Crisis hotline hang-up

In September, more than 1,200 calls to the state’s only suicide and mental health crisis hotline were "abandoned" after the caller stayed on the phone through an average of 16 rings, listened to a recorded announcement, and was then, in many cases, asked to leave a message.

Hundreds more were disconnected before the caller ever got to the recorded announcement.

And for those who did leave voice mails, which the state doesn’t tally, it took as long as half an hour for someone to call them back.

"It’s horrendous," said Bud Bowles, executive director of United Self-Help, a Hawaii nonprofit that provides support groups and classes for those with mental illness. "This line we’re talking about is the 911 for mental health."

State Health Department officials acknowledge concerns with the 24-hour Access hotline and, in response to increasing complaints from providers, have formed a team to look at how to improve the service. They have also worked quickly in recent months to fill vacant positions.

"We’re getting permission and approval to make things better, and that’s what we’re going to do," said Dr. William Sheehan, chief of the Adult Mental Health Division.

Mental health providers say the hotline, at its best, serves as a lifeline for adults and teens statewide experiencing a crisis, and that it is long overdue for improvements. It is also a vital source of advice for family members worried about a loved one suffering from a severe mental health issue.

Screeners at the hotline have the ability to deploy a crisis team, are trained to deal with people threatening to harm themselves or others, and can serve as intermediaries, calling 911, a client’s doctor or mental health professionals to assist someone.

While there is a national hotline that can be used as an alternative for people who are suicidal, people who are experiencing severe psychological distress —and their families — have few other options.

"If there’s no answer or a delay (at the hotline), that’s really unconscionable," said Marya Grambs, executive director of Mental Health America of Hawaii. "People who are suicidal should not be put on hold. People who are psychotic, that’s another thing that can’t wait."

Susan King, a mental health client and peer specialist for those with mental illness, said she knows a number of people suffering from mental health issues who refuse to use the hotline because of bad experiences they have had.

"Calling the Access line has created additional trauma, by either putting them on hold when they’re in crisis or telling them to leave a message when they’re suicidal," she said. "It’s not an isolated incident."

Among the biggest problems with the hotline, mental health advocates say, is that in addition to taking crisis calls, it also serves as a referral service for those seeking mental health assistance.

There is no way for hotline counselors (called screeners) to triage the calls — taking the most severe first and getting back to those who merely have questions about accessing services.

Advocates also say that problems with the hotline have been years in the making, and have worsened amid budget cuts and with short staffing.

HOW THE STATE will improve the hotline — and when those changes will kick in — is not yet clear.

But Sheehan said the state is talking to providers and mental health clients to gather suggestions, and is working to improve existing services in the meantime. The hotline currently has 13 full-time staff members taking calls, up from 11 last year, and is bringing on one more screener soon.

The call center personnel work staggered shifts: At least five are on the first shift, from 6 a.m. to 5 p.m., three are on in the evening, from 2 p.m. to midnight, and at least two are on the overnight shift.

The state spends about $788,000 a year on the access hotline, $36,000 of which goes to operating expenses.

The rest covers personnel, including overtime costs and overnight differentials.

Sheehan said because of staffing issues, overtime at the crisis center has been a continual expense.

In September, counselors at the hotline accrued 241.5 overtime hours (which averages out to 18.5 hours per hotline staff member). In 2011, the total number of overtime hours in one month went as high as 420; in 2010, the high was 434 hours.

The hotline has also struggled to boost its performance in recent years. As far back as 2009, pro­viders were raising concerns about the service. Last year, it was labeled a "train wreck" by a group of advocates who convened to make recommendations on a host of adult mental health programs.

Ideally, one of the counselors answers the phone within a few rings.

But if a counselor is not available, the call can go to a recorded announcement after a varying number of rings.

So far this year, 11 percent of calls to the hotline were dropped while the phone was ringing, up from 7.8 percent in 2011 and 4.5 percent in 2008.

About 10 percent of calls on average were dropped during or after the recorded announcement with no message left. That’s down slightly from the 11 percent averages seen in 2010 and 2011, but still way up from 2008, when 5.5 percent of calls on average were dropped after the recording.

Sheehan said the hotline strives to hit an industry standard of no more than 10 percent of dropped calls after the recorded announcement.

He said calls dropped before the recorded announcement are not counted because they probably are made by people not in immediate need and may include misdialed calls.

State figures show the hotline went above the 10 percent benchmark three months this year. That is an improvement over last year, when the hotline failed the standard for 10 months.

CONCERNS ABOUT the hotline come as it appears to be in greater demand.

As of September, the average number of calls per month to the access hotline was 9,109. In 2011, the monthly average was 8,490.

Those numbers don’t include calls diverted to the hotline by 911 operators and that come through the National Suicide Prevention Lifeline, an 800 number. Lifeline calls dialed from an 808 area code are automatically sent to Hawaii’s hotline, but if the state’s crisis center doesn’t answer they’re bounced to one on the mainland.

Sheehan, of AMHD, said he wants to craft solutions to the problems plaguing Hawaii’s hotline before the end of the fiscal year in June.

"I think we’ll land on something, but I don’t know what it’s going to be," he said.

He also said creating new positions or breaking the hotline into parts — with one number taking crisis calls and another handling referral requests — "would be a challenge" given the current budget climate.

He added, "We have approval to re-evaluate how we do this service."

Sheehan urged the Star-Advertiser to try the Access hotline to see whether calls would be answered.

A call made at 1:30 p.m. Friday rang four times before being transferred to a recording to leave a message.

A few minutes later, a real person picked up after the fifth ring.

At 2:50 p.m., a call made to the hotline rang three times before being put on hold for 30 seconds, then transferred to voice mail.

Jlorra Savala, of Maui, who suffers from major depression, said over the past few years she has called the hotline about seven times. On five occasions, she was experiencing a crisis.

And in several instances, she said, she has been unable to get through. She hasn’t left a message.

"I called the Access line because that’s what my case worker had said to do if I was ever in crisis," said the 39-year-old mother of four. "I’ve given up on calling Access line."

Pualani Kamaunu, Savala’s mother and an advocate for those who have a family member with mental illness, said she knows a number of people who have had bad experiences with the hotline.

"They call and no one answers," she said.

She added the average number of rings — 16 — before a call is answered is "unacceptable."

"I’m sorry, that does not fly with me," she said, "especially since we’re paying for this."

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WHERE TO GO FOR HELP
>> Hawaii Access Hotline: 832-3100 (on Oahu); 800-753-6879
>> National Suicide Prevention Lifeline: 800-273-8255; www.suicidepreventionlifeline.org
>> Kristin Brooks Hope Center: 800-442-4673; www.hopeline.org