Why the new 988 hotline has the potential to transform mental health care [PODCAST]

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“The federal 988 hotline represents a promising new approach to alleviating the nation’s growing mental health crisis, but several key challenges loom that could derail this well-intentioned initiative.

One significant information technology challenge the hotline will face involves how to uniformly store and interpret mental health data (more on that later) but the most immediate roadblock is a lack of awareness.

Though the hotline is scheduled to debut in July, the program, which is federally sanctioned and funded but left up to individual states to implement, was announced with little fanfare, so many people within and outside of the medical community likely are unaware of its existence.”

Rich Parker is an internal medicine physician.

He shares his story and discusses his KevinMD article, “The new 988 hotline has the potential to transform mental health care, but challenges loom.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at kevinmd.com/rate. Subscribe at kevinmd.com/follow.

Today we welcome back to the show Rich Parker. He’s an internal medicine physician. His latest KevinMD article is titled “The new 988 hotline has the potential to transform mental health care, but challenges loom.” Rich, welcome back to the show.

Rich Parker: Thanks, Kevin. Great to be here again.

Kevin Pho: So we’ll get to the article in a little bit, but for those who didn’t get a chance to listen to our first episode together, just briefly share your story and journey to where you are today.

Rich Parker: Sure. My father was a psychologist, and when I went to med school, I was always interested in psychiatry, but I went into internal medicine. Then, practicing internal medicine, I quickly realized that a high percentage of patients that I saw in the office had behavioral health concerns: a lot of anxiety and depression. I saw my share of personality disorders, schizophrenia, and bipolar illness.

Then, fast-forward, our own family had a psychiatric emergency a few years ago. Fortunately, all worked out well, but I actually had to call the police to come to our house to intervene. It was scary, and a lot of families have experienced this. As a result of that, I became involved with NAMI. For those who don’t know, NAMI, N-A-M-I, is the National Alliance on Mental Illness. It’s a volunteer group; every state has chapters, and I serve as a family support facilitator. We have Zoom groups for families who have a loved one with severe mental illness. We see a tremendous lack of adequate mental health services in the U.S., and this is at least some way to try to address that.

Kevin Pho: All right, and before we get into the article, just give some background and context. What is the national 988 hotline?

Rich Parker: For a long time, it’s been understood that the system of emergency care in the United States is very patchwork. There are a lot of holes, a lot of gaps. There’s something called the National Suicide Prevention Lifeline, which has been around for a long time, and actually, I’ll just take the opportunity to share that phone number with any listeners who might be having thoughts of suicide. That number is 1-800-273-TALK.

However, Congress realized that they needed to do better, so legislation has been passed to create a national hotline for behavioral health, for mental health, and that number is 988. So instead of having to dial that 10-digit number I just gave you, there’s a three-digit number. This legislation is operative in all 50 states starting this month, and it’s funded with $282 million, which might sound like a lot of money to some people, but for a national endeavor, it’s really not a lot of money. And this has to be funded by each individual state, so they’ve got to hire people for the phones, and they’ve got to get the information technology together. There’s a huge amount of work to do for each state to get ready for the mandated start of 988 this month.

Kevin Pho: So according to the plan, if someone dials, what happens next? Who picks up on the other end?

Rich Parker: Right. So depending upon how organized their state has been, hopefully someone in their state will pick up within 10 seconds. We’ve been assured that if states have fallen behind, there are ways that these calls will get routed, literally, to other states where there are more operators with mental health training. So calls will be answered, but it remains to be seen whether calls will be answered immediately, and that actually will be part of the data challenge: to track how well 988 is doing in every state.

Kevin Pho: All right, and you talk more about the challenges in your KevinMD article. It’s titled “The new 988 hotline has the potential to transform mental health care, but challenges loom.” So as you summarize the article, how does it have the potential to transform health care? And certainly talk about some of those challenges.

Rich Parker: Sure. Well, the challenges are pretty big. Just by way of context, right now in the U.S., there are over 100,000 drug overdose deaths per year. There are almost 50,000 suicide deaths per year, and there are more than 1 million suicide attempts per year. So just to give your listeners an idea of the magnitude, the problem in mental health is really huge, so there’s a lot of room for improvement.

So that’s the bad news. The good news is we’re working on it. So 988 is not a panacea. It’s not going to solve everything by a long shot. It’s not going to create more social workers or psychiatrists or psychologists. But at least it’s the beginning of a system to try to put a safety net under people who are in a crisis and are calling, literally calling out, for help.

Kevin Pho: And is this going to replace the suicide hotline that you mentioned earlier, or is it going to be working concurrently with it?

Rich Parker: My understanding is it will work concurrently. They would never want to turn off a phone number that people think someone’s going to pick up. But the goal is that 988, over time, will be the national system.

Kevin Pho: In terms of an ideal world, let’s say there was enough funding and staffing. Give me the ideal situation of how this is actually going to transform mental health care.

Rich Parker: Right, so, great question. Ideally, in the perfect world, we wouldn’t just be talking about a 988 telephone number, which is a little bit of a flimsy safety net. We’d be talking about adequate mental health services for children, for teenagers, for adults, and for elders, in every state, in every county. And really, we just have a tremendous shortage of behavioral health, and that is a systemic problem that relates to the way health care is funded in the United States.

You and I know that people who go into behavioral health are the lowest-paid people in the provider world. So the market speaks, and we don’t have enough of them. On top of that, we have more stress than ever. We have a pandemic, we have economic inequality, and we have all sorts of insecurity about in the land. So there’s more stress and more need for behavioral health at a time that we just have a tremendous shortage of people to provide it.

Kevin Pho: What would be a typical scenario of someone who will call one of these hotline numbers?

Rich Parker: Sure. So often it’s someone who’s really desperate, and they haven’t been able to get help from their family, their friends, or their own doctor. Maybe they’ve been afraid to reach out for a variety of reasons. Maybe they feel humiliated, maybe they feel stigmatized, and they feel desperate to some degree, and they are afraid that they might hurt themselves or maybe hurt someone else.

And so they call, and when they call, that call will be answered by someone with some behavioral health, mental health, training, who will be calm, who will be caring, who will be thoughtful, and who will be able to take a quick, good history of that patient and find out if they are in imminent danger of harm. These people are trained to know that if they think the person is in imminent danger, they will actually call 911 if they have to do it. They don’t like to do that, because obviously the person calling did not want to call 911, because that’s a whole other set of problems: When 911 is called, usually the police respond, who may not have adequate behavioral health training, and we know the consequences of that can be poor or even deadly.

So the person takes the call. They will talk with the person as long as necessary. If the person is not in imminent danger, then the person on the phone will offer them some advice about where they can get some help and get resources. I’m sure they could direct them to NAMI, and hopefully they have some understanding of that person’s local geography and behavioral health resources, so they’ll start to hook them up.

Kevin Pho: So then the 988 operator is not personally going to be the therapist. You’re going to make sure the person is safe, and then they’re going to try to connect that person with local resources to help them move forward.

Now, given your background in the mental health space and the limitations and challenges that you articulated in your article and in this interview, what do you envision the path forward to be for this new hotline?

Rich Parker: I think it’s going to be very interesting to see how this rolls out. Hopefully not a huge number of bumps; hopefully there’ll be a smooth transition in most states. Personally, as the chief medical officer for a data aggregation and analytics company, I’m very interested to see how the data gets aggregated and how 988 nationally starts to measure its results. Hopefully they’ll be transparent about reporting those results, so we can all learn something pretty quickly. So it’s going to be one of these iterative processes, where it’s going to start, there’ll be bumps, and we’ll fix and we’ll make better. And hopefully we’ll use aggregated data and analytics to understand where the places are that we can fix it most quickly.

Kevin Pho: We’re talking to Rich Parker. He’s an internal medicine physician. His latest KevinMD article is titled “The new 988 hotline has the potential to transform mental health care, but challenges loom.” Rich, so in my primary care office, if I wanted to share the 988 number with one of my patients, what’s the scope of the services that they provide? Just give me a sense of what kind of patients I can share this number with.

Rich Parker: Right. I would back that up one step and say the first thing is making the public aware of 988. I actually heard this on the radio this morning, a discussion on NPR, 988, and I was really happy to hear it. So hopefully there’ll be public service announcements, but I would hope that your health care system and your listeners’ health care systems will advertise 988. Put up a flyer in your waiting rooms: “988, mental health call available.” We have to start to make this widely known.

Part of the process also is to destigmatize psychiatric illnesses and treat them more like physical illnesses. Everyone is deserving of care and health and compassion, and there’s still a lot of stigma about mental health. So part of my goal with 988 is just to make it more friendly, available, kind of in your face, so to speak: This is for you to know about. Kids should know about it. Schools should advertise 988. It should really become part of our culture.

Kevin Pho: And my final question: your take-home messages that you want to leave with the KevinMD audience?

Rich Parker: Take-home message: Mental health is incredibly important. It is a huge problem in our nation. We need to do better, and I want everyone to know about 988. Learn about it. Tell your friends and your family. If you’re a physician, put a poster up in your office, so we can educate people about 988 and save some lives.

Kevin Pho: Rich, thanks again for coming back on the show and sharing your time and insight.

Rich Parker: Thanks, Kevin. Always a pleasure.

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