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Call centers struggle to hire for nation's new mental health crisis line

A crisis counselor answers calls at First Choice Services in West Virginia.
Lata Menon / Submitted Photo
A crisis counselor answers calls at First Choice Services in West Virginia.

if you or someone you know is struggling with suicidal thoughts, help is available. Contact the National Suicide Prevention Hotline at 800-273-8255 or the Crisis Text Line by texting HOME to 741741.

Jennifer Battle is open to just about anything to find people to answer the phones at her Houston-area crisis line.

“It's like we need to have some kind of dating app, except for crisis work. Like, swipe here if you want to work in the middle of the night and talk to people in need,” joked Battle, director of access at the Harris Center, Texas’ largest public mental health agency.

Battle has been trying for the last 18 months to hire 25 counselors to answer 988, the country’s new mental health crisis line. Her center is one of more than 200 agencies that currently answer the National Suicide Prevention Lifeline and will begin answering 988 on July 16.

2020 law converted the 10-digit Lifeline number down to three and expanded the line’s mandate to encompass all mental health care needs, including suicide, addiction and severe mental illness.

Some have described 988 as “911 for mental health,” and lawmakers hope the three-digit number will make it easier for the 50 million Americans with a mental illness to get help. Today, fewer than half get treatment.

As many as 12 million people could reach out to 988 in its first year, according to federal officials, quadruple the number the Lifeline served in 2020.

The people setting up 988 agree the counselors answering these calls, chats and texts will be critical to the new line achieving its goals. But with just six weeks before it goes live, hundreds of positions remain unfilled — putting those looking to the line for help at risk. It also makes it more likely that those who have been hired will end up overworked.

In her 20 years running crisis lines, Battle said this is the most trouble she’s had hiring.

“There's always been this core pocket of people who are right for us. And now it feels like that pocket of people, I don't know where they're going,” she said.

911 as a cautionary tale 

As 988 creeps closer to launching without sufficient staffing, some experts worry that workers for the new crisis line could face the same challenges as their cousins at 911.

Understaffing has long plagued 911 call centers, and it intensified during the pandemic. 911 call-takers earn $47,000 a year, on average, and research shows more than half are obese, with many workers reporting high levels of physical pain from sitting through tense shifts, sometimes for eight to 12 hours. One-quarter of 911 professionals have symptoms of depression and post-traumatic stress disorder, on par with rates among police officers and firefighters.

“Whether you want to admit to it or not, it affects you,” said Rita Salazar, who’s been answering 911 calls near Seattle for more than 20 years. Salazar was diagnosed with PTSD last year after a traumatic call nearly forced her to quit her job.

There’s no direct evidence linking 911 call-takers’ health to their job performance, but Northern Illinois University psychology professor Michelle Lilly, a leading 911 researcher, said a large body of evidence from other fields shows, “when you have PTSD and depression, it affects your decision-making, your concentration, your attention, your sleep. And all of these things are critical in being able to perform successfully, particularly under pressure.”
Rebecca Neusteter, the executive director of the Health Lab, a health care and criminal justice research group at the University of Chicago, worries the efforts to form the 988 workforce are being built on the same swampy foundation as 911.

The Biden administration has committed about $400 million to scaling up 988, but like 911, there is no new sustained federal funding. Instead, both lines primarily rely on state and local funding, and neither has uniform national training standards.

“If we're not attending to the staff, ultimately that has huge detrimental impacts on communities,” Neusteter said. “People won't call anymore, which could leave people in crisis with even fewer resources to seek help.”