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By Jessica Bari, Minnesota Public Radio News

Parker Roth handles some of the hardest calls in Minnesota.

A specialist and assistant manager at the 988 suicide and crisis lifeline run by Greater Twin Cities United Way, Roth takes calls ranging from someone who just wants to talk to someone thinking about suicide. They range from young to old. One caller he talked to was 5 years old.

“We get calls that are very low risk, people who just need someone to talk to. We also take extremely high-risk calls, where someone is very actively considering suicide whether they’ve already attempted it or not before reaching out to us,” he said.

“We deal with a lot [of issues], so people calling us about grief, or depressive symptoms or anxiety, panic attacks, or substance use issues.”

Now starting its third year, 988 has turned into a lifeline for tens of thousands of Minnesotans. In 2023, the state’s 988 centers answered more than 50,000 calls, texts or chats, according to the Minnesota Department of Health, which oversees the state’s 988 operation. That’s a 74 percent increase from the prior year.

The 988 system was designed to improve outreach to the pre-existing National Suicide Prevention Lifeline, a 1-800 number that was tough to remember in crisis situations. Advocates say it’s been a success here and around the country, although challenges remain.

Minnesota a leader nationally

With nearly $1 billion in federal funding, 988 connects people to a national network of centers. Individual states are responsible for setting up the infrastructure.

Minnesota is one of 10 states that has passed legislation to build 988 to better serve residents, according to the National Alliance on Mental Illness. Lawmakers approved a 12-cent telecommunications fee to monthly phone bills, a move expected to provide about $9 million in annual funding. It’s similar to how 911 is supported.

Observers say the state stands out for its rollout of 988 and its high answer rate. When someone with a Minnesota area code calls, texts or seeks to chat online, 87 to 90 percent get connected quickly with a person who can help.

“Not only through funding, but also the lifeline centers have been able to increase their staffing capacity to answer those calls, texts and chats that are coming in from Minnesota residents,” said Tanya Carter, suicide prevention supervisor for the state’s 988 program.

There are four centers in Minnesota, including one that covers the North Dakota-Minnesota region of Fargo-Moorhead.

Help-seekers have the option to stay anonymous. Women and girls make up most of the callers who share information about themselves. The largest age group of users is 25 to 44 years old.

“Usually, we’re trying to have a little bit more of a conversation first, and we always try least-invasive measurements first. So, de-escalation,” Jamie Drewlow, text and chat supervisor for First Call for Help, a call center based in Grand Rapids told MPR News in a recent interview.

“We try to do a safety plan, connect other resources. And if somebody’s feeling like they might need more support, we do try to connect them with a crisis response team,” Drewlow said. “That’s always our goal, to meet people where they’re at and meet their needs.”

Roth said some of the most common calls he gets are from someone who is worried about the well-being of someone they know or a member of their community who seems unwell.

His center is open 24 hours a day and employs 31 trained suicide prevention call specialists. Some months, it handles nearly 3000 calls from people who need support.

Minnesota also has a center, run by Mental Health Minnesota, dedicated to texts and chats only. This is a steadily growing area of contact, and an assumed preference for many young help-seekers.

‘Just feeling heard’

Nationwide, the implementation of 988 is considered a success, although advocates say there is still work to do.

Despite the high volume of contacts from help seekers, public awareness is still low — 51 percent of Americans say they don’t know when to call 988 and 38 percent report not knowing what to do if a loved one is experiencing a mental health emergency, according to a national poll commissioned by the National Alliance on Mental Illness.

Although there have been improvements with the phone system, help-seekers say wait times can be long, and the hold music is not therapeutic.

Area codes can also be a problem. The system is set up to route calls to a center based on a phone’s area code. If a caller moves to Minnesota from another state and still has their old phone number, they end up connected to a 988 center in the prior state.

At the Greater Twin Cities United Way center, Roth said they have a protocol in place for those situations, but it can slow the process of connecting help-seekers with local resources or emergency services for those who need them.

Federal officials say they’re working on a solution that will include a geo-routing solution, but it will take time to work out.

Overall, though, the view on 988 has been positive. It’s an additional, welcomed tool to strengthen a growing mental health care system and get people the level of care they need at the right time, said Sue Abderholden, executive director of the NAMI chapter in Minnesota. It took a long time for people to embrace 911, she noted, but it’s a necessary service now calling for help.

There was some initial concern that 988 would prevent people in a mental health crisis from getting emergency support, but the Minnesota Department of Health reports only 1.2 percent of people needed to be transferred to 911 for emergency intervention and 4.8 percent were transferred to a mobile crisis team.

The other 94 percent of help-seekers seemed to be served and stabilized by reaching out to 988.

Roth said most people he talks to can get the support they need by talking to a trained crisis counselor.

“Just having someone on the other line to be there to support you, or even just to hear you, can be so huge,” he said. “The vast majority of our contacts just feeling heard or feeling supported is kind of the intervention that’s necessary.”

How to identify and help someone struggling with mental health

NAMI Minnesota has a list of suicide warning signs to watch. They include talking about wanting to die or being a burden to others, feelings of being trapped, or changing behaviors such as researching ways to die, withdrawing from friends and giving away important items and taking dangerous risks, such as driving extremely fast.

If these warning signs apply to you or someone you know, call or text 988 to talk with trained counselors who can help. The 988 suicide and crisis lifeline is available 24/7.