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.
In this article, we’ll take a quick look at what 988 is, why it’s needed, and some of the challenges the project will need to overcome to reach its full potential.
The 411 on 988
Think of the 988 hotline as a 911 for mental health crises. The line will provide a direct route to mental health services, whether for callers or their friends or family members. While some states already operate their own mental health hotlines, the new approach features an easy-to-remember number that exists nationwide and is easy to access anywhere there is a phone signal, reducing friction for those seeking mental health services.
For those undergoing mental health crises, parsing through options can seem overwhelming. The 988 hotline will serve as a connecter for these individuals, helping them obtain counseling, seek out emergency services, or any avenues to improve mental health.
Why we need 988
The new mental health hotline embodies a much-needed new approach to what has become a national catastrophe: it has become painfully obvious that our current blueprint for solving the nation’s mental health crisis simply is not working.
In 2021, drug overdose deaths in the U.S. topped 100,000, up 29% from the prior year, according to the U.S. Centers for Disease Control and Prevention (CDC).
Suicide deaths in the U.S. nearly reached 46,000 in 2020, about one every 11 minutes. The number of people who think about or attempt suicide is even higher. In 2020, an estimated 12.2 million American adults seriously thought about suicide, 3.2 million planned a suicide attempt, and 1.2 million attempted suicide, according to the CDC.
Too often, our approach to those undergoing mental health crises involves emergency personnel such as police and firefighters arriving on the scene for situations they aren’t trained for, and that should ultimately fall outside their purview. Near Boston, we saw this recently when 28-year-old Michael Conlon displayed violent behavior during an episode at a candy store. When the shop owner called 911 after a failed attempt to intercede, a foot chase inside the store with police ensued, and the story ended with Conlon’s death from multiple gunshot wounds.
The hope is that Conlon’s story would have unfolded differently with a call to 988 instead of 911.
Even in the best of circumstances, solving a mental health crisis is no small feat, so the 988 hotline is certain to encounter substantial hurdles. With a budget of just $282 million for a national project, getting 988 off the ground across the country will be a heavy lift.
Additionally, many states face a shortage of mental health workers, while phone operators generally earn low salaries, likely creating substantial staffing issues for the hotline. As a result, most callers are unlikely to be connected with an operator who is familiar with their history and can deliver treatment more tailored to that individual.
Then there are the data and IT challenges. Unlike more standard patient encounters, in which an EKG provides a graphed read-out or a blood test reveals a quantity of platelets, mental health encounters often result in a jumble of provider notes in the patient record expressed in a freeform style as unstructured data.
Collecting and gathering these disparate pieces of mental health data and then combining, normalizing, and standardizing them into usable information, will be a monumental task for program administrators. Conquering this data challenge will enable a patient’s history of mental health data to be legible across dashboards and networks for operators and counselors.
However, this data has relevance beyond a mental health counselor’s desk. For example, a suicidal patient’s ideation affects what type of medicine she is prescribed, or whether a surgical procedure should be scheduled as soon as possible or can wait a few months. The same holds true for bipolar disorder or generalized anxiety, both of which interact with certain medicines or could necessitate different courses of mental health care.
The path to overcoming the 988 hotline’s roadblocks starts in a familiar place: funding. Grants and state dollars could make the information technology infrastructure that backs the initiative much stronger, enabling the hotline to accommodate a heavy volume of callers and employ many counselors. As new needs emerge, strategy around the 988 hotline will inevitably change, and mental health data will point the way towards new services that will support this ambitious approach to tackling our national mental health crisis.
Rich Parker is an internal medicine physician.
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