Oklahoma’s mental health leaders are singing their hope for improved crisis care this Suicide Prevention Awareness Month to the tune of 988.
The revised, three-digit Suicide & Crisis Lifeline launched nationwide in July, and the Oklahoma Department of Mental Health and Substance Abuse Services says the one-stop number is “tying a bow” on its burgeoning efforts to ease accessibility to immediate, professional mental health help and coordinate with local services.
In its first two months, 988 received about 5,000 calls from Oklahomans, 30% of which were spurred by suicidal ideation, according to data provided by the Department of Mental Health.
Carrie Slatton-Hodges, Department of Mental Health commissioner, said the helpline is a major step forward in preventing suicides in Oklahoma, which is the second leading cause of death for residents ages 10-34 in the state and ninth overall.
In 2020, 869 Oklahomans took their own lives, a nearly 9% increase from the year before. Almost two-thirds of firearm deaths in the state were suicides, according to the Department of Mental Health and U.S. Centers for Disease Control and Prevention data presented by the American Foundation for Suicide Prevention.
Suicide prevention does not occur in a vacuum and must be part of a continuum of care, Slatton-Hodges said.
“The 988 lifeline is the first stop,” she said in a news release.
Although some calls will be lifesaving, Slatton-Hodges said some people just need someone to talk to. If a caller needs more assistance, call takers can dispatch mobile response teams and make appointments with local providers.
All callers will receive a follow-up call to ensure that their needs were met.
“Connecting people to services is the key,” Slatton-Hodges said.
The rollout of 988 represents a “critical juncture” in the state’s move toward wraparound mental health care, said Zack Stoycoff, executive director of the Healthy Minds Policy Initiative.
Using federal and state funding, Oklahoma is developing a comprehensive crisis care system that includes investing in mobile response teams, crisis care centers and a number of other contracted services across the state.
More than 70% of the state’s communities did not have enough mental health providers to serve residents in 2021 based on federal guidelines, according to AFSP, but the welcome shift is expected to lift Oklahoma to standard.
Now, Department of Mental Health spokesman Jeff Dismukes said he can’t keep up with the expansion of urgent recovery and crisis centers across the state — there were 37 as of Friday.
“We’re very hopeful about all the work going on,” Stoycoff said.
Mental health must be at the core of all societal plans because it is “core to nearly every outcome we all want to see in our community,” Stoycoff said. That means getting appropriate treatment early enough in the crisis that the person doesn’t fall into criminal justice involvement, emergency rooms or homelessness.
Law enforcement leaders have been advocating for many of the changes included in the state’s plan for years, Dismukes said, including expanding mobile crisis teams equipped with licensed mental health professionals and providing private transportation to psychiatric care.
He pointed at the success of criminal diversionary programs, drug courts being one example, that helped state lawmakers get on board with expanding into prevention.
“It’s a shift in understanding behavioral health; what it always has been and what we’ve known it to be,” Dismukes said. “It’s a medical issue; it’s about brain health. That’s part of the stigma around many of the diseases that we’re talking about, and substance use issues — we’ve criminalized it. Some have looked at it as a law enforcement issue, and I think that has created barriers to people needing care and reaching out when they’re in need.
“Fact is, the back of a police car really isn’t the best place for a person experiencing a behavioral health crisis.”
The latter term, Dismukes said, isn’t being defined for 988.
It’s a crisis line for “anything behavioral health,” he said, not only for individuals in crisis but also those who are seeking to support them. Anyone can call, and a licensed professional can assist and send out a local team if necessary. The 988 crisis line is offered in English and Spanish by text or call.
Phone-based counselors like those at 988 are able to stabilize a caller in place more than 80% of the time, according to a primer on 988 that Stoycoff’s agency produced, and of the remainder, locally dispatched mobile crisis teams are able to resolve the issues in the field an estimated 70% of the time.
Calls to 988 averaged 20 to 30 minutes each, and more than 250 crisis teams were dispatched in July and August, according to Department of Mental Health data.
“Hopefully people will call before they reach that crisis; when they aren’t sure where to turn,” Dismukes said.
Some regions in Oklahoma, including Tulsa, have had local, piecemeal crisis response systems in place the past several years, and 988’s rollout brought questions about how they fit into the new model.
The state has awarded contracts and partnered with many agencies to expand its answering services and breadth of mobile crisis teams, including with Tulsa’s Family & Children’s Services.
F&CS has operated its own area hotline and mobile response through COPES, Community Outreach Psychiatric Emergency Services, for a number of years, and that will continue even with the addition of the 988 contract, said Dee Harris, spokeswoman for F&CS.
“We’re thrilled to be part of the 988 mobile team and also the backup line,” Harris said. “This is all about getting people to the resources they need to get better, and 988’s just one more pathway to do that.”
Instead of using contractors previously retained to answer national hotline calls in the state, Oklahoma solicited bids to find a facilitator for 988 because leaders knew they wanted it to be more than a suicide crisis line, Dismukes said.
Arizona-based Solari Crisis & Human Services now operates the state’s call center, with several employees in Oklahoma City. In the case of a deluge, COPES is one of two existing call centers in the state contracted as backup, Harris said.
Solari also is able to dispatch COPES’ mobile team to respond to local calls.
In July, COPES answered four rollover calls from Solari and dispatched its mobile response teams 28 times for calls originating at 988, Harris said, and there’s no sign that the organization will strain under the additional service requests.
“COPES is growing and continuing to add clinicians and expand,” Harris said. “We’re not having any issues with staffing.”
Family & Children’s Services’ multitude of local crisis continuum services remain in operation. COPES is still receiving and responding to calls from established clients and community partners, but 988 is a great place to start for anyone else, Harris said.
“We’re offering same-day, next-day care now,” Harris said. “If you don’t know who to call or you can’t remember a number, 988 is the way to go.”