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Calls expected to surge with new 988 suicide hotline. Florida centers are already strained

Miami Herald - 7/15/2022

Florida’s mental health crisis call centers are gearing up for a surge in calls beginning on Saturday, when the National Suicide Prevention Lifeline switches to a new 3-digit number for calls and texts, 988.

The number is easy to remember in a crisis, and calls are expected to rise, challenging the capacity of Florida’s 12 national lifeline centers, which answer the third-highest call volume in the nation.

A spike in calls and referrals for services will also test the abilities of Florida’s behavioral health services network, mental health advocates say, because the resources to respond to such crises vary by county and region.

Advocates say the new national lifeline has the potential to connect people experiencing a mental health or suicide crisis, and their loved ones, with a convenient entry point to ask questions, or receive referrals for care, or request a crisis response team.

911 not going away

“The vision is to have 988 become a portal into suicide prevention, veterans crisis and also just behavioral health crisis, because we don’t have that right now,” said Amy McClellan, a longtime advocate for mental health services in Miami-Dade and Monroe counties. “People call 911.”

Florida’s other three-digit call centers, including 211 and 311, which can provide information on housing and social services, will not go away, and certainly neither will 911.

“We want to offer an alternative to calling 911,” said Gayle Giese, president of the board of the nonprofit Florida Mental Health Advocacy Coalition. “911 is still needed if it’s a high-risk situation. If someone is in the midst of taking their own life, certainly call 911, or if someone has a weapon, call 911.

“But for most behavioral health crises,” she said, “what you need is a calm deescalation by a well-trained counselor, possibly a mobile response team or someone to come to your home, and possibly somewhere to go to be stabilized and receive services.”

Intensifying mental health issues among young people

The 988 call centers will focus on mental health crises and suicide prevention — two needs that were already a public health concern before the pandemic and that have grown in intensity since, especially among high school students and other young people.

“People are really confused when a mental health crisis happens, unless you’ve been through it a million times,” McClellan said. “People develop the symptoms of serious mental illness when they’re in their teens and their early 20s. You don’t really know what’s going on when it first happens, and it can take 10 years for someone to get diagnosed and get the proper treatment.

“This is a way of getting behavioral health help right away,” she said.

The transition to a national lifeline, 988, is a starting point, Florida mental health advocates say, for building out a network of call centers staffed with trained counselors, mobile response teams that can be dispatched to a crisis, and stabilization facilities that can provide behavioral health services that jails and many hospitals cannot.

Police and paramedics will remain important partners in the state’s crisis response system in part because there aren’t enough behavioral health providers available or the funding to build out a robust network yet, said Micki Thompson, president of 211 Tampa Bay Cares, the nonprofit call center serving Hernando and Pinellas counties, and which will be part of the 988 lifeline.

“I don’t think the 911 law enforcement and fire are going to be exiting our mental health system. They’re still also critical partners,” Thompson said. “I think [988] just enhances the ability to maybe divert individuals, youth and children, maybe from the deeper end of behavioral health services.”

Many people experiencing a mental health crisis or struggling with drug use often end up in jail and sometimes a hospital, and those who are deemed a danger to themselves or to others can be held against their will for up to 72 hours under Florida’s Baker Act.

READ MORE: A rising number of children are being Baker Acted in Florida

De-escalate situations

Often, Thompson said, those outcomes can be avoided if someone experiencing a mental health crisis has a counselor to talk to or to text or to chat with online, as the 988 system can do. And if someone needs urgent attention, a mobile response team can be dispatched to the scene to help de-escalate the crisis.

“It’s about giving them the right service at the right time,” Thompson said. “They may not need deep end services at this time, and maybe by diverting them from the deep end services they don’t fall further down into an extreme crisis.”

Fortifying Florida’s fractured behavioral health services network will require recurrent funding from federal, state and local governments, nonprofit groups and philanthropists, advocates say.

Florida government agencies and nonprofit lifeline centers have been working over the past year to prepare for Saturday’s transition, led by the state’s Department of Children and Families and the so-called Managing Entities that distribute state funding to Florida’s 12 national call centers located across the state and two others?.

The U.S. Department of Health and Human Services, through the Substance Abuse and Mental Health Services Administration or SAMHSA, has laid out a five-year plan that begins by establishing a network of call centers.

The next step is assembling mobile response teams who can be sent to help someone in a crisis. The last step is building out crisis stabilization centers where people can recover instead of going to jail or a hospital.

SAMHSA awarded Florida a $5.3 million grant this year to hire more staff for 988 call centers and to build a telephony network that ensures all calls and texts originating in the state are routed to a local, regional or state-based lifeline center. The grant is part of $282 million funding from SAMHSA for all states to reinforce and expand their lifeline networks

The federal government is counting on states to also fund 988 and to build out capacity for behavioral health services so counselors can refer people in crisis to a provider.

Big increase in calls expected, concern over funding

So far, four states — Colorado, Nevada, Virginia and Washington — have adopted cell phone fees to sustain their national lifeline centers into the long-term, said Dr. Benjamin Miller, president of the Well Being Trust, a philanthropic fund that advocates for improvements in mental health services.

“We need to have a way to bring in new dollars to support 988,” Miller said. “Without that, these lifeline centers are not going to have any increased financing to support what we anticipate will be a 300% to 800% increase in calls in Florida.

“By not having a financial model in place, a lot of these call centers are going to go understaffed, people are going to have longer wait times, and in the worst case scenario … They’re going to get a police response instead of the appropriate response they need.”

Florida has not adopted fees to fund 988, but the state’s Department of Children and Families has funded call centers through so-called Managing Entities that contract with local providers, such as 211 call centers, in each region.

DCF also funds 39 mobile response teams in the 67 counties throughout Florida, and the state’s data shows they have helped reduce the need for involuntary commitments of people in mental health crisis.

In 2021, DCF’s mobile response teams received received 22,160 calls and responded, either face-to-face or via telehealth, to 16,651 or 75% of those calls. Of the 16,651 calls responded to, 3,145 or 19% resulted in an involuntary examination and 13,506 or 81% were “potentially diverted from an involuntary examination,” according to DCF data.

Included in DCF’s annual spending on mobile response teams is an $18.3 million annual commitment under public safety legislation adopted after 17 students and faculty were killed in a mass shooting at Marjory Stoneman Douglas High School in Parkland in Broward County in February 2018.

READ MORE: Four years past Parkland, closure is elusive

Florida could get Medicaid to fund response teams, but hasn’t done so

Anne Swerlick, an attorney and senior policy analyst with the nonprofit Florida Policy Institute, authored a study in February that said Florida could receive more federal support for its mobile response teams through Medicaid, the public health insurance program for low-income and disabled Floridians.

The American Rescue Plan Act enacted in March 2021 created an option for states to fund mobile response teams for five years through Medicaid, which is funded by federal and state governments. In Florida, the federal government pays for more than half of all Medicaid spending in the state.

Under the ARPA provision, Medicaid would fund 85% of the costs of Florida’s mobile response teams for the first three years, according to a study by the Florida Policy Institute.

“The pandemic has triggered skyrocketing behavioral health needs,” according to a July 14 letter addressed to Gov. Ron DeSantis and co-signed by the Florida Policy Institute and 35 other organizations and individuals.

“Opioid overdose deaths have spiked,” advocates said in the letter, “a third of Florida adults report symptoms of anxiety and/or depressive disorder, and thousands of children and youth in crisis are subject to involuntary examinations under the Baker Act.”

Mobile response teams were credited with reducing the rates of children and adolescents involuntarily held for examination in areas that used them in 2018, according to a DCF task force that recommended Florida expand the teams statewide.

Currently, mobile response teams in Florida are not covered under Medicaid. They’re funded with state and local dollars. But Florida lawmakers could make mobile response teams eligible for federal reimbursement for five years, beginning in 2022, by using ARPA.

Swerlick said doing so would make Florida’s annual spending of $18.3 million a year on mobile response teams eligible for $100 million a year in federal matching funds for the first three years and $28 million a year for the last two years.

“We’re calling it low-hanging fruit,” she said. But Florida lawmakers have not responded to FPI’s calls.

Concluded Swerlick: “We get back to the long-term problem we’ve had in Florida of not having enough resources to provide the whole range of behavioral health services.”

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