related calls to 911 with law enforcement. Those calls include people who are experiencing a mental health crisis and are either showing aggressive behavior, have medical needs or are under the influence of drugs or alcohol.

MERT mental health professionals respond to calls made to 800-952-2335 Monday to Friday between 8 a.m. to 5 p.m. to help adults and children experiencing a mental health crisis.

While the 988 hotline provides a supportive responder to those in crisis via a phone call, MERT provides the in-person response and will continue to do so. As lawmakers work toward passage of AB 988 and provide counties with standards to develop an alternative response system to law enforcement, MERT will continue to respond to calls, as will the mental health clinicians who accompany law enforcement.

In 2021, MERT provided services to 850 people — an increase compared to the prior year, but not the highest number of calls the service has received, according to Turnbull. Mental health clinicians responded to 2,775 calls.

These mobile crisis teams have generally been able to respond to the need in the community with fluctuations in calls occurring occasionally as well, Turnbull added.

While these teams have been working in the county locally for several years, it’s not clear what an entirely new system that meets the state’s plans will eventually look like. The county is still looking to hire a program coordinator to help with that vision.

“At this point, the way in which that’s going to be funded, the way that it’s going to operate is obviously going to be different in every county,” Turnbull said. “I think Santa Cruz is certainly wanting to get community input as we start to roll that out.”

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