Suicide hotline calls could go unanswered in South Carolina from a lack of funds

Bill Lindsey's son died three years ago, after "his bipolar illness got the best of him."

Lindsey, the executive director of the South Carolina National Alliance on Mental Illness (NAMI), doesn't know if the new three-number code to the National Suicide Prevention Lifeline would have saved his son, but he believes it can save the lives of others.

It's one reason he is advocating for funding to fully implement 988, which will soon be the new way to call or text the suicide prevention hotline.

The new number is, as Lindsey describes it, "another tool to be able to call someone immediately for help and not have to call a 10-digit number or something like it was before.”

But a lack of funds to fully implement 988 could indirectly lead to people's deaths in Greenville and across the state.

That’s the realistic fear of some mental health advocates who expect a surge in calls to the hotline when the shorter, easier to remember code goes live on July 16.

Greenville’s Mental Health America has the state’s only certified Lifeline call center, but is lacking the funds to adequately hire and train more people to answer calls and meet the anticipated demand.

The need comes at a time when calls to the local crisis hotline are at their highest. In March, Mental Health America Greenville County answered more than 2,400 calls — their highest number ever answered in the state, according to Jennifer Butler, director of the office of emergency services for the state Department of Mental Health.

The suicide death rate in South Carolina was 16.3% (868 deaths) in 2020, up from 16.2% (852 deaths) in 2019, according to the National Center for Health Statistics.

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Calls to the suicide hotline need to be answered in 20 seconds before they're routed to a back-up center in another state, Butler said.

The person in crisis who calls and has to wait for someone in another state may get tired of waiting, hang up out of frustration, and not call back, said Jennifer Piver, executive director of the nonprofit MHA in Greenville.

The worst case scenario, she said, is "people would die."

'Nobody did any work'

The 988 Implementation Act, which was mandated by the federal government in 2020, is intended to help save lives, in part, by making it easier for someone in need of suicide prevention or who is in a mental health crisis to access the help they need. It also serves as an alternative to calling 911.

As part of the mandate, states are required to "implement their 988 and crisis response infrastructure that relies on trained mental health specialists instead of armed law enforcement" ahead of the launch. Only five or six states had done so by January, according to the National Alliance on Mental Illness.

"Our state legislature did not have a pre-filed bill when they went back into session the first of January," said Ken Dority, executive director of NAMI Greenville. "Nobody did any work, so we've been behind the apple cart instead of in front of the apple cart."

The SCDMH's three-year funding plan for 988 includes a request for $1.5 million for MHA Greenville's operating costs and $1.6 million to staff crisis receiving units. Neither of these are in the SCDMH's FY22-23 budget requests.

The SCDMH is also requesting $1.3 million to create a backup call center in Charleston, as well as funds to expand its mobile crisis intervention services to rural areas, areas with high call volumes, and to increase access to mobile crisis telehealth services.

During the April 13 Senate Finance Committee, Sen. Thomas Alexander of District 1 of Oconee County announced that they are recommending over $1 million for a secondary call center.

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Dority believes the MHA Greenville call center should be funded first to the necessary capacity to get through this next year.

"Then we can make different plans, working with the Senate and the House, come up with better plans and sustainable funding for an ongoing basis," he said.

"We do need the funding this year. Right now. July is fast approaching and these folks that we hire have to go through a lot of training to be able to sit in those chairs and take those calls."

MHAGC, in partnership with NAMI, The Phoenix Center, and Prisma, was awarded $6.2 million in Greenville County COVID grant funds for a crisis stabilization center and crisis helpline expansion. The organization also upgraded technology in its call center.

In addition to now having a rollover site in Greer, MHAGC has almost 50 workstations that could be used on a 24/7 basis and remote desks to enable them to handle hundreds of thousands of calls, Piver said.

“We have this massive infrastructure there, we have the training, we have the certification, and we need zero construction,” she said. “We have all of this physical infrastructure and it’s sitting there with empty chairs. There’s a lot of hope with those empty seat, but we don’t have it funded.”

The MHA Greenville call center is not able to answer all of South Carolina’s calls right now, Butler said.

In February, 500 calls to the center went out of state. In March, the number was 600 or 700, Butler said.

But it is known that South Carolinians are in distress, she said. Last year, the calls to 911 for suicide or self-harm increased 40% from the year prior.

Butler said she learned of five suicides and several people who’d harmed themselves and were in critical condition in the last week alone.

“These numbers represent lives. They represent family members and important voices in South Carolina and they deserve to have a fully operated comprehensive 988 continuum of care,” she said.

“They deserve to have two call centers to make sure that every call is answered in South Carolina. They deserve to have robust mobile crisis, so that everybody is able to have a timely response in-person if needed, and they deserve to have a place to go — a crisis stabilization unit when they are in distress."

But funding or no funding, 988 will happen, she said.

When it does, the call volume is going to dramatically increase, Lindsey said.

“They’ve been increasing all along during the pandemic,” he said, and "the pandemic is a reason people are in crisis."

“Imagine how all of us feel when we cannot be around friends and relatives because of the pandemic, but you’ve got a mental illness, suicidal tendencies,” he said. “That isolation is horrible. That’s why the calls have gone off the roof."

Last year, Piver said, the state legislature required that the Lifeline number be placed on the IDs of students grades seventh and up. That, too, will go into effect in July.

"That's one little thing that wasn't calculated into those moderate growth projections," Piver said. "We don't know what that impact is."

Need for funds

MHA Greenville is seeking grants from foundations to effectively implement 988.

"We don't know if more dollars will come through the government," Piver said, "but, "we're gonna keep fighting for it."

On Tuesday, the Department of Health and Human Services (HHS), through its Substance Abuse and Mental Health Services Administration (SAMHSA), announced that it is awarding nearly $105 million to 54 states and territories to bolster crisis care infrastructure in advance of 988.

The SCDMH was awarded $1,390,817 to enhance workforce capacity and improve in-state response to 988 contacts through the Lifeline. Eighty-five percent of those funds must go directly to the one Lifeline crisis center responding on behalf of the state, MHAGC, according to Christopher Garrett, senior media advisor for SAMHSA.

"While the funding is a small start, it does not address the needs for the full 988 Crisis Continuum of Care," Butler said in an emailed response Wednesday about the new grant funds. "It will not begin to touch the costs associated with running either call center. It doesn’t provide funding for mobile crisis expansion or the development of Crisis Stabilization Units in SC."

The total funding amount was based on SC’s current call volume of the Lifeline only, not the additional calls that went to 911, SCDMH Mobile Crisis or other hotlines in the state, according to Butler.

"It did not include the number of individuals going to the ERs with suicidal ideation or attempts," she said. "Those are important factors and access points that are meant to now be funneled through 988.

It also did not factor in the number of people dying by suicide or the level of distress South Carolinians are in at this time, Butler said.

Piver said they are extremely grateful to have the funding that’s coming, which amounts to $350,000 a year for two years. But, she said, the organization has very little funding for its current employees and “who knows when the SCDMH will get to build their second location and take rollover calls? That’s one of the concerns we have right now.”

SAMHSA’s goal, Piver said, is to have MHAGC handling 90 percent of their current call volume by June 15.

The center’s current answering rate is just north of 80 percent, Piver said. Because of the need to fund current operations, Piver fears the center’s answer rate will drop below 30 percent.

MHAGC became part of the Lifeline network in 2007 and in early 2019, “before any funding was coming our way, we could only answer about 5 percent of the Upstate (calls)," Piver said. "Now being an over 80 percent answer rate for the whole state just demonstrates that with the funding we’ve consistently been able to perform.”

MHA Greenville has been taking hotline calls in its center since 1990. At one time, it was one of four call centers in the state.

"That's what we did, that's what we want to do," Piver said. "We want to pick up the call when it rings."

Here's a breakdown of what the 2-year funding grant from SAMHSA will provide in SC:

• The total amount of the grant is $1,390,817 ($695,000 per year over two years).

• Mental Health America-Greenville County will receive $350,000 per year for 2 years to fund 8 staff members

• $241,000 per year for 2 years will be distributed to begin the work of certification and establishment of a second call center.

• The remaining funds will support 1 coordinator to oversee the project, 1 grant evaluator (both positions are required by SAMHSA) and associated implementation/coordination costs.

This article originally appeared on Greenville News: Lack of funds could lead to unanswered suicide hotline calls in SC