This story is part of The Salt Lake Tribune’s ongoing commitment to identify solutions to Utah’s biggest challenges through the work of the Innovation Lab.
Dina Nielsen works with young people struggling with their mental health and suicidal thoughts for her job managing crisis intervention for an online college.
So when a friend reached out to Nielsen for help finding mental health resources for her daughter, Nielsen’s first instinct was to call 988, the national-three digit suicide and crisis lifeline.
Rather than hearing the voice of a human being, Nielsen was surprised when she was greeted with an automated voice.
“Please stay on the line while your call is directed to an available responder. Please continue to hold. Please stay on the line while your call is directed to an available responder.”
Nielsen waited for about three minutes before she was transferred to a crisis worker. She says once connected she explained the situation and the crisis center reached out to her friend, who received the help needed for her child.
“My friend got really good service from it, and I feel confident they are doing what they need to do,” Nielsen said. The only thing that bothered Nielsen was the longer than expected wait time.
She wishes there was more information about what to expect when calling 988, so that those in crisis know it might be a few minutes before they reach someone, but once they do, they will receive the support needed.
“If you establish that expectation, then they’re prepared for it and they don’t feel put off,” Nielsen said. “That is the one thing that is missing.”
It’s been five months since the National Suicide & Crisis Lifeline shifted from a seven-digit number to the simple and more easily remembered 988. The Tribune spoke with the people running the state lifeline, leaders who advocated for the changes and mental health professionals about their hopes for the service and its the future in improving mental health care in Utah.
Overall, the rollout of 988 has gone well in Utah but there’s still progress to be made with boosting staffing, closing the gaps in rural versus urban care and building out crisis receiving centers.
“I think we were already ahead of the curve,” said Rachel Lucynski, director of community crisis intervention and support services at the Huntsman Mental Health Institute. “There’s still work to be done, of course, but I think we’ve just received a lot of support that helped us incrementally grow and prepare to meet the demand for those services.”
Why the comparison to 911?
The move to 988 represented more than just a number change. Some dreamed 988 would become the “mental health system equivalent to 911,” said state Republican Sen. Dan Thatcher, who represents Magna and other areas in western Salt Lake County. Thatcher has been one of the crisis line’s key proponents.
But the system is not quite the 911 for mental health that advocates like Thatcher envisioned. Some are concerned early promotional efforts to so closely compare the two numbers may have created confusion.
“It’s a double edged sword, because we want folks to get it in their mind, yes, it is a three-digit number that starts with a nine for a mental health emergency,” Lucynski said. “That’s really where the comparison to 911 should stop.”
When someone calls the lifeline there’s an option for veterans, Spanish speakers and those who identify as LGBTQ. If you don’t choose one of those options, you simply wait on the line for the first available crisis care worker.
Listing these options takes time, but “there are a lot of benefits to receiving specialized care for folks in those specific populations,” Lucynski said.
The longer wait times for 988 are also a function of the service — unlike 911 the people answering the phone aren’t quickly dispatching services, but are taking the time to listen and understand each individual caller.
“When you connect to the 988 suicide and crisis lifeline, it’s a different experience,” Lucynski said.”[Our team] is working to provide compassionate, empathetic listening and support, deescalating an emotional crisis, assessing for the level of active suicide risk or safety that someone is currently experiencing.”
The Huntsman Mental Health Institute also operates a “warm line” staffed by peer support specialists for times when someone might be at an emotional simmer rather than a boil, Lucynski said. “If you just need someone to listen and provide that validation and support, kind of talk through some challenges in life.”
What are the response rates?
On average, calls to the lifeline take about 20 minutes and between 86% to 90% of calls are resolved on the phone. Roughly 6% to 8% result in the dispatch of mobile crisis outreach, according to Lucynski. Mobile crisis outreach teams, which do in-person response to crisis, include a master’s level clinician and a peer specialist.
From July 1, 2021 to June 30, 2022 the Huntsman Mental Health Institute received over 100,000 calls.
“It would require so much more staff and so much more money in Utah and across the country to really have the capacity that 911 has,” Lucynksi said.
When calls aren’t answered by Utah’s crisis center within two minutes, they’re routed to the national center and answered by someone out-of-state.
September 2022 Huntsman data showed crisis line workers had an 85% in-state answer rate, and 90% of those calls were taken within 30 seconds.
“We’re usually very quick to answer,” Lucynski said. However, “you can’t predict when people will be in crisis so if there’s a surge of calls at the same time, that can impact answer rates.”
How are rural needs being met?
The push for mental health care in Utah isn’t just about having someone answer the phone.
The state has long had mobile crisis outreach teams, made up of licensed mental health professionals who can go out and assess a situation rather than having police show up. These services can be crucial because interactions between those with mental health issues and police can result in real harm. A 2021 Tribune investigation found that at least 42% of police shootings in the past decade involved a person in crisis or suicidal.
Future focused plans include the creation of more “crisis receiving centers,” a place besides jail or a hospital emergency department where those experiencing mental health crises can go and meet with psychiatrists, social workers or peer specialists. Davis, Utah, Weber and Salt Lake Counties all currently have receiving centers.
The Huntsman Mental Health Institute has run a small receiving center for the past 12 years, but an expansion to a 78,000-square-foot facility is in process. The facility will have 30 chairs, 24 private inpatient units and a floor with a bevy of resources from a free dental clinic to intensive outpatient programs, said executive director Ross VanVranken.
Plans are also underway to build receiving centers in more rural parts of the state. Price, in Carbon County, will have the first rural receiving center in Utah, said Melissa Huntington, executive director of Four Corners Community Behavioral Health, which serves Carbon, Emery and Grand counties.
“We’re hoping to have the inside completed by the end of January and be able to start receiving clients there,” she said. The facility will be open 24 hours every day of the year.
“We don’t want people who are going to jail, that really could be better served with a mental health intervention,” she said. “And we don’t want people going into emergency departments where they may be met with well-intentioned physicians who maybe don’t have all the answers to intervene with someone who’s in that level of crisis.”
What comes next?
Lucynski is thinking about ways to expand the crisis care continuum, from receiving centers to mobile crisis teams to hiring additional qualified workers.
In the coming months, the center plans to boost 988 chat and text capabilities — which will require more staff. Huntsman hasn’t been immune to a tough hiring market, although offering benefits and a starting wage of $20 an hour has helped. The center would also like to hire a more geographically representative workforce, and is making efforts to hire crisis workers who live across the state — they hired their first fully remote employee out of St. George.
Hiring more workers will be key to expanding the center’s capacity as demand and awareness of 988 grows. In October, Lucynski’s department had 130 people on staff and was set to reach about 200 by the end of the year.
Overall, nationwide promotion of 988 has been slow in order to avoid overwhelming call centers. A national analysis of call volumes by the Kaiser Family Foundation found that in July 2022, the month 988 launched, there was a 28% increase in calls, texts, and chats. But the following month that growth slowed to just a 2% increase.
But in the summer of 2023, Lucynski expects more national public awareness campaigns to launch.
“If you’re on hold for five minutes, you may not call again,” she said. “So it’s really that delicate balance of making sure that people know about the service but that marketing doesn’t drive up utilization to where it exceeds capacity.”
Legislators like Thatcher are also still working to improve mental health care in Utah.
Now chair of a nationwide mental health group, Thatcher plans to assemble a team of like-minded legislators “to build essentially a blueprint of how to have a fully functional, robust, best practices mental health crisis continuum.
“My expectation,” he said, “is frankly to get society to where it is presumed that mental and behavioral health are is handled equally to physical health.”