Mental health experts weigh in on 988 and its future: Q&A
By Oyewumi Oyeniyi
Youthcast Media Group®
This story was originally published on USA Today's website on Feb. 25, 2023.
On June 5, 2017, Zachary Bear Heels, a 29-year-old Native American man diagnosed with bipolar disorder and schizophrenia, died in police custody in Omaha, Nebraska.
Bear Heels was arrested, tased 12 times, and punched in the head after allegedly refusing to leave a gas station during a delusional episode.
Bear Heels died of excited delirium, physical struggle, physical restraint and use of a stun gun, according to officials cited by the Associated Press. There was no video recording of the police response.
“There was no interaction, no real opportunity of visiting with this individual,” said Anitra Warrior, a Nebraska-based psychologist with Morningstar Counseling, which specializes in serving the Native American community in that state. “We’ve had such horrible interactions with police in general for our population specifically that having more things like this happen creates even more of a barrier for our people.”
If the national mental health crisis hotline, 988, had been up and running when Bear Heels was in crisis, Warrior said, the outcome may have been very different.
Warrior and half a dozen other experts on the effort to decriminalize mental illness spoke to student reporters from Youthcast Media Group® (YMG) at the 3rd Annual Sozosei Foundation Summit in December about incidents like the death of Bear Heels, the national and local rollout of the 988 crisis line, the challenges to making it work, and what lies ahead.
Their responses have been lightly edited for length and clarity.
YMG: The three-digit mental health crisis hotline 988 launched nationally in July of 2022. How do you think the rollout has gone so far?
Dr. Sosunmolu Shoyinka, chief medical officer of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS): Nationally there has been a lot of variability as a result of many factors – it is a new initiative and has been impacted by pre-existing issues with staffing. Our efforts in Philadelphia actually began in 2019 on the adult crisis system and so we were fortunate to be quite a bit ahead when the implementation began. I think we also have to keep in mind that this is a very, very new program and that we are also fresh out of a global pandemic. You're creating in many places systems that did not exist before. So it will take a while.
Tansy McNulty, CEO of 1M4 (1 Million Madly Motivated Moms): I think we're slowly getting more people aware of what 988 is and then what it's not. For our community, we're trying our best to let people know that yes, it is…a true one-for-one replacement for the Suicide Lifeline and it will become even more of a true mobile crisis response for those in mental health emergencies.
Jonah Cunningham, CEO of National Association of County Behavioral Health and Developmental Disabilities/National Association for Rural Mental Health: Some positives have been that 988 has brought about more visibility of mental and behavioral disorders and helped destigmatize them. However, getting more awareness of 988 and optimizing its widespread use is a long process that will take time.
YMG: What about 988 is working best and why?
McNulty:  is easily memorizable and has quick responses. It has cut down on wait times and more people are being served as soon as they reach out. It also helps that the responses are culturally competent and so the circumstances of the people being called are understood, this is in no doubt a result of the community organization partnerships 988 has fostered.
Cunningham: 988 has had a lot of success in the early adopter states like Utah. It is hard to compare them to other states because the goals of the states are different and so success cannot be measured by just one metric.
YMG: What has been the biggest challenge in making 988 successful so far?
Warrior: We haven't seen a great deal of advertising or promotion about 988 in our tribal communities. We're hoping to see that more. We're taking our own steps in sharing that information to make sure our people are aware that this is a service that is a quality service that's available to them. And so hopefully we'll see more people reach out and accept the support that's there.
Cunningham: There has been a recent workforce shortage which has also impacted call centers and the number of people answering calls and the time it takes them to answer those calls. Lack of sustainable funding also plays a factor. There needs to be constant resources going towards 988 in order to maintain it.
Tiffany Russell, Chief Officer of Crisis and Justice Partnerships, Substance Abuse and Mental Health Services Administration (SAMHSA) 988 and Crisis Behavioral Health Coordinating Office: A lot of the issues that we see around mental health services is the stigma that's associated with receiving them. African Americans have the highest number of mental health conditions in the United States of America, but they are the least likely to get service, mainly because of the stigma that's associated. You know, that's just something we don't do—we [think we] don't need psychiatrists, we don't need therapists.
And so when you are in communities that are marginalized and under-resourced, it's really difficult to get someone to come in to services, when the person they want to talk to does not look like them.
H. Jean Wright, Deputy Commissioner, City of Philadelphia DBHIDS: I think the biggest challenge is not having the resources, or the ability to really ramp it up at a high level, but having to really take our time and do it in iterations. I think that's a major, major concern… So people are still calling 911 so we're hopeful that once we do a major, major rollout, that those calls that are going to 911 that should be going to 988... will actually happen.
YMG: What major change would you like to see to improve access to mental health crisis services?
Warrior: I would like to see more regional services being offered that are specific to our tribal communities as well as more of our clinics. I often talk about decolonizing behavioral health — what this means is we’re going to remove all the institutional pieces of what healthcare looks like and really focus on the community and who we’re serving. This means we’ll come out of our offices, this means we’ll be part of the community, this means you’ll have increased access to us, and the relationship will be more of a relative than a healthcare provider. This does not have to be Native-specific, because of the intimate relationship between the healthcare provider and those they’re serving, this could be put in place across the country.
Nancy McGraw, chief development officer of the Corporation for Supportive Housing: There needs to be more brick and mortar associated with 988. Without supportive housing it will be difficult for any progress made to stick. Supportive housing provides the base and structure to heal and grow, with possessions of your own making a huge difference. This is especially important as people with mental disabilities have a harder time maintaining housing.
Elinore Marsh Stormer, Summit County (Ohio) Probate Judge: I would like to see mental health crisis services treated as any other health issue. So if I cut my finger, or I have a mental health issue, or a sudden heart attack, I get the same level of treatment and care in real time, right now.
H. Jean Wright: Our crisis response and treatments and our resources should reflect the fact that it's not an individual by themselves that is in the crisis. It's a family, it's a community, maybe a school... everyone that is connected to that individual is impacted by that individual's crisis.
YMG: What gives you hope for the future of mental health crisis care?
McNulty: The young Gen Zers -- y'all are so dope. You don't have any problem telling us about ourselves. You're very honest, you're very open, very transparent (and) direct. So honestly, that gives me the most hope for the next generation.
Cunningham: When I first started, no one wanted to talk about behavioral health. It was underfunded and they didn't want to talk about it. Policymakers didn't see it as a winning issue. That's changed over the last, let's say, two to five years. Also, I get encouragement from the younger generation – they're more accepting, they're more loving and more compassionate, and they're pushing for a more just and equitable system.
Warrior: There are a lot of active efforts being done to help our rural and Native communities. We’re starting as young as middle school and high school to recruit people into this field. We are also getting more Native providers throughout our communities in addition to seeing more workforce development and partnerships being made.
Shoyinka: During COVID many people experienced struggles with their own mental health, something that changed the previous widespread narrative of mental health. There is now a new awareness of the importance of mental health services and funding is being put into the field, which is particularly encouraging as funding drives these operations. Overall, there is now more mainstream national discussion about mental health and structural racism which is helping destigmatize mental illness, especially in communities of color.
Oyewumi Oyeniyi is a junior at Cristo Rey Philadelphia High School and attended the Sozosei Foundation Summit as a student reporter with Youthcast Media Group®, a nonprofit that trains high school students from under-resourced communities in journalism. YMG’s content and programs director, former (Cleveland) Plain Dealer health reporter Brie Zeltner, contributed to this report.