How a 988 crisis center helps people with mental and behavioral health emergencies

On July 14, the National Suicide Prevention Lifeline became available through a short, three-digit dialing code: 988. The easy-to-remember number is designed to ensure that people experiencing suicidal crises and behavioral health emergencies have quick and easy access to attention.

State and local governments are largely responsible for building the infrastructure needed to strengthen and expand Lifeline; Since 988 went live, 23 states have enacted legislation to support the new number.

For example, Maryland is considering legislation that establishes a funding stream to implement 988. In Columbia, Maryland — about halfway between Baltimore and Washington, D.C. — the nonprofit Grassroots Crisis Intervention Center provides 24/7 suicide prevention, behavioral health, shelter and counseling. Housing Support Services. In addition to answering 988 calls, Grassroots conducts walk-in counseling programs and operates a mobile crisis team to respond to behavioral health emergencies.

The Executive Director of Grassroots, Dr. Mariana Israelson, is a licensed clinical alcohol and drug counselor with decades of experience managing nonprofits in health care settings.

This interview with him has been edited for length and clarity.

How has your call volume changed since the launch of 988?

It has gradually increased to 30% more now than before 988. Text and chat functions increased by the largest amounts; We are seeing the younger generation use those functions more. Young people seem to sense a level of privacy in text or chat that they don’t when picking up the phone.

From our side, it has been a matter of making sure we have the appropriate personnel to respond to calls.

What type of calls are you getting?

Most of our calls are from people who are thinking about suicide. We also have many third party callers, such as concerned family members who want to know how 988 works and how to connect a loved one with us. And we have more health care providers calling 988 than ever before, looking for help for their clients or patients.

There are also a significant number of people who regularly call 988 for support—and were doing so even before we switched to 988. And since last year, we’ve partnered with the Howard County Police Department so that any calls the department receives about non-emergency mental health issues can be forwarded to our counselors.

At its core, 988 is a support line. The idea is that the counselor will work with you to help you resolve your distress or anxiety so that you can get on with your day.

Can you tell us through a specific call?

First of all, we would say, “Hi. Thanks for calling 988,” and then we’d ask, “How are you today?” We then settle into a normal rhythm of conversation, with the counselor focused on the caller and their needs. We also try to collect demographics in an empathetic manner, so that we can get a little more insight into how helpful and considerate we can be in discussing a caller’s distress.

When it comes to suicide – a term that includes suicidal thoughts, plans, intentional self-harm and suicide attempts – we tend to focus on the crisis. We ask the caller what thoughts are on his mind and if anything happened during the day that affected his feelings. Counselors try to give them the time and space to explain and help them navigate their feelings. The hope is that by providing that release, the caller will not engage in any dangerous behavior. The counselor’s goal is to help reduce the caller’s anxiety and stabilize the person so they feel heard and understood.

Some of the calls we get are from people struggling with sadness, loneliness or heartbreak. It is sometimes a misconception that only people with mental health conditions call the hotline, but suicide can be a different issue. For example, you may be heartbroken and experience feelings of sadness that can lead to suicidal thoughts.

How are staff trained to respond to someone experiencing suicidal thoughts?

Our center is accredited by the American Association of Suicidology, whose specific training we follow. We require new employees to undergo 40 hours of training—both in-person and online. After passing the practicum, they are eligible to shadow a consultant for three weeks.

During the shadowing process, a new employee would pick up the call, and the supervisor would listen and evaluate their progress.

We also require all employees to complete Crisis Counselor Certification within one year of employment. Besides, we can never have a single person with 988 employees; Two people and a supervisor should be available at all times.

What does your crisis counselor do to make callers feel cared for?

The key is to make people feel that they have been heard. Our Crisis Counselors listen to callers and validate their feelings, and help them work through what they’re feeling. We let them express their feelings without judgment or criticism.

The counselors also ensure that the caller is safe before disconnecting the line. They do this by examining what other connections or resources—whether family, friends, or therapists—are available to help the caller feel better. The counselors will also ask if they can do a follow-up phone check with the caller the next day. And if a caller has expressed suicidal thoughts, we follow up within 24 hours to check with a mental health provider or contact with a loved one.

Do you coordinate with 911 when needed?

We have very specific, detailed protocols. We use a short questionnaire called the Columbia Suicide Severity Rating Scale – which has been approved by the Substance Abuse and Mental Health Services Administration – to assess suicide risk. If a counselor determines that the caller cannot be stabilized on the phone and appears to have a weapon or other lethal means, that call is escalated to 911.

what happens then?

The counselor remains on the line during the entire 988 call. If a person is attempting to die by suicide and has a weapon or deadly means, we call the police. If the person is not actively planning suicide and is willing to participate in a safety plan, we dispatch a mobile crisis team made up of mental health professionals to talk to the caller face-to-face and defuse the situation .

But an “active rescue” component, where we call law enforcement or dispatch a mobile crisis team, rarely happens — about 7% of our calls. Most of the time, we are able to resolve situations over the phone.

How do you count a call as “resolved”?

A successful call is one where we can defuse the situation to such an extent that the anxiety level is significantly reduced; The person is no longer having active suicidal thoughts and is safe.

Usually, when the crisis subsides, the caller doesn’t want to talk anymore. They would rather continue with their day and hang up the phone. For us, there is a sense that the person felt heard and that they are comfortable with the resources to help them.

Have you experienced any challenges since the launch of 988?

Our biggest challenge is staffing. I have enough money; But I don’t have enough staff, even though we’ve increased consultants’ salaries by at least 40% over the past two years. We can’t compete with some other industries. And to become a counselor at Grassroots, we need a bachelor’s degree.

Plus, it takes a certain type of person to do this job. Counselors are mostly talking to individuals who are unhappy, and while there is satisfaction in the resolution of the call, most calls are difficult. We recognize that we need to take care of our counselors. We offer a licensed clinical counselor or social worker for them to consult with during particularly difficult calls, which is one of the ways we create a supportive environment.

If you or someone you know needs help, please talk to someone who can help: 988 Suicide and Crisis Lifeline Call or text 988, or visit and click on the chat button.

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