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The United States is facing a major health crisis. Even before the pandemic, Americans died younger compared to those in other wealthy nations, with many dying from drug overdose, suicide and cardiometabolic disorders at far higher rates.
More often the cause, and therefore the solution, is not found in our costly medical system. Extensive research has shown that medical services have a limited role in adding years to how long people live. Medical services often intervene when treatment is needed, which can be too late.
Social determinants such as education, employment and access to safety nets and social services are crucial to adding years of life in society. What drives a person to have a psychological crisis and ultimately a drug overdose or suicide are often related to social and economic stressors — losing their job, unable to pay rent or put food on the table, and family disputes, which can lead to accidents, crime and violence.
Fortunately, on July 16, the U.S. launched a crucial initiative to call 988. Anyone will be able to call 988 and seek mental health support. 988 will help to divert calls from 911 to those who are experts in responding to a mental health crisis and connecting individuals to behavioral health resources. 988 will create a channel to address the underlying psychological as well as social and economic causes of despair facing our country.
If you are contemplating suicide, call 988 to get help.
The 988 has some key differences from 911, however. Importantly, it routes to a central 988 service that then routes to a local or state chapter based on the area code of the caller. This differs from 911, which is based on the geographic location of the caller. Someone with an 808 number calling physically from Maine will get routed to the Hawaii chapter, whereas someone in Hawaii with a non-808 number will get routed to the chapter closest to their phone’s area code.
Fortunately, the 988 does not preclude Hawaii residents from calling the Hawaii line directly, Hawai‘i CARES, 808-832-3100. As a 988 chapter, Hawai‘i CARES is financed by the Hawaii Department of Health (DOH). Currently, Hawai‘i CARES is contracted and operated by two vendors — Care Hawaii, Inc. for suicide prevention and Aloha United Way for substance abuse disorder treatment.
A few months ago, the DOH terminated the contract with the University of Hawaii, which operated the call center from 2019, and started contracts with the two new vendors for Hawai‘i CARES. As a DOH contractor, the university had followed DOH’s directive to do the painstaking and hard work to merge two disparate call centers, one for mental health and another for substance use, into a single call center. (I was a principal investigator for the Hawai‘i CARES contract when it was at UH.)
When the DOH leadership changed in December 2021, a decision was made to split the call center back into two starting April 1, 2022. This decision was contrary to federal guidance and best practice to combine mental health and substance use services together under the same roof.
Fragmenting a call center into two call centers is very costly for patient callers. Most mental health crises are also substance use crises. By fragmenting the system, callers can be ping- ponged between call centers, resulting in lower quality and an increased risk of self-harm. Ultimately, it is the public that is harmed by a fragmented system.
All that said, Hawaii is still fortunate to have a centralized line, at least on paper. In other states, multiple call centers administered by different organizations can be confusing for callers. Like all public policy, the devil is in the details of implementation. Making 988 call center services work for what is in the best interest of callers and the community is very hard work, requiring patience, persistence and perseverance.
Victoria Fan, an associate professor at the University of Hawaii-Manoa, is founder of the Hawaii Pandemic Applied Modeling Workgroup and director of the UH Pacific Health Analytics Collaborative. She writes this in her individual capacity, not as a UH representative.
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