Less than 1% of health care spending in the United States is on mental health, but the landscape is changing as awareness of mental health disorders is increasing and the stigma is decreasing.
Kentuckians and all Americans now have access to a 988 suicide and mental health crisis line, which has been operational for a little over a year. Beyond suicide ideation (the term for someone thinking about suicide) the line accepts calls, texts, and online chats at 988lifeline.org from anyone who needs support for a suicidal, mental health, and/or substance use crisis. It is available to everyone, every hour of every day.
Angela Roberts is the 988 program administrator. The program is a part of the Department for Behavioral Health, Development and Intellectual Disabilities, which falls under the Kentucky Cabinet for Health and Family Services. She said the line is for anyone experiencing a crisis and described the system as having three pillars ‒ someone to call, someone to respond, and a co-responder model with other resources such as EMS, 911, and social workers.
“Mental health is ‘health,’ and we need to shift the mindset in order to build systems that people need,” Roberts said. “911 is a bridge to resources; when you call 911, someone is going to get you the help you need. With 988, the trained professional on the other end of the line often is the resource.”
She said the program’s goal is to provide the “localest” intervention possible, and emphasized that when someone contacts 988, they will reach a compassionate, highly trained counselor who can help address their issue in the least intrusive way possible.
In Kentucky, 988 calls go to one of 13 Community Mental Health Centers (formerly known as Comprehensive Care Centers), which are accredited as National Suicide Prevention Lifeline call centers. If someone in central Kentucky calls 988, it will go to the nearest center. If the line is busy, the call will automatically roll to another center in Kentucky, which has the same list of resources and services. The service also provides prompts for persons to get assistance in Spanish, and there are pathways for veterans, LGBTQ+, blind, and deaf/hard of hearing persons.
Roberts said there are not enough mental health professionals in Kentucky, which amplifies the need for tools like the crisis line. She said in some communities, first responders are using iPads in the field to give individuals in need immediate access to 988 on the spot.
Steve Shannon, executive director of the Kentucky Association of Regional Programs, the non-profit representing the commonwealth’s Community Mental Health Centers, said 988 is not just for persons experiencing mental health crises, but also for those concerned.
“Family members, coworkers, neighbors, and classmates all have an opportunity to call 988,” he said. “My hope is that someday soon 988 is as common as 911.”
Of the 4.5 million people in Kentucky, 3.2 million live in a community that does not have enough mental health professionals. Another sobering statistic is that 746,000 Kentuckians have a diagnosable mental health condition – that is more than 10 times the population of Bowling Green. Beyond that, 189,000 Kentuckians have a serious mental illness, which contributes to other community issues such as higher utilization of school resources, EMS, fire, and police services, emergency department visits, and the judicial system. It also adds another layer to many persons experiencing substance use disorder or homelessness.
According to Centers for Disease Control (CDC) data, Kentucky’s depression rate is the fifth-highest in the United States. People of all ages are impacted including children, youth, adults, and the elderly. And, in Kentucky, one in four people with a serious mental illness has been arrested, and seven in 10 youth in the juvenile justice system have a mental health condition. Additionally, suicide is the second-leading cause of death for youth and young adults in Kentucky. According to a Youth Risk Behavior Survey released in late 2021, 15% of Kentucky high school students and 17.4% of middle schoolers reported that they had seriously considered taking their life at some point.
Launched in July 2022, Kentucky’s 988 service is responding to thousands of monthly contacts and is still building capacity. One sign of success is that only 2% of the calls to the crisis line have ultimately resulted in a visit to the emergency department.
Roberts said, “The 988 lifeline helps us to build stronger more resilient communities, and this number will help ensure adequate access for all to mental health care, including residents of all ages.”
The Kentucky system was made possible with several federal grants, including a $1.16 million grant from the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration. The Commonwealth of Kentucky has also committed budget funding to help build infrastructure and capacity for 988, as well as to fund mobile crisis services.
“988 is not just a number, it’s a health system,” said Marcie Timmerman, executive director of Mental Health America of Kentucky. “In Kentucky, there’s no barrier for you.”