Submitted Photo FirstLink’s 988 Coordinator Rachel Pavlicek, left, and call specialist Jill Borowicz, right, take the first calls in the new, larger call center in Fargo in 2022.

A mental health crisis line celebrating its second anniversary has seen calls increase 61% from 2022 to 2023, and the agency coordinating the service reports another 36% increase so far this year.

Jeremy Brown, a development director with FirstLink, the agency in charge of the 988 Suicide and Crisis Lifeline in North Dakota, theorized the increase is partly because more people are becoming aware of the program and partly because people are paying more attention to themselves and others since the COVID-19 pandemic.

“People are being more conscientious of their mental health, and they are looking out for other people in their life,” Brown said.

He also sees the change two years ago to a three-digit helpline phone number as a factor. The new phone number is easier to remember than the traditional lifeline phone number, 1-800-273-8255.

On July 16, 2022, the United States moved from the 10-digit phone number for the suicide and crisis hotline to the shortened number. The shorter number enables those in crisis to more easily recall it and makes the number easier to pass on to people who need it. If either the old number or the new number is called, operators on the other end of the line can help.

When people call the 988 lifeline, they will speak with operators who have received specialized training to fill that role. The operators, or call specialists, have many resources at their disposal to help callers through a vast variety of situations.

Brown said when someone contacts 988, the person will be offered a prompt for specific lifelines, such as a veterans lifeline or one for the LGBTQ+ community. If neither of those lines are applicable, calls will be answered by an operator who will “open up the conversation to be what that person needs,” according to Brown.

“We like callers to share what they are comfortable sharing,” he said.

Operators also will establish a safety plan, in which they ask questions to ensure the safety of callers. If the caller is in distress, operators will attempt to de-escalate the situation and offer listening support and coping skills, then move the conversation toward resources available.

Brown said the agency has a directory of more than 5,500 resources in North Dakota it can recommend to callers. These resources include counselors, healthcare representatives, financial security counselors and even recreation, such as sports clubs, art classes and other activities.

“If you’re struggling with anything, if you need any sort of support, we are the best first number to call,” he said.

All of the services and resources the lifeline may connect a caller with are not-for-profit or offer a sliding fee scale. No one will be turned away for the inability to pay.

“Accessing resource information by calling/texting 988 or visiting FirstLink website is always free. We will never charge to offer information for a referral,” Brown said.

Since the program was adopted in 2005, call specialists have fielded more than 33.4 million calls nationwide. Chat and text functions have also been added to the capabilities for those who may be more comfortable communicating through those means.

Melissa Markegard, a suicide prevention administrator with North Dakota Health and Human Services, cautioned if someone is at an imminent risk of harming themselves or others, 988 isn’t the right number to call. Bystanders should call 911 instead and inform emergency personnel.

Brown said if waiting is a personal barrier to seeking treatment, North Dakota has a fairly unique program called the Care and Support Program, through which lifeline operators can call a person in need weekly, bi-weekly or once per month to continue offering phone support. This is a form of interim support to assist people in getting through difficult times and acts as a bridge to help get to an in-person appointment.

The program is in partnership with several hospitals around the state. If a patient is discharged for mental health problems, a suicide attempt or substance use, the individual will be referred to the Care and Support Program.

According to Brown, a study found patients who were treated for a suicide attempt were much more likely to reattempt within the first 72 hours of discharge. The Care and Support program takes the initiative and reaches out within that timeframe to check on patients and help ensure they are doing well. The study found checking in with patients “to be really effective, so we continued to offer that to our state,” Brown said.

The program isn’t only for those who have had thoughts of suicide but can be used by people who are dealing with substance abuse, anxiety or other aspects of depression or other mental health issues.

The only time emergency personnel will be dispatched is when callers are in emergent situations. Brown said fewer than 1% of calls end in emergency services being called.

During conversations with callers, operators will gather more details to be able to provide additional resources. For example, if a caller is having problems paying rent, the operator may ask if the person has been served an eviction notice.

Brown said operators “don’t go digging for identifying information unless it’s relevant to being able to offer support,” explaining that offering identifiable information is voluntary.

“Mental health is dependent on what is going on in your life. The more good factors, the better off you are,” Markegard said. She further explained these good factors – called protective factors – can be generalized in “the eight dimensions of wellness.”

Brown explained the eight dimensions of wellness as “a holistic approach to mental wellbeing and building resiliency.” Brown and Markegard both said the different aspects of wellness act as protective factors to help an individual’s physical and mental wellbeing.

The eight dimensions of wellness are social, emotional, spiritual, intellectual, physical, environmental, financial and occupational.

According to the U.S. Substance Abuse and Mental Health Services Administration, a person should work toward strengthening oneself in each of these areas for a longer, healthier and happier life.