By Taylor Knopf 

In July, there will be a new universal phone number — 9-8-8 — for people across the United States to call when they or someone around them experiences a mental health crisis. The idea is that it’s short, easy to remember and the same everywhere. 

Right now, most everyone knows to call 9-1-1 in an emergency. But law enforcement and emergency responders are not always equipped to help someone who is in mental health distress or having a psychotic episode or thinking about suicide.

People with mental health issues are 16 times more likely to be killed by police, according to a 2015 report from the Treatment Advocacy Center. On top of that, people of color are killed by law enforcement at much higher rates than white people, according to a Washington Post database of all fatal police shootings

Police involvement in connecting people to mental health care is stigmatizing and can deter people from getting help in the future. However, NC Health News found that when given a chance to rethink law enforcement involvement in mental health crisis care in 2019, most North Carolina counties maintained the status quo

The 9-8-8 mental health crisis number is designed to give people a different option that isn’t routed through law enforcement.

Ready to launch?

Congress passed the National Suicide Hotline Designation Act of 2020 which created the 9-8-8 hotline. It’s supposed to launch nationwide in July, but most states do not have a legislative plan for the rollout of the service. 

North Carolina, on the other hand, is ready and on track for the July launch date, according to Deepa Avula, director for the NC Division of Mental Health, Developmental Disabilities and Substance Use Services. 

“I was involved very heavily in the implementation on the front end of 9-8-8. So I know where North Carolina is relative to other states, and North Carolina’s Crisis Response Suicide Lifeline response is very, very strong compared to others,” said Avula who worked for 20 years at the federal Substance Abuse and Mental Health Services Administration prior to her current role.

Readers may also be familiar with the Hope4NC helpline, which can be reached at 855-587-3463. It was created as a natural disaster relief line in North Carolina after Hurricane Florence, Avula explained, and is scaled up or down as needed. 

That line is different and will remain separate and accessible even after the launch of the 9-8-8 mental health hotline, she said. 

How it works

Right now, North Carolina already participates in the National Suicide Prevention Lifeline — 800-273-TALK. When someone calls that number, they are routed to their local crisis center, Avula explained. Starting in July, that same crisis line will be reachable by dialing 9-8-8.

Due to the ease of remembering the number 9-8-8, Avula said there is an expectation that the call volume will increase by potentially up to 30 percent. So the state is working to increase the capacity of the actual call center by hiring more people to answer the phone. The call center is contracted out to a group called Real Crisis Intervention headquartered in the eastern part of the state. 

9-8-8 callers will immediately be put in touch with a trained crisis counselor, Avula said. Many times, the counselor can help de-escalate the situation over the phone. 

If the caller is still in need of help, a mobile crisis team of mental health professionals will respond. The hope is that when people dial 9-8-8 during a mental health crisis instead of 9-1-1, mental health crisis teams will be dispatched to respond to these situations, not law enforcement. 

More mobile health teams

There are currently mobile crisis teams in every NC county, Avula said, and the state is working to expand the number of mobile crisis teams to respond to calls. 

“What I’m describing in terms of expansion will require additional resources,” she said without specifying an amount. When asked about possible legislation to fund the 9-8-8 expansion, she said those details will be included in the governor’s budget when it’s released, likely sometime this month.

North Carolina has sought to expand its mobile units of mental health teams in recent years. In December, the Department of Health and Human Services gave $4.4 million to fund 15 mobile units to provide screening, assessment, treatment, primary care and recovery support services to people with substance use disorders. 

Last month, DHHS and Trillium Health Resources launched seven mobile health clinics in eastern North Carolina to address mental health and substance use issues in 17 rural counties.

“There is no health without behavioral health & it must remain at the front of everyone’s mind in our COVID-19 recovery,” state health and human services Secretary Kody Kinsley wrote on Twitter after the ribbon-cutting ceremony for the seven new mobile units.

Crisis hotlines aren’t enough

In the days following the January suicide death of Miss USA Cheslie Kryst, a North Carolina native, many people took to social media to post sentiments such as “you are not alone” and “please reach out for help.” 

However, imploring people to simply reach out to a crisis line isn’t going to be enough to stop the rising number of suicide deaths in this country. Cherene Allen-Caraco, founder Promise Resource Network, a Charlotte-based mental health organization run by people with their own experiences of mental illness, took to social media to ask people to stop posting these sentiments. 

“At a time when we have the highest rate of suicide attempts and completion, we also have the largest suicide awareness campaigns and trainings,” she wrote on Facebook. “Think about your darkest moments. Could you simply make a call or ask for help? For many of us, for many reasons the answer is no.” 

Allen-Caraco is a suicide attempt survivor and talks openly about suicide and helping people navigate suicidal thoughts

“If we could just reach out and remember we are not alone, our rates wouldn’t be so high,” she wrote. “In addition to posting those messages, what should we do?”

Allen-Caraco went on to list 10 things people can do to help people struggling with thoughts of self-harm or suicide. 

“Reach in,” she said. “Ask curious questions with no intention other than to hear and see another’s pain. Validate the person’s pain, distress, hesitations – whatever they’re expressing.”

She encouraged people to be vulnerable and share personal experiences of pain, trauma or suicidal thoughts. This is one key aspect of peer support, where people with their own history of mental health issues support others in distress or navigating difficult life circumstances. 

“Arm yourself with information,” Allen-Caraco wrote. “One of my favorite trainings for non-attempt survivors is called ‘When the Conversation turns to Suicide.’”

“Check out ‘The S Word’ documentary for some insights from survivors. Don’t simply seek a clinical perspective or opinion, seek knowledge from people that experience thoughts and attempts of suicide.”

Promise Resource Network also has a warm line, a mental health line people can call that is completely staffed by peers, others with lived experience of mental health issues. The warm line is funded by Mecklenburg County, but has received nearly 30,000 calls from around the state since it launched at the beginning of the pandemic. 

Allen-Caraco said no warm line callers have died by suicide or drug overdose, and her organization has not needed to call 9-1-1 or initiate an involuntary commitment in response to any of the calls. Despite this success, she said there isn’t enough funding to keep the warm line available to the entire state, and she may soon have to limit it to Mecklenburg County residents.

Peer support is supposed to be part of the 9-8-8 initiative’s continuum of mental health resources, and Allen-Caraco hopes her organization’s warm line can be part of North Carolina’s.

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...