One year after the launch of the 988 Suicide and Crisis Lifeline, many Floridians still don’t know it exists and about 25% of the calls in the state are going unanswered.
When you dial 988, it will route you to one of about 200 crisis call centers throughout the country based on your area code. From a Fort Lauderdale crisis center, counselor Brenda Mann-Kelly receives calls from a 754 or 954 area code.
Over the last year, Mann-Kelly and the staff at Florida’s 13 crisis centers answered more than 82,000 calls to 988 after the National Suicide Prevention Lifeline underwent a transformation, recasting its 10-digit number as 988. That’s the fifth highest state-level volume in the U.S.
When Mann-Kelly answers the calls, she may have only minutes to respond and save a life.
Yet, Florida crisis centers are following behind on answering calls.
Florida had a average answer rate of 75% in June, up from an average answer rate of 52% in October 2022. Some states, such as California, Mississippi and Nebraska, had answer rates well over 90%.
Over the last year, at least 48,000 calls to 988 from Florida area codes went unanswered by state crisis counselors and had to be routed to the national back-up network where counselors are less familiar with local services, according to data from Vibrant Emotional Health, the administrator of the lifeline.
The expectations weren’t high
Florida’s mental health advocates had predicted the 988 roll out in the state would be difficult.
Some states had created dedicated ways to pay for more staff and upgrade technology to support their 988 call systems. Florida relied on a patchwork of funding, with some counties more ready than others for the surge in volume projected.
“We have made a lot of progress, but there’s still a lot of work to do,” said Gayle Giese, president of the Florida Mental Health Advocacy Coalition. “We are doing better than some states, and worse than others.”
For Mann-Kelly, the calls are non-stop. With mental illness on the rise, the hotline operator spends most of her workday finding the right intervention for callers in crisis, gauging whether they just need someone to listen or if they are actively in the process of trying to take their own life. She may send the troubled caller a list of nearby therapists, dispatch a mobile crisis team, suggest inpatient services or even connect them to 911 or emergency services if they mention a weapon or pills.
“Every call is different, but the majority of time people are overwhelmed and in distress,” she said. “People are having issues with relationship dynamics, and feelings of isolation. A lot of people are feeling very alone in this connected world and since COVID it has gotten worse.”
988 is not only for emergencies
A person doesn’t need to be in crisis or suicidal to call 988 and speak with a counselor. The help line is a free service available at all hours, day or night, for anyone who needs support. A big part of the makeover of the National Suicide Prevention Lifeline was to lessen the reliance on law enforcement or emergency departments to handle mental health crises.
On a national scale, the 988 Lifeline encountered record demand in the past year.
Since its launch in July 2022, more than 5 million calls, chats and texts have been routed to 988, that’s 2 million more than the previous 12 months before the three-digit number and a federal investment. Now, the federal government and Lifeline partners announced the addition of Spanish text and chat services as of July, as well as specialized services for LGBTQI+ youth and young adults.
Mann-Kelly, 58, says the shift to 988 allowed her to answer Broward calls as a peer support specialist, people with “lived expertise” who are prioritized as call recipients. She can now disclose to callers that she once was in their shoes, also in crisis mode, and currently in recovery from mental illness.
“The benefit is people feel connected to me,” she said. “They may call feeling embarrassed, but once I self disclose it makes the process easier and helps me de-escalate quicker.”
Florida needs a lot more mental health services
Many challenges still lie ahead for the national mental health network. Some of the biggest problems are a need for awareness of the three-digit hotline, along with long-term funding to boost staff at the crisis centers. In May, the federal government allocated another $200 million in new funding that states will receive later this year to build local capacity for 988 and related crisis services.
Mental health experts say Florida needs much more than just additional staffing at its crisis call centers. The state also needs more resources, particularly places to refer adults, teens and children struggling with mental health issues.
Francisco Isaza, chief operations officer at 211 in Broward, the local call center for 988, said his crisis counselors can offer some resources to callers but admits there are gaps. “The whole purpose behind 988 is not just a call center number but a system of care that is there to support people in times of crisis,” he said. “There has to be treatment services and support services that are available. The vision needs to be to create a robust system of care so anyone going through a mental health or substance abuse crisis can get a full spectrum of support.”
State lawmakers have taken a proactive step and created a Commission on Mental health and Substance Use Disorder to review how 988 is working in the state, identify any deficiencies in mental health services, assess the state’s crisis response capabilities and recommend changes. Florida Gov. Ron DeSantis included more money in this year’s budget to expand the mobile response teams that could respond to a 988 call.
Some counties need more psychiatric inpatient beds, others need more mobile response teams or mental health counselors.
“The need is always going to outweigh the services available,” says Mann-Kelly who spends her off-work hours in support groups and therapy to maintain her own mental health. “In Broward, we have a continuum of mental health care, but we always need more.”
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.