As 988 unfolds across the U.S., communities are expanding their 988 crisis services to ensure that every person, whether they call, text, or chat, has a safe person to talk to (crisis counselors), a safe team to respond (mobile crisis unit), and, if needed, a safe place to go (crisis stabilization center), 24/7. Notably, the 988 suicide and crisis lifeline is not just a resource for those in a suicidal crisis and their loved ones — it’s for anyone facing an emotional crisis, including those working in the mental health crisis space.
I’m familiar with 988 on multiple levels. Long before 988 launched, I had the privilege of witnessing and writing about the collaborative efforts of experts from across the nation as they were developing the program under the guidance of the Substance Abuse and Mental Health Services Administration. The development process was fraught with challenges and milestones, from getting an approved number to tackling issues like handling the sheer capacity of callers and, of course, funding. Above all, the common goal, passion and commitment to increasing access to care for every person during times of crisis rang true for everyone at the table. As someone with lived experience myself and having loved ones with serious mental illness, their efforts meant the world to me, and I suspected I would get first-hand experience with 988 at some point in my life.
One beautiful fall afternoon, I came to a crossroads when someone close to me was experiencing a mental health crisis. I have had multiple (too many to count) occasions to assist someone during a crisis, yet I was at a complete loss, and my level of stress was skyrocketing.
When I first thought of calling 988, I hesitated because this wasn’t an issue of suicidality, and I’d been indoctrinated that emergency help is only for extreme situations. Don’t be premature, I told myself. Thankfully, the voices of those who brought 988 to the nation drowned out my fear, and I called 988. I knew the steps and remembered the amazing testimony about how helpful 988 could be. But would that be my experience? Only time would tell.
Thankfully, I knew I’d made the right decision from the moment my call was answered. The crisis worker was compassionate and knowledgeable, a dynamic duo you don’t always find in healthcare. They helped me ground myself so I could respond to the crisis instead of reacting. They provided guidance and local contacts who were willing to support me and called daily to make sure that I was okay, that my loved one was okay, and that we both were getting the help we needed. Frankly, it gave me a whole new appreciation for the word “lifeline” and increased my already deep appreciation for people working in the field, people who are also under incredible emotional strain and stress.
Workplace stress is the fifth leading cause of death in the United States, according to some experts. Whether it comes from external or internal forces, stress impacts us psychologically and physically, threatening our well-being. For the body, long-term stress can lead to heart disease, high blood pressure, muscle tension and pain, headaches, poor sleep, stomach discomfort and excessive weight gain or loss. Mentally, it can lead to depression, anxiety, burnout, outbursts, withdrawal, fatigue, substance misuse, anger, irritability, unexpected mood swings and lack of motivation or focus. Unfortunately, stress can infiltrate the body, mind, and spirit in many more ways, some obvious and some subtle.
As 988 grows, there’s mounting pressure on crisis mental health workers from every direction, increasing the likelihood that they will suffer from chronic stress, burnout and workplace conflict. Long hours, shift work, compassion fatigue, lack of funding, low pay, and the burden of handling the increasing volume of 988 users are just a few of the issues culminating in an unprecedented workforce shortage. Targeted workforce support is critical to stem the tide of this shortage, which negatively affects access to care, particularly for Medicaid recipients and rural populations.
To address workforce shortages, some states are increasing rates, reducing the administrative burden on providers, finding ways to extend the workforce and incentivizing providers with prompt payment. Other states, including Minnesota, Delaware, Oklahoma, Virginia and New York, have implemented strategies such as educational loan repayment assistance for those practicing in underserved areas, hiring peer support specialists with a criminal record who have been successfully rehabilitated, and expanding recruitment, training and collaboration with primary care.
Beyond state strategies, there are many resources to help organizations stem the tide. In 2023, the National Alliance for Mental Illness, or NAMI, published an analysis and recommendations on the challenges and barriers facing crisis line workers. Informed by the National Association of State Mental Health Program Directors, commonly known as NASMHPD, analysis of 988 crisis contact centers in 17 states, NAMI outlined the five areas of concern, each with a list of specific challenges and recommendations: administrative roles and technology, scope and practice, training, salaries and work environment.
On the federal level, SAMHSA released a 2022 publication on evidence-based strategies to address burnout, resulting in statistically significant improvements for the behavioral health workforce. Some examples of interventions include creating a positive work environment, improving ergonomics, communications, training, and teamwork/spirit, prioritizing physician well-being at an equal level of quality of care, and identifying individual and organizational stressors.
“Employers have a responsibility to address mental health and support overall employee well-being in the workplace… including working towards the reduction or elimination of stressors in the workplace,” according to the National Safety Council. And it’s in their best interest to do so because they also bear the brunt of the high cost of stress, burnout, and conflict. Specifically, work stress amounts to an annual spend of $221 million to $187 billion, while burnout comes in at $550 billion. Conflict represents a staggering $359 billion annually, a price that will climb as workplace conflict is sure to increase.
Thankfully, organizations can address and mitigate the associated catastrophic outcomes and exorbitant price tags with healthy returns on the investments. According to the Bureau of Labor Statistics, as of March 2024, over 60 percent of all employees have access to Employee Assistance Programs and 47 percent have access to wellness programs. EAPs provide confidential counseling and referrals for personal and work-related concerns, free consultations with financial experts and attorneys, health and wellness support, and critical incident response to threats, violence, natural disasters, injury and death. The return on investment to the organization for offering EAPs ranges from $2,000 to $3,500 per employee, depending on the organization’s size.
Conflict resolution training is another effective way to reduce workforce stress, according to research on workplace conflict. This is very important when 36 percent of employees involved in workplace conflicts report higher levels of emotional exhaustion, 60 percent report decreased job satisfaction, leading to higher turnover rates, and over 30 percent report anxiety and depression due to workplace conflict. Further, conflict resolution training improves productivity with an ROI of $4:1 for every dollar spent on ordinary mental health concerns.
Mediation provides another alternative when informal discussions prove ineffective. Having an independent third party establish a safe and respectful way to discuss issues has a significant ROI as well, including approximately 78 percent resolution rate, 90 percent savings on litigation costs, 20-to-30 percent increased productivity, and long-term cultural benefits such as trust, better communication, and collaboration.
Organizations can also hire expert facilitators to help decrease stress, burnout, and conflict while fostering innovation, collaboration, and problem-solving. Assisted by a trained practitioner, parties define and analyze issues and develop and execute alternatives in a respectful, safe environment. At the same time, organizations benefit from reduced meeting times, lower resolution costs, increased decision-making and productivity, and a success rate of more than 80 percent.
The mental health workforce is profoundly vulnerable to stress and its consequences, including burnout, conflict, and a national mental health workforce shortage. With resources like 988, EAPs, conflict resolution training, mediation, and facilitation, stress does not have to take such a high toll. When these resources are offered, individuals can benefit from lower stress, burnout, and conflict, higher job satisfaction, better cohesion, and work-life balance. Organizations can recoup extremely high costs associated with lost time, productivity, and turnover, and in turn, the entire workforce is supported in significant, long-lasting ways.
An unprecedented number of Americans, me included, need and rely on the mental health workforce to get through the rough times and to thrive despite diagnoses. Let us not neglect to consider and support their unique needs as well to ensure resources like 988 become as commonplace as 911.
