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Saturday, May 25, 2024

Rhode Island’s 988 success story

The first thing many callers do is apologize 

By Alexander Castro, Rhode Island Current

The 988 Lifeline was designed to help people ask for help — whether they’re struggling with thoughts of self-harm, suicide, depression or any other crisis. 

Just as 911 redirects people to local emergency services, the 988 number directs people to local call centers, where trained crisis counselors can listen when someone needs to speak their mind.

But the first thing many people do when they call Rhode Island’s crisis hotline is apologize.

“Pretty regularly people will call and they’ll apologize for their crisis,” said Sydney Muraoka, manager of the Rhode Island 988 Suicide & Crisis Hotline. “[Callers will] say ‘I’m sorry you have to hear this. There’s plenty of other people that have it worse and need services more.’” 

“Too many people think that their struggles are a burden, or they aren’t as deserving of kindness and support as others around them. But the point is we’ve got enough kindness to go around,” Muraoka said at a press conference on Monday, outside the BH Link call center in East Providence to celebrate Rhode Island’s responsiveness to people in crisis. 

Since the 988 Lifeline was introduced in July 2022, Rhode Island’s call center has seen 13,527 calls, with a 98% average answer rate, according to data from BH Link. That means most calls are handled in-state, rather than outsourced to a national crisis support network. Calls are typically responded to within two seconds, and the average call lasts 17 minutes.

The 988 hotline replaced the clunky, 10-digit number of the National Suicide Prevention Hotline with a new, easy-to-remember three-digit code a lá 911. 

“Several years ago, my colleagues and I in the Senate made an incredible intellectual breakthrough. We figured out that three numbers were easier to remember,” said Democratic U.S. Sen. Jack Reed, Rhode Island’s senior U.S. senator, who cosponsored the October 2020 legislation that created the 988 hotline nationally.

Muraoka has fielded over 1,000 of crisis calls since she began working at the BH Link call center. Since the 988 Lifeline replaced the National Suicide Prevention Hotline, proponents have been careful to point out that the hotline is not only about suicidality. In fact, only 15% of callers in Rhode Island expressed thoughts of harm or suicide, accoding to BH Link.

Whether people are struggling with substance use, depression or anxiety, Muraoka said that the privacy of a phone call can help people speak up.

“That level of anonymity kind of allows people to feel a little more free to share what’s really going on, and get the support that they need from professionals that are not going to come in with preconceived notions of judgment,” she said in an interview after the press conference.   

The state’s Department of Behavioral Health, Developmental Disabilities and Hospitals has funded BH Link’s call center activities since 2019, before the national hotline’s emergence. At the press event, Richard Leclerc, the recently appointed director of the department, pointed out that a state survey found 63% of Rhode Islanders know about 988 — a majority, but still not enough in his view.  

“While this is a pretty good number, 37%, or more than a third, do not know about 988 so therefore can’t access it when they need to. That means we have more work to do,” Leclerc said, and motioned to poster boards on display behind him, announcing a new statewide public awareness campaign about 988. 

Stable funding needed

When the 988 service launched in July 2022, NPR reported that some mental health advocates were concerned 988 would lead to involuntary hospitalization or police intervention.

In Rhode Island about 3% of calls resulted in “community wellness checks” involving police or other emergency intervention, according to stats from BH Link.  

Muraoka told Rhode Island Current that the purpose of the 988 Lifeline is to divert people from interventions like hospitalization that can be traumatizing in their own right.

“The idea is always the least restrictive method of intervention possible — not just because that’s what the Lifeline says we should do, but for our callers, to really work with them to figure out what is the least restrictive and what is going to be the most therapeutic and the most helpful to them in the long term.”

Muraoka said that the BH Link call center is familiar with behavioral health resources in the area and can direct people to the most appropriate care.

The newness of the 988 hotline means its efficacy hasn’t been extensively studied yet. Some research has started to emerge, like an April 2024 policy analysis in the journal Frontiers in Public Health. The article’s authors focused on Georgia, which had “a robust statewide suicide hotline prior to 2020” — but also “significant” gaps in mental health coverage, with an uninsured rate of 13.7%, the third highest in the country.

“Overall, this analysis shows that the performance of the crisis system in Georgia improved since the implementation of 988,” the article concludes. “However, sustainable state funding mechanisms must be instituted to ensure the sustainability and effectiveness of the Lifeline going forward.”

About $1 billion in 988 funding came from the American Rescue Plan and Bipartisan Safer Communities acts. That money won’t last forever, so the question of how to fund the nation’s loose network of crisis centers has come up in several states. In April, state lawmakers in Maryland passed a bill that would fund the hotline’s continued existence via a 25-cent monthly tax on cell phones. And in February, Wyoming lawmakers battled over budget proposals for 988.

In Rhode Island, Rep. Mary Ann Shallcross Smith, a Lincoln Democrat, is lead sponsor on Bill H7035, which would use $1,875,000 of federal money from the state fiscal recovery fund to maintain the 988 hotline. The bill has been held for further study since its May 15 hearing at the House Committee on Finance. A companion bill by Sen. Sandra Cano was heard on April 2 at the Senate Committee on Finance. 

More stable funding would help support a population whose concerns are always changing. Muraoka told the crowd – which included U.S. Sens. Reed and Sheldon Whitehouse, Gov. Dan McKee and House Speaker K. Joseph Shekarchi as well as numerous community and health leaders — that no two days at the call center are the same.

“We want to help everybody,” Muraoka told Rhode Island Current. “Crisis and pain and suffering: It’s not necessarily something that can be ranked on some sort of universal scale. … So it kind of breaks your heart a little bit when people do call and say, ‘Hey, ‘I’m so sorry.’ It’s like, ‘No, this is what we’re here for.’”

If you or someone you love is going through a mental health or substance use crisis, there is help. Reach a trained crisis counselor 24-hours-a-day, seven-days-a-week by texting or calling 988.



Rhode Island Current is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Rhode Island Current maintains editorial independence. Contact Editor Janine L. Weisman for questions: Follow Rhode Island Current on Facebook and Twitter.