Starting Saturday, there will be a new three-digit number to remember: 9-8-8, set up by the Substance Abuse and Mental Health Services Administration. The hope is that this number will connect people with a response to mental health-related emergencies.
WASHINGTON — The long-awaited three-digit crisis hotline known as 988 rolls out nationally Saturday, a win for mental health advocates who see the simplified number as the first step on a path toward building out crisis care.
But how ready states and advocates feel about the next steps to improve mental health is more complicated.
The implementation of 988, which will direct callers to the National Suicide Prevention Lifeline, is the first of the federal government's three-step process to building better mental health care. The steps include the crisis call center number, which will take calls and dispatch support; mobile crisis response, which will send teams to the crisis; and crisis stabilization services, or facilities to receive and serve those undergoing a crisis on a short-term basis.
Experts said that's not unusual — the implementation, funding and widespread adoption of 911 in the late 1960s and 1970s took years to achieve, for example.
Becky Stoll, vice president for crisis and disaster management for Centerstone, a nonprofit health system specializing in mental health and substance use disorder services, said "nothing magical" is tied specifically to Saturday.
Instead, she likened it to a launchpad.
"I almost feel like we've been pregnant for a really long time and we're overdue," she said. "This is the beginning of what, I think, is going to be transformative for the mental health system. So I really hope there's not a focus on, 'We're not ready.' … I just think that sends the wrong message."
The three-digit crisis hotline known as 988 rolls out nationally Saturday.
Miriam E. Delphin-Rittmon, assistant Health and Human Services secretary for mental health and substance use, said funding from the 2021 COVID-19 relief law allowed the lifeline, still at 1-800-273-TALK, to answer substantially more calls in May compared to February 2022, she said.
The current lifeline answered 27,000 more calls, a 20 percent increase; 27,000 more chats, a 165 percent increase; and 3,000 more texts, a 93 percent increase, Delphin-Rittmon said during a briefing hosted by the nonprofit Education Development Center and National Action Alliance for Suicide Prevention.
Advocates have called for sustained funding as state approaches to find support for crisis centers have varied widely. Four states — Virginia, Washington, Colorado and Nevada — have enacted comprehensive legislation that can generate a sliding scale of income depending on the state's needs. As with 911, the fees would be tacked onto phone bills.
Lauren Conaboy, vice president of national policy at Centerstone, said she would like to see state legislatures enact laws to authorize flexible telecom fees this session, suggesting they could look at data collected so far and adjust if needs increase.
But getting state legislatures to act has been a challenge, said Lauren Finke, a policy adviser at The Kennedy Forum, a mental health organization founded by former Rep. Patrick J. Kennedy. She said at least 18 states have pursued fee legislation that has been watered down, stalled or minimized, largely because of lobbying efforts by telecom and cable companies.
Finke said states have also been reluctant to build out crisis care systems without more guidance from the federal government clarifying whether more federal dollars are available to them.
"It's clear that states need more guidance in order to be compelled to act, but there's nothing keeping states from acting right now," she said. "I very much worry that as we're waiting for guidance from the federal government to come down, that really we're just dragging our feet on something that we'll need to figure out as a state anyway, so I think states should enter into these planning processes."
Conaboy acknowledged the implementation of 988 comes at a unique time.
"We never imagined that — fast forward to July 2022 — we'd be a couple of years into a global pandemic and the most historic workforce shortages we've faced and particularly strong workforce shortages in mental health," she said. "Then on top of that, probably the most acute mental health needs that our country has ever faced."
National Council for Mental Wellbeing CEO Chuck Ingoglia said that while participating in a webinar about 988 readiness last week targeted at providers, he observed differences among the approximately 700 attendees.
"What struck me is the varying levels of knowledge about all of this, so I still think we've got people all over the place," he said. "So it's gonna take a while."
Understanding the connections between mental health conditions and substance use disorders
Understanding the connections between mental health conditions and substance use disorders
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The stigma surrounding substance use disorders and mental health conditions has long dominated how both issues are discussed, and how those who experience these issues are seen. Because substance use disorders and mental illness frequently co-occur, meaning individuals experience both at the same time, increased stigma and stereotypical associations of one condition with the other have colored people’s views of both.
Substance use disorders are a type of mental health condition, a disorder affecting the brain that impacts an individual’s ability to moderate their use of substances. Some of the substances commonly associated with this include alcohol, tobacco and nicotine products, opioids like heroin and oxycodone, stimulants such as methamphetamine and cocaine, and tranquilizers, including Xanax and Valium.
Though they manifest in many different ways, mental illnesses are disorders that disrupt the brain, mood, and behavior, and impact daily life. In 2020, 6.7% (or 17 million) of U.S. adults had both a substance use disorder and at least one other diagnosed mental illness. Those with serious mental illness, or mental illness that significantly impacted daily activities, had particularly high rates of co-occurring substance use disorder with certain substances. Misuse of opioids and tranquilizers, for instance, was roughly 6 percentage points higher among those with serious mental illness than those without a diagnosed mental illness.
Understanding why the two conditions often co-occur relates to recognizing that substance use disorder is a mental health condition, influenced by many of the same factors as other mental illnesses like depression and schizophrenia. Genetics, experiences with trauma or violence, environmental conditions, and many other factors impact how and why substance use disorders and other mental health conditions occur. Decreasing the stigma around both conditions will, according to research, likely make receiving treatment easier.
To explore the factors that influence these conditions, Zinnia Health looked at the connection between mental illness and substance use disorder, citing early 2020 data from the Substance Abuse and Mental Health Services Administration (released in October 2021) and academic studies.
21% of US adults suffer from mental health disorders
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More than half of all U.S. adults will receive a mental illness diagnosis in their lifetime, according to the U.S. Centers for Disease Control and Prevention. Many mental health conditions occur together, including depression, anxiety, attention deficit hyperactivity disorder, bipolar disorder, and post-traumatic stress disorder.
Substance use disorder also commonly co-occurs alongside other mental health conditions. Despite the common co-occurrence of substance use disorder and other mental illnesses, one condition does not always cause the other, and experiencing one condition does not always mean a person will develop the other.
Family history can influence mental health risk factors
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Over the last couple of decades, scientists have increasingly come to recognize the influence of genetics on mental illness. Most research indicates that while there is no one specific gene responsible for mental health conditions, thousands of gene variants can have small impacts on mental health.
Similarly, family history and genetics account for between 40% and 60% of an individual’s susceptibility to substance use disorder. Certain genetic factors can predispose people to dependence on certain substances. Genes can also interact to alter one’s behaviors toward risk-taking or reward-seeking, increasing or decreasing the likelihood of trying substances in the first place.
Research has also shown that similar genes are responsible for the risk of mental illness, as well as for substance use disorder, illuminating new ways of understanding the high rates of both issues occurring simultaneously.
Stress and trauma can be contributing factors for developing mental health disorders
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Traumatic experiences, as well as acute stress, have been shown to have the capacity to alter the brain, particularly the amygdala, hippocampus, and prefrontal cortex (which deal with emotion, memory, and decision-making, respectively). But environmental factors like trauma and stress also have the potential to change genetic expression, bringing out some genetic material that may have previously been dormant. The idea that environmental circumstances can trigger changes in our bodily systems, called epigenetics, also means that mental illness or substance use disorder can sometimes be brought on by traumatic or stressful situations.
Apart from the biological changes stress and trauma can inflict on the body and brain, experiencing traumatic events can cause some to self-medicate in order to deal with psychological distress. Using psychoactive substances to self-medicate can create the risk of developing future mental health conditions, as well as a substance use disorder.
Substance use can increase risk for developing other mental health conditions
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Substance use can change the brain in many of the same areas altered by mental health conditions such as anxiety, depression, impulse-control disorders, and schizophrenia. Psychoactive substances can also bring on symptoms similar to those caused by mental illness, including psychosis, paranoia, hallucinations, altered sleep patterns, mood swings, and increased risk-taking behavior. And if substance use begins before the onset of mental illness, it can increase the risk of developing a mental health condition in predisposed individuals.
There are many effective drug therapies for treating mental health conditions
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Medication-based therapy has proven to be effective for many with both mental health conditions and substance use disorder. With medical supervision, antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers, among others, can help mediate mental illness symptoms by reducing irregular brain activity, managing physical symptoms like increased heart rate, and changing how compounds like serotonin are used in the brain.
Medication-assisted therapy can also be successful in treating substance use disorder and addiction—particularly when used in conjunction with counseling and behavioral therapy. Medications like methadone can help safely prevent recovering individuals from using substances and can reduce uncomfortable or dangerous withdrawal symptoms.
Targeted behavioral therapies can also help patients with co-occuring mental health conditions
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Behavioral therapies, along with medication-based treatments, can help those coping with substance use disorder and or a mental health condition. Integrated treatments, which involve treating both the substance use disorder and the mental illness simultaneously, are seen as the most effective since they acknowledge the often-intermingled causes and symptoms of the co-occurring conditions.
There are, however, many barriers that keep over half of those experiencing a mental health condition from receiving treatment. Stigma around both mental illness and substance use disorder can make seeking help feel shameful and can inspire fear and real-world consequences for wanting treatment.
Many individuals suffering from a mental health condition or a substance use disorder fear losing a job or being ostracized from their community or family. Another major barrier to receiving treatment is its often-prohibitive financial cost. Stark disparities have emerged in who has access to quality treatment, falling along class and racial lines. While 37.6% of white adults with a diagnosis-based need for mental health or substance use disorder treatment received care, only 22.4% of Latinos and 25% of Black Americans did.
This story originally appeared on Zinnia Health and was produced and distributed in partnership with Stacker Studio.
