MORGANTOWN — The state Department of Health and Human Resources said Wednesday that it continues moving forward to be ready when the nation moves to an easy-to-remember 988 National Suicide Prevention Lifeline in July.
“West Virginia has been working with the federal Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Suicide Prevention Lifeline to plan for 988 implementation,” said Christina Mullins, commissioner of DHHR’s Bureau for Behavioral Health (BBH).
Over the past few months, the focus has moved to preparing and training staff to be ready to answer increased voice calls and adding chat and text options, she said.
West Virginia is one of the top-five states for its National Suicide Prevention Lifeline call center answer rates, answering at least 90% of calls within West Virginia, DHHR said.
On July 16, the three-digit dialing code for the Lifeline will go live as 988, replacing the current phone number of 800-273-8255, which will remain active. “In the end, 988 is an easier-to-remember way to access a strengthened and expanded network of crisis call centers,” SAMHSA said in a FAQ (frequently asked questions) page.
The state BBH funds West Virginia’s single National Suicide Prevention Lifeline call center, operated by First Choice Services, to answer in-state calls to the Lifeline, which includes the Veterans Crisis Line. First Choice Services also serves as a backup center for other states when they cannot answer their own chats and/or texts.
DHHR reported in April that BBH secured a $561,131 award from SAMHSA for the transition to 988. West Virginia was one of the 54 states and territories to receive a federal grant.
The Lifeline accepts calls from anyone experiencing suicidal crisis or mental health-related distress, DHR said. The state Lifeline/988 call center will also begin accepting texts and chats after July 16.
Mullins said, “988 is the first step in building an accessible crisis system that includes someone to talk to, someone to respond, and a safe place to be. Roughly 75 to 80% of calls help de-escalate and provide support without further crisis intervention needed.”
DHHR told The Dominion Post the Lifeline received 7,300 West Virginia calls in 2021; 10 calls were transferred to 911 (0.14%); 18 were transferred to children’s mobile crisis response (0.25%); active rescue was engaged 102 times (1.39%).
DHHR said 39% of calls came from males, 56% from females, 5% unknown.
Calls are answered by a trained crisis counselor who will ask if the individual is thinking of suicide and assess immediate risk, DHHR said. If there is an active, life-threatening attempt in progress, the crisis counselor will encourage a voluntary emergency response or resort to an involuntary response if necessary.
If the situation is not immediately life-threatening, the crisis counselor will try to encourage the caller to accept help by first determining if there is an individual they would be comfortable calling or if there is someone the individual and crisis counselor could call together who would respond to a request for help. If not an option, the crisis counselor begins a conversation about voluntary emergency response and resorts to involuntary emergency response only as a last resort.
For most calls, DHHR said, there is not an active suicide attempt in progress and the crisis counselor has time to gain an understanding of the individual’s situation to assess risk on a deeper level. As the crisis counselor gains a clearer understanding, they move into safety planning and work with the caller to develop a personalized safety plan which can later be emailed or texted to the caller.
During the safety planning process, the crisis counselor helps the caller explore formal supports and makes referrals. Before ending the call, the crisis counselor tries to confirm permission to follow up, review the safety plan, and reminds the individual that crisis counselors are available 24/7.
DHHR said the call center administers follow up calls within 48 hours of each initial call, at one week, at four weeks, and at three months to ensure the caller obtained the services to which they were referred, to offer additional supports, and to track outcomes.
For callers who need additional crisis services (someone to respond or a safe place to be), the state is enhancing its crisis continuum, DHHR said. Presently, West Virginia has statewide Children’s Mobile Crisis Response for children and youth up to age 21 available through the 24/7 Children’s Crisis and Referral Line (844-HELP4WV, https://www.help4wv.com/ccl). Adult crisis response services are available in certain counties.
988 background
In 2020, SAMHSA said, Congress designated the new 988 dialing code to operate through the existing National Suicide Prevention Lifeline’s network of more than 200 locally operated and funded crisis centers across the country. The Lifeline provides free and confidential support to people in suicidal crisis or mental health-related distress 24 hours a day, 7 days a week.
SAMHAS said numerous studies have shown that the Lifeline works — most callers are significantly more likely to feel less depressed, less suicidal, less overwhelmed and more hopeful after speaking to a Lifeline crisis counselor. However, up until now, the network has been massively underfunded and under-resourced. “This patchwork of local, state, and private funding for the network has fallen way short of meeting the need. That’s why, in anticipation of the expected increase in volume of 988, it’s crucial that we shore up the infrastructure of the Lifeline and support the local crisis centers.”
How will it work? SAMHSA said that starting July 16, 988 callers will first hear a greeting message while their call is routed to the local Lifeline network crisis center (based on the caller’s area code). A trained crisis counselor will answer the phone, listen to the caller, understand how their problem is affecting them, provide support, and share resources if needed. If the local crisis center is unable to take the call, the caller will be automatically routed to a national backup crisis center. The Lifeline provides live crisis center phone services in English and Spanish and uses Language Line Solutions to provide translation services in over 250 additional languages for people who call 988.
“The primary goal of the Lifeline is to provide support for people in suicidal crisis or mental health-related distress in the moments they most need it and in a manner which is person-centered,” SAMHSA said. “The vast majority of those seeking help from the Lifeline do not require any additional interventions at that moment. Currently, fewer than 2% of Lifeline calls require connection to emergency services like 911. While some safety and health issues may warrant a response from law enforcement and/or Emergency Medical Services (namely when a suicide attempt is in progress), the 988 coordinated response is intended to promote stabilization and care in the least-restrictive manner.”
Suicide numbers: U.S. and WV
SAMSHA said that in 2020 alone, the U.S. had one death by suicide about every 11 minutes — and for people ages 10-34, suicide is a leading cause of death. Additionally, from April 2020 to 2021, more than 100,000 individuals died from drug overdoses.
CDC reports that in 2018, suicide was the 12th leading cause of death nationally, with 45,979 deaths, averaging 14.2 per 100,000 population. Firearm suicides were first, with 24,292, followed by suffocation and poisoning. 2018 was the peak year; the rate fell to 13.5 per 100,000 in 2020.
While the suicide rate was lower in 2020 than the the previous years, CDC said, the overall rate rose by 30% from 2000 to 2020.
The suicide rate for males was 3-4 times higher than for females during that period. The suicide rate for females 25 and up has declined recently but risen for the 10-14 and 15-24 age groups. Up until 2020, poisoning was the leading means of suicide for females but firearms became the leading means in 2020.
The CAMS-care (Collaborative Assessment and Management of Suicidality) website reports that West Virginia is ranked 10th in the nation for its suicide rate. Suicide is the second-leading cause of death for ages 10-34; fourth-leading cause of death for ages 35-44; seventh-leading cause of death for ages 45-54; 11th-leading cause of death for ages 55-64; and 17th-leading cause of death for ages 65 and up.
CAMS said that more than 5 times as many people died by suicide in 2019 in West Virginia than in alcohol-related motor vehicle accidents. And 82.6% of communities did not have enough mental health providers to serve residents in 2020, based on federal guidelines.
Prevent Suicide West Virginia reports that from 2010-2019, West Virginia saw 3,445 suicide deaths, 18.8 per 100,000. Monongalia County saw 124 suicides during the period, but its rate was second best, at 12 per 100,000. Gilmer was best, at 9.6 per 100,000. McDowell was worst at 34 per 100,000. Preston saw 59 suicides (17.5 per 100,000) and Marion saw 90 (15.9 per 100,000).
The statewide suicide rate for ages 10-14 was 14.6 per 100,000 (338 deaths). For ages 15-24, the state saw 338 suicides (14.6/100,000). Mon saw 15 (5.7/100,000); Preston 5 (a statistical zero); Marion 11 (14.3/100,000).
For ages 25-64, the statewide rate was 25.2 per 100,000 (2,423 deaths). Mon, 83 suicides (16.3/100,000); Preston, 43 (23/100,000); Marion, 65 (22.7/100,000). McDowell was again the worst, with 54/100,000.
The statewide rate for ages 65 and up was 19.7/100,000 (655 suicides). Mon, 23 deaths (19.7/100,000); Preston, 10 (statistical zero); Marion, 11 (10.7/100,000). Mercer ranked worst in this group, with 41 suicides (33.6/100,000).
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