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'Hello, This Is 988. What Is Your Mental Health Emergency?' A New Crisis Help Line Is Now Available

Ann L. Contrucci, MD

July 28, 2022

Suicide attempt…acute mental health crisis…nonsuicidal self-injury. These terms often signal a sense of helplessness, or even hopelessness, for many physicians. There are many reasons why, not the least of which is the stigma surrounding mental illness — or more accurately, neurobiological diseases. Acute crises are difficult to manage, few physicians are comfortable with these situations due to lack of training or certain biases, and frustration is rampant with lack of resources for post-emergency care. Shocking statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA) reveal that in 2020 alone in the United States, one person died by suicide every 11 minutes. From April 2020 to April 2021, over 100,000 drug overdoses occurred.

What happens when a patient or concerned friend/family member calls 911 for assistance with an emergent/urgent mental health crisis? An already overburdened 911 emergency services system often cannot provide adequate support for various reasons, including lack of training and sheer volume of calls. An illustration of this is a situation that haunts me daily, involving a personal friend (and fellow physician) who found his family member virtually unresponsive after an intentional overdose and called 911, only to be put on hold twice for 5 minutes each time, with EMS eventually arriving after 45 minutes.

When EMS and the police arrived, the first concern they had was whether the individual was armed with a weapon. When the individual was able to be aroused and refused transport to the hospital (though he was unable to even complete a rational sentence due to the overdose), EMS personnel said, "He is an adult so we can't transport him if he refuses." The frantic family member asked EMS personnel whether, if he had been a patient having a stroke with an altered mental status, would EMS have had the same reply? Most assuredly not. Fortunately, my physician friend insisted that they transport the patient and there was eventually a good outcome. This is not always the case.

Enter stage left…the 988 Suicide & Crisis Lifeline, which officially launched on July 16, 2022, as an enhanced mental health acute crisis line in the United States. How is this different from the National Suicide Prevention Lifeline in place since 2005? 988 now replaces the previous 800 toll-free number of the hotline. The new lifeline number is meant to continue the ongoing work of the current 200-plus centers in the United States.

Trained crisis counselors are available 24 hours a day/7 days a week to offer immediate assistance to anyone in a mental health crisis, including those with suicidal thoughts as well as substance use crisis or other acute mental distress. They are there to provide resources, guidance on next steps, and eventually coordinate local care. The 988 Partner Toolkit is a wealth of information to become familiar with. Trained crisis counselors are merely the beginning of this colossal project, much like 911 dispatchers who are crucial links at the beginning of the chain to help someone with a physical emergency.

I am personally and professionally so excited about the potential in those three little numbers, 988. My hope is that this is a real and substantial commitment to ushering in a new era of opportunity to create a full range of crisis care services easily available to all. Think of the early days of the 911 system and emergency services and how far we have come. This is a similar vision. Will it happen immediately? Nope. Not even close. Will it happen without bumps in the road? Nope. Will it cost money? Yep. But how long will we continue to make sweeping statements about "the mental health crisis in the US" without doing something about it?

This is a promising start. Nobody would think twice about calling 911 for a "medical emergency." My hope and expectation is that in the not-too-distant future, nobody will hesitate to call 988 for a "mental health emergency." And that patient will be treated with the same compassion and respect as someone experiencing a heart attack. Too optimistic? Maybe. Rose-colored glasses? Perhaps. But we as physicians must help make this a reality. It is our obligation to our fellow humans, including those who have been on the fringes due to stigmatization for far too long. I challenge you, my colleagues, to familiarize yourself with the 988 Partner Toolkit right away.

Be an advocate, as always, for your patients and your community. Hope and help are on the way.

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About Dr Ann Contrucci
Ann L. Contrucci, MD, is a board-certified pediatrician with almost 30 years' clinical experience. She has practiced rural and suburban primary care as well as urban and suburban pediatric emergency medicine throughout her career. She also had her own solo practice in Ontario, Canada. She is currently an Assistant Professor of Pediatrics in the Clinical Education Department at Philadelphia College of Osteopathic Medicine. Her particular areas of expertise and passion include mental and emotional health issues in children and adolescents, in particular anxiety, emotional dysregulation, and eating disorders.

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