Colorado was better prepared for the transition to the 988 crisis hotline than many states, but people working in the mental health field still anticipate some bumps along the way.

The National Suicide Prevention Lifeline activated its shorter number last weekend, though state and federal officials emphasized it’s still a work in progress.

Call centers nationwide are trying to hire additional people trained in crisis counseling, and, unlike 911, the system can’t detect where a call was placed. That means that people calling from Colorado with cellphones that have out-of-state area codes may need to be transferred to get local help.

The previous number, the national Suicide Prevention Lifeline at 800-273-8255 (TALK), will remain active for the foreseeable future. A Colorado-specific crisis line, available by calling 844-493-8255 or texting TALK to 38255, also continues to operate.

People who need local help can get it more directly by calling the Colorado line, but the new number also serves a purpose, said Dr. Kiara Kuenzler, president and CEO of Jefferson Center for Mental Health.

“If they can’t remember that number but can remember 988, go ahead and use it,” she said.

About 200 crisis call centers nationwide handled 3.6 million calls, texts and online chats in 2021, and federal officials think that number could more than double this year as the need remains high and the easier-to-remember number is publicized. There are 14 backup centers that can handle calls if a specific area is overwhelmed by volume, though ideally callers would be connected back to a local center that knows more about resources in the area.

Bev Marquez, CEO of Rocky Mountain Crisis Partners, said its operators didn’t have an unusual volume of calls on the first weekend after the transition, but they did get more calls that were just requests for information about what the line is for and whether it’s connected to 911. They also had more callers who were in severe distress than is typical, but that might be coincidental, she said.

“We don’t know if people called us instead of 911. We don’t know if a lot of people were having a particularly tough weekend,” she said.

Rocky Mountain Crisis Partners answers calls, texts and online chats for both the national Lifeline and the Colorado crisis line. Only seven states have their own crisis lines, so Colorado had more practice than most in handling multiple modes of communication, Marquez said.

“For us, it’s an expansion of services versus a development of services,” she said.

Data from the first three months of the year showed local call centers in Colorado were able to answer 5,947 of the 12,095 calls the national lifeline received, or about 49%. Only Illinois and Texas had lower rates, though states that answered higher percentages of calls were generally those with less demand.

The data doesn’t count calls to the Colorado crisis line, however, so a higher percentage of all calls seeking help stayed in-state.

States have generally soft-pedaled 988’s launch, partially due to concerns that they aren’t ready for an influx of calls. Still, some call centers reported double their volume over the weekend, while others said they had little or no change, according to STAT News.

The day before the transition, Secretary of Health and Human Services Xavier Becerra said that 988’s success ultimately will depend on what states choose to do, since the federal government is only assisting with text and online chat services temporarily, and resources for people in crisis will have to be provided locally.

“This is not a federal program. It’s just that President Biden made a deep commitment to it,” he said at a press briefing.

The federal government has spent about $177 million on 988 infrastructure, like backup call centers, and made about $105 million in grants to states. Another $150 million from the recently passed Safer Communities Act will go toward 988 in the future. In a typical year, the federal government spent about $24 million on the hotline.

Colorado is one of four states that passed a surcharge on phone bills, of about 18 cents per month, to help fund 988. The surcharge allowed Rocky Mountain Crisis Partners to raise starting pay from $17.50 to $19.50 an hour, with annual 5% raises, and to add benefits like vision coverage, Marquez said.

The surcharge also can be used to help expand crisis services in the future, Kuenzler said. Jefferson Center for Mental Health budgets for about 700 positions, and 100 are vacant now. At least 90 of those are clinical positions, and if all were filled, they could serve about 15,000 more people, she said.

Since there’s a shortage of workers in the mental health field, they’re trying to reach more people with the available staff by testing a virtual drop-in clinic and hiring more case managers to help with tasks that don’t require a licensed professional, Kuenzler said. They’ve also emphasized assessing patients quickly to determine who needs therapy and who would likely see their symptoms largely abate once they’ve received help with their material needs, she said.

Kuenzler estimated their center typically handles about 3,000 crises per year through its walk-in centers and its mobile team. They’ve had to shift some people away from other services to meet the need for crisis care. Still, she said they don’t want people to hesitate to call if they’re concerned about their mental health or substance use, or worried about a loved one.

“We want people to know that they get to define their own crisis,” she said. “If you need to talk to someone right now, just call.”

Crisis care is a tough field for recruiting, Marquez said, but the 38 people they’re currently training should cover the expected demand for the call center through next June. For now, they’ve canceled July vacations and given employees incentives to pick up shifts, though she asked callers to be patient if it takes a bit longer than usual for someone to answer.

In the majority of cases, a counselor can talk the person through an immediate crisis during the call. In some parts of the state, they could send a mobile mental health unit if someone is in imminent danger.

Federal health officials estimated between 2% and 4% of calls require a response from police or paramedics. Eventually, 911 operators will be able to transfer calls that don’t require a police or ambulance response to 988, but that’s still in the works, Marquez said.

Dr. Emmy Betz, a professor of emergency medicine and physician at the University of Colorado Anschutz campus, said she’s not sure if the new line will result in fewer people coming to emergency rooms because of mental health crises.

The emergency room is the right place for people with a life-threatening condition — for example, someone who swallowed too many pills or seriously injured themselves — but calling the hotline or using the walk-in crisis centers in the Denver area can be a better option for those who aren’t in imminent danger, she said.

It’s not clear whether the easier-to-remember number will result in more people asking for mental health services, since at least some would have entered the system in another way, Betz said.

“If there’s an initial bump or pressure, that’s a good thing,” she said. “These are people we want to be seeking care.”

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