A new three-digit crisis line is aimed at giving people in Hawaii more accessible support for mental health and substance abuse. Now local providers must cope with a rise in callers across the state while facing staffing shortages.

The 988 hotline, which began operating 24/7 in mid-July, is designed to be easy to remember so callers can quickly get help for any mental health emergencies or suicidal thoughts.

If callers have an 808 area code, they are routed to the state Department of Health’s Coordinated Access Resource Entry System, a state-run call center that is part of the National Suicide Prevention Lifeline.      

Those who call the line with a different area code will be routed to a call center in that location but may request to be transferred back to Hawaii, said Belinda Danielson, community programs supervisor for the DOH adult mental health division. She added that the federal Substance Abuse and Mental Health Services Administration, which oversees the national lifeline, hopes to eventually use geolocation, rather than area codes, to match individuals to local call centers.

Mobile phone.
People who call 988 from a phone with an 808 area code will be routed to the Hawaii CARES call center. The hotline is aimed at making it easier to quickly access mental health services. Cory Lum/Civil Beat/2022

The ease of recalling three digits enables more people to access the support they need while in crisis, and the calls to Hawaii CARES can help the state recognize where there is greater need for mental health resources, said Marie Vorsino of Parents And Children Together, which provides social services to local families and individuals.

Since the introduction of the 988 line, CARES has faced a greater volume of calls. According to the health department, the call center averaged 324 calls a day within the first 11 days of 988’s implementation compared with an average of 282 daily calls between June 1 and July 15.

That has complicated the ability to dispatch mobile crisis response teams to reach the callers in a timely manner.

Staffing shortages over the past six months have made it more difficult for the teams to reach callers within the 45 minute timeframe stipulated in DOH contracts, Danielson said. She added that, in some cases, outreach teams have been flown to Kauai because coverage has been especially strained on the island.

She said that, as of early August, DOH was holding back on its outreach initiatives advertising the 988 line in order to ensure that individuals’ calls would not go unanswered. She added that DOH’s decision was in accordance with a request from the federal group to do so.

“The biggest problem is personnel and having people available to do the job,” Danielson said.

As of May, the average dispatch time for crisis mobile outreach teams ranged from 31 minutes on east Hawaii island to 85 minutes on Oahu, according to DOH.

CARE Hawaii, a private provider that helps to run the call center and provide crisis mobile outreach to all islands but Maui, hired more workers prior to the rollout of 988 and has been able to respond to the rising demand for services, said Brian Morton, who is president of the organization.

Morton and his team insisted that CARE Hawaii is able to successfully fulfill its contract with DOH, despite concerns about recent staffing shortages.

Concern was also raised about the new structure of Hawaii CARES, which was run by the University of Hawaii until March 31.

Victoria Fan, an associate professor who was the principal investigator for CARES at that time, said people used to be able to get help for mental health and substance abuse issues with a single call.

“If you’re at risk of suicide, you may also need substance abuse treatment. And, similarly, if you need substance use treatment, you may also be at risk of suicide,” said Fan. “They’re very much related problems.”

However, DOH enlisted two different providers, CARE Hawaii and Aloha United Way, to run the call center beginning in April. CARE Hawaii supports individuals in crisis, while Aloha United Way responds to calls relating to substance use disorders.

Fan said she worries that transferring callers from one provider to another could prevent people from receiving the integrated support they need.

“If someone calls, an individual with a mental health or substance use disorder, it’s hard enough to get them onto the phone,” Fan said. “We should avoid transferring calls as much as possible and use the opportunity and the rapport you’ve just established through that initial call to get them linked into the services that they need.”

Aloha United Way 988 Hotline Hawaii CARES
As one of two contractors for Hawaii CARES, Aloha United Way responds to calls relating to substance use disorders. Aloha United Way

Danielson said DOH still considers CARES to be a single call center, although it now contracts out to two organizations. She added that CARE Hawaii receives all incoming calls through the 988 line, allowing for a single point of entry into the system. If a caller is not in crisis, CARE Hawaii operators will perform a “warm handoff,” staying on the line with individuals until an Aloha United Way worker picks up the call.

According to DOH, CARES saw a 20% increase in incoming calls since changing contractors from UH to CARE Hawaii and Aloha United Way. At the same time, abandoned calls fell from around 25% per month to 7% per month.

Danielson acknowledged the ongoing challenge of responding to the rising number of calls and demand for outreach services but said CARES has been growing its staff accordingly. She also said public awareness of 988 has recently grown with the national rollout, and CARES is ready to meet the state’s needs.

“The cat’s out of the bag, and that’s totally okay,” Danielson said. “People need to know that the service is there.”

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