A three-digit mental health lifeline gave Californians hope, but a big issue remains

If someone right now were to call the national mental health and suicide prevention phone number — the 988 Suicide and Crisis Lifeline — there’s a chance they’d be sent to a call center thousands of miles away.

Where a caller is sent depends on the area code of their telephone number. That means someone who originally got their phone number in Maryland or some other distant state would be routed to that state even if they were currently in Sacramento.

This can be a huge problem for the counselors trained to quickly, decisively help callers. Counselors often want to recommend local resources or, if needed, send law enforcement intervention.

While most callers don’t require someone to check on them in person, seconds do matter when someone’s life is at risk.

“We can’t just be assuming that just because they have a ‘559’ that they’re here in the Valley,” said Jessica Franco, an outreach coordinator at the operator of the Fresno lifeline call center.

“We want to make sure that we’re giving obviously the appropriate information to PD.”

The problem could soon be fixed. The federal agency that regulates communication services kickstarted a rulemaking process last month to require wireless carriers to implement a solution.

The Federal Communications Commission approved starting the process of getting wireless providers to have 988 calls “geo-routed.” Geographical routing or “geo-routing” does not give a caller’s precise location. It sends calls to a destination based on the nearby wireless tower it used to connect.

“I think it’s time to change this,” Chairwoman Jessica Rosenworcel said during the FCC meeting on the plan last month. “If we do, I think we can save more lives by getting more people connected to resources nearby.”

Central Valley callers want 988 fix

A year-and-a-half ago, her adult son was missing over the holidays. The mother called 988, the three-digit number for the Suicide and Crisis Lifeline implemented in 2022.

The local crisis counselor who answered gave the mother some solace. The case didn’t require police intervention like previous times her son was in crisis. She had vowed never to dial 911. He was almost shot after a neighbor called 911 earlier in 2022. The 988 number was the perfect alternative.

The mother, who wished to remain anonymous because her son is still in recovery and whose experience involves violent history, said in an interview that she found her son sleeping in his car the night after calling 988.

She decided that, if he were ever in need again, 988 was far better than 911. Police intervention in prior years had landed her son in mental health wards, jail and finally a program to help — sometimes leaving him sedated and other times irate, hearing voices.

Behind bars, he wasn’t getting the help he needed.

Recovery for her son included moving from the Sacramento area to Southern California, near family, to start over. They drove south in late April.

After she moved, the mother wasn’t sure who to call if she needed to, since she’d be routed to Sacramento.

“I don’t know the local number to a crisis line yet,” she said. “I don’t know anything. It’s like, oh, God, I don’t have any resources here. So yeah, I am concerned.”

When could this change be implemented?

A solution for her and others could be far off, given the glacial federal rulemaking process.

There are multiple steps before the FCC can vote on a final rule. Last month’s FCC meeting kicked off a period of public comment, which the agency will then review. A spokesperson for the FCC didn’t speculate on timing.

This proposal has been in the works for a while. Rosenworcel previously asked wireless carriers to explore a geo-routing solution in September 2023.

It’s important because 80% of 988 calls come from mobile devices, Rosenworcel said.

While 80 to 90% of calls do not require someone be sent to check on the person, often callers are referred to mental health care and other services, said Hannah Wesolowski, chief advocacy officer at the National Alliance on Mental Illness (NAMI).

Some states’ counselors can schedule callers appointments with local community mental health providers or recommend local groups to assist with issues that are stressing callers, like a lack of affordable housing.

“If you want to help the most people and ensure that they don’t keep cycling into crisis, you want to connect them to community resources,” Wesolowski said in an interview last month. “Everyone who calls 988 is met with a trained crisis counselor, but their ability to connect to local resources becomes limited if they’re across the country.”

NAMI has long pressed federal officials to enforce wireless providers connect people with the closest 988 call center, she said.

Said Wesolowski, “When it becomes that somebody’s life is at risk, it’s complicated anyway to get those services dispatched — even more so when they’re not in the geographic area.”

What is the situation in California?

California has received the most 988 calls of any state, according to data collected on the Lifeline.

The 988 Lifeline is free and confidential and operates 24/7 with over 200 call centers across the country. There are 13 call centers in California, including one in Sacramento and another in Fresno.

Franco, the outreach coordinator at behavioral health company Kings View, which operates the Fresno-area Lifeline, said in an interview that her facility gets calls out of state with the 559 area code “rarely” through 988. Still, it happens, and it affects her recommending local resources at the end of the call.

Calling law enforcement is a last resort, she said, because of the negative impacts that experience can have on someone in crisis. However it is important to get the right information if that last-resort intervention is needed.

“That’s why it’s always important to ask, ‘Hey, my name is Jessi from the Suicide Hotline. What’s your name and where are you calling us from?’” she said.

Franco said they receive calls ranging from young children to older adults in various levels of crisis. Normally they have text-response services, but the center has recently been understaffed.

More than 4,000 California residents died by suicide in 2023, the most recent full-year data that the state’s California Vital Data Report has.

In 2019, before pandemic lock-downs began in 2020, close to 4,500 California residents had died by suicide, the data shows.

Suicide deaths are hard to track, and generally are under-reported.

What is the 988 Lifeline?

The three-digit Lifeline launched in July 2022. The 988 number expanded services and shortened the telephone number from the National Suicide Prevention Lifeline that was in place since 2005. California calls to the Lifeline surged in the year after the three-digit 988 number was implemented in 2022.

After former President Donald Trump signed the change into law in late 2020, President Joe Biden’s administration allocated about $1 billion before the program was implemented nationwide in 2022. About half of states, including California, have passed laws to sustain 988 call centers.

Since 988 began, it’s received 9.6 million calls, texts and chats, according to the Substance Abuse and Mental Health Services Administration. The Lifeline can aid in Spanish and American Sign Language and has special lines for veterans and young LGBTQ people.

In late April, the Biden administration released an updated National Strategy for Suicide Prevention, including additional support for the 988 Lifeline.

Awareness of 988 remains low, said Wesolowski.

Only 22% of U.S. adults said they were very or somewhat familiar with the Lifeline in October 2023, a NAMI-Ipsos poll released in November found.

There are local crisis numbers where callers can reach out — the Central Valley Crisis and Suicide Prevention Hotline is reachable at 888-506-5991, and Kings View answers that too. But the three-digit 988 number is faster and nationally accessible.

The mother who moved from the Sacramento area to Southern California hopes if she must call 988 again, it will help her locally.

“I’ve learned to find out what the local non-emergency dispatch number is, and if there’s a crisis rapid response number that can tie us in 988 that 988 is usually interfaced with,” she said. “But yeah, I don’t know what’s going to happen when I dial 988 now, if it’s going to go to Sacramento.”

The 988 Suicide and Crisis Lifeline offers free, anonymous help to anyone in crisis and their loved ones. Access the 24-hour hotline by calling or texting 988. A live chat is available at 988lifeline.org. WellSpace Health, which operates the universal service in the capital region, can also be reached at 916-368-3111 or by texting HOPE to 916-668-4226.