With September, which is national Suicide Prevention Month, having come to an end, advocacy organizations don’t want the issues facing the mental health of thousands of Minnesotans to be forgotten.
In the past months, the 988 Suicide & Crisis Lifeline has received more calls, which can be attributed to the hotline phone number change in mid-July to a shorter three-digit number, 988.
Minnesota has four call centers. Comparing call volume in June 2022 to that of July 2022, calls increased by 44%, according to the Minnesota Department of Health (MDH).
From January 2022 to August 2022, Minnesota call centers received 23,099 calls, an increase of around 16.6% from the 19,796 calls made during the same time in 2021, according to MDH.
The centers are seeing more frequent callers, according to Carolina De Los Rios, the senior program officer for the Mental Health & Suicide Prevention at Greater Twin Cities United Way. Those callers will sometimes call multiple times a day, she said.
The underlying issue, De Los Rios says, is many callers most likely don’t have the resources to seek long-term care. So their only option in times of difficulty is the hotline, which is not a sustainable source of help.
Suicide, or death by intentional self-harm, has been steadily rising in Minnesota for the past 20 years. According to the Minnesota Department of Health, there were 777 suicides in 2021, making it the seventh consecutive year where more than 700 Minnesotans died by suicide.
Where are the calls coming from?
De Los Rios said that when someone calls the lifeline, the call is then routed to a specific center depending on the caller’s area code. In Minnesota, the health department receives data from the 988 Suicide & Crisis Lifeline, parsed by county. The call centers and the health department have no way to identify what populations or communities might be calling more often, other than information that callers may choose to share. If the call centers could separate the data by ZIP code and demographic information, it could shine a light on disparities in access and the need for mental health care in different communities, De Los Rios said.
“Data tracking and demographic is a huge priority to be able to track what communities are not being served in terms of mental health access. However, this is where we face a challenge. People are particularly cautious when they reach out to our line,” De Los Rios said.
Some people worry that if the call centers know the caller’s ZIP code or address, police could become involved in a non-productive way, she said.
Lolita King, a psychologist at NorthPoint Health and Wellness Center, thinks that while the 988 lifeline is a step in the right direction, trust has to be built with underserved communities so that mental health care disparities can be reduced.
“I don’t think it’s going to be the end all be all. It will require a lot of informing the public of how it can be useful. And that takes more than just a billboard or a flyer. It will probably take some one-on-one contact, showing up in the community and dispelling any concerns that a person might have,” she said.
The call center doesn’t ask for a ZIP code unless they need to reach out to emergency services. In 2020, 988 dispatched the police around 2% of the time, which De Los Rios says happens when the person is no longer able to keep themselves safe, or there is an attempt in progress.
“People don’t (want to) say much about themselves, and since it’s a crisis call, we prioritize the safety and the de-escalation as opposed to, like, gathering demographics,” De Los Rios said.
When callers share their demographic information, the centers keep track of it and send it back to the Minnesota Department of Health. That data is not complete, however, because it is self-elected.
“There is a healthy suspicion oftentimes in underrepresented populations about how this information may be used, who has access to it. Can this have a detrimental impact on them in terms of the court system?” King said.
Hennepin County had the most calls in 2021 with 20,749 calls, followed by St. Louis County with 1,328, Stearns County with 1,101, Olmstead County with 934 and Isanti County with 712.
Of the 33,887 calls made to Minnesotan call centers in 2021, around 60% were from Hennepin County, although only about 22% of Minnesotans reside in Hennepin County.
Call center specific
Minnesota’s four call centers all have different experiences with callers, though a common theme is that the calls have increased since the switch to 988.
For example, the Greater Twin Cities United Way lifeline is available seven days a week at all hours, either by calling or texting. De Los Rios said it had received over 4,200 calls in the past two months.
Its staff includes 18 suicide prevention call specialists who work remotely. Given the recent increase in call volume, they want to recruit four more people. The specialists are not required to be licensed clinicians, but instead, the center aims to target people with inpatient facility or case management experience.
Of that lifeline’s average 2,000 to 2,500 monthly callers, approximately six to nine of them are frequent callers, according to De Los Rios.
She said there’s an evident lack of long-term mental health care for those individuals.
“We sometimes have frequent callers that, for very unfortunate reasons, are not able to find resources within their communities, so they utilize the call center, almost like a long-term service, which is not the (intent),” De Los Rios said. “I’m glad the callers feel confident and comfortable reaching out to us. But what that also tells us is that they’re not able to find resources within their community. It is concerning when they basically continue reaching out and disclose that they have not been able to feel confident that they are getting the care they need in their communities.”
Barriers to long-term care
King, who has worked in behavioral health for more than 20 years, recommends that the call center create some form of informed consent, which is upfront about why the call centers are requesting the information and being clear that the use and purpose of the data is to reduce disparities.
The inequities around access to mental health care arise from various barriers like access to transportation and difficulty navigating insurance systems could prevent people from getting long-term care, despite how needed it may be. On top of that, there is also the stigma of receiving mental health services that can prevent people from seeking help, King said.
“Traditionally, there’s been a stigma about those who seek mental health or behavioral health services, particularly in underserved communities,” she said. “It’s not without any basis and reality because we do know that there have been some atrocious things that have happened to the African American community … so our culture and our community continues to remember that.”