Kaiser Health News
A Year With 988: What Worked? What Challenges Lie Ahead?
by Colleen DeGuzman
Wed, 26 Jul 2023 09:00:00 +0000
The Suicide & Crisis Lifeline's 988 hotline marked its one-year milestone this month. Mental health experts say the three-digit number made help more accessible than before.
The hotline was designed with the idea that people experiencing emotional distress are more comfortable reaching out for help from trained counselors than from police and other first responders through 911.
Since the federally mandated crisis hotline's new number launched in July 2022, 988 has received about 4 million calls, chats, and texts, according to a KFF report — up 33% from the previous year. (The hotline previously used a 10-digit number, 800-273-8255, which remains active but is not promoted.)
At a July press event, policymakers and mental health experts celebrated the hotline's first-year successes as well as its additional $1 billion in funding from the Biden administration. Health and Human Services Secretary Xavier Becerra described 988 as a “godsend” during taped remarks. “It may not be the solution,” he said, “but it lets you touch someone who can send you on a path to where you will get the help you need.”
Those same advocates recognized the dark reality represented by 988's high call volume: The nation faces a mental health crisis, and there is still much work to be done.
One year in, it's also clear that the 988 hotline, a network of more than 200 state and local call centers, faces challenges ahead, including public mistrust and confusion. It's also clear the hotline needs federal and state funding intervention to be sustainable.
Here's a status check on where things stand:
What Worked?
The original 1-800 national mental health crisis hotline has operated since 2005. The huge increase in calls to 988 compared with those to the 1-800 number in just a year is likely linked to the simplicity of the three-digit code, said Adrienne Breidenstine, vice president of policy and communications at Behavioral Health System in Baltimore. “People are remembering it easily,” she told KFF Health News.
According to a survey by NAMI and IPSOS conducted in June, 63% of Americans had heard of 988, and those ages 18 to 29 were most aware. Additionally, the survey found that LGBTQ+ people were twice as likely to be familiar with 988 as people who don't identify as LGBTQ+.
The 988 hotline provides 24/7 support for people in suicidal crisis or other kinds of emotional distress, Breidenstine said. “They can be calling if they really just had a bad day,” she said. “We also get some calls from people experiencing postpartum depression.” Callers are directed to a menu of options to choose which kind of service would best help them, including a veterans' line.
As it launched, mental health experts worried about the hotline's ability to keep up with demand. But it appears to be growing into its position. “Despite a huge increase of demand on the system, it's been holding up, and it's been holding up exceptionally well,” Hannah Wesolowski, chief advocacy officer at the National Alliance on Mental Illness, told KFF Health News. It now takes an average of 35 seconds for someone reaching out to 988 — by calling or texting — to reach a counselor, according to data from the Substance Abuse and Mental Health Services Administration. A year ago, that average was one minute and 20 seconds.
Wesolowski said one of the biggest surprises with the launch was the frequency of text-message traffic. In November 2022, the Federal Communications Commission voted to require 988 to be texting-friendly.
In May, according to SAMHSA, 988 received about 71,000 texts nationwide with a 99% response rate, compared with 8,300 texts in May 2022 with an 82% response rate.
This month, HHS announced the addition of Spanish text and chat services to 988.
Challenges Ahead
More than half of Americans have heard of 988, but only a small fraction understand how the hotline operates. According to NAMI's survey, only 17% of people who responded said they were “very/somewhat familiar” with the hotline.
Most people think that by calling 988, like 911, emergency services will automatically head their way, the survey found. Currently, 988 does not use geolocation, meaning call centers don't automatically receive information about callers' locations. Vibrant Emotional Health, which operates the hotline, is working to incorporate geo-routing into the system, which would help identify callers' regions — but not exact locations — making it possible to connect them to local counseling groups and other mental health services.
But incorporating geo-routing into the hotline isn't without controversy. When it launched, people responded on social media with warnings that calling 988 brought a heightened risk for police involvement and involuntary treatment at psychiatric hospitals. “Based on the trauma that so many people in the mental health community have long experienced when they've been in crisis, those assumptions are very understandable,” Wesolowski said.
Fewer than 2% of calls end up involving law enforcement, she said, and most are de-escalated over the phone.
“The vast majority of people think that an in-person response is going to happen whenever you call — and that's just simply not true,” Wesolowski said.
Another challenge mental health advocates face is informing older adults about 988, especially veterans, who are at higher risk of having suicidal ideations. Americans ages 50 to 64 had the lowest awareness rate of 988 — at 11% — among all age groups, according to NAMI's survey.
This is a telling sign of how older generations are less willing to discuss and admit to mental health struggles, Wesolowski said. “Young people are just more willing to be open about that, so I think that breaking down that stigma across all age groups is absolutely vital, and we have a lot of work to do in that space.”
Is 988 Sustainable?
Since the hotline launched, it has been dependent on federal grants and annual appropriations. A gush of funding flowed when 988 launched, “but those annual appropriations are something you have to keep going back for year after year, so the sustainability aspect is a little more fraught,” Wesolowski said.
This is where Congress and state legislatures come in.
Mental health leaders hope to push legislation that allows 988 to be funded the same way 911 is nationwide. The Wireless Communications and Public Safety Act of 1999 mandated 911 to be the country's universal emergency number, and ever since, users have automatically been charged — an average of about a dollar a month — on their monthly phone bills to fund it. Six states have imposed a similar tax for 988, and two states — Delaware and Oregon — have bills for this tax on their governor's desks.
It's under the FCC's power to levy a nationwide tax, but the federal agency hasn't done so yet.
By: Colleen DeGuzman
Title: A Year With 988: What Worked? What Challenges Lie Ahead?
Sourced From: kffhealthnews.org/news/article/a-year-with-988-what-worked-what-challenges-lie-ahead/
Published Date: Wed, 26 Jul 2023 09:00:00 +0000
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Kaiser Health News
Journalists Delve Into Climate Change, Medicaid ‘Unwinding,’ and the Gap in Mortality Rates
Sat, 04 May 2024 09:00:00 +0000
KFF Health News senior correspondent Samantha Young discussed Medicaid and climate change on KCBS Radio's “On-Demand” podcast on April 29.
- Click here to hear Young on KCBS
- Read Young's “AC, Power Banks, Mini Fridges: Oregon Equips Medicaid Patients for Climate Change“
KFF Health News contributor Andy Miller discussed Medicaid unwinding on WUGA's “The Georgia Health Report” on April 26.
- Click here to hear Miller on “The Georgia Health Report”
- Read Phil Galewitz' “Millions Were Booted From Medicaid. The Insurers That Run It Gained Medicaid Revenue Anyway.“
KFF Health News Nevada correspondent Jazmin Orozco Rodriguez discussed mortality rates in rural America on The Daily Yonder's “The Yonder Report” on April 24.
- Click here to hear Rodriguez on “The Yonder Report”
- Read Rodriguez' “City-Country Mortality Gap Widens Amid Persistent Holes in Rural Health Care Access”
——————————
Title: Journalists Delve Into Climate Change, Medicaid ‘Unwinding,' and the Gap in Mortality Rates
Sourced From: kffhealthnews.org/news/article/journalists-delve-into-climate-change-medicaid-unwinding-and-the-gap-in-mortality-rates/
Published Date: Sat, 04 May 2024 09:00:00 +0000
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https://www.biloxinewsevents.com/oh-dear-baby-gear-why-are-the-manuals-so-unclear/
Kaiser Health News
Oh, Dear! Baby Gear! Why Are the Manuals So Unclear?
Darius Tahir
Fri, 03 May 2024 09:00:00 +0000
Since becoming a father a few months ago, I've been nursing a grudge against something tiny, seemingly inconsequential, and often discarded: instructional manuals. Parenthood requires a lot of gadgetry to maintain a kid's health and welfare. Those gadgets require puzzling over booklets, decoding inscrutable pictographs, and wondering whether warnings can be safely ignored or are actually disclosing a hazard.
To give an example, my daughter, typically a cooing little marsupial, quickly discovered babyhood's superpower: Infants emerge from the womb with talon-strength fingernails. She wasn't afraid to use them, against either her parents or herself. So we purchased a pistachio-green, hand-held mani-pedi device.
That was the easy part. The difficulty came when we consulted the manual, a palm-sized, two-page document.
The wandlike tool is topped with a whirring disc. One can apparently adjust the speed of its rotation using a sliding toggle on the wand. But the product manual offered confusing advice: “Please do not use round center position grinding,” it said. Instead, “Please use the outer circle position to grinding.” It also proclaimed, “Stay away from children.” In finer print, the manual revealed the potential combination of kids and the device's smaller parts was the reason for concern.
One would hope for more clarity about a doodad that could inadvertently cause pain.
Later, I noticed another warning: “If you do not use this product for a long time, please remove the battery.” Was it dangerous? Or simply an unclear and unhelpful yet innocuous heads-up? We didn't know what to do with this information.
We now notice shoddy instructions everywhere.
One baby carrier insert told us to use the product for infants with “adequate” head, neck, and torso control — a vague phrase. (The manufacturer declined to comment.)
Another manual, this one online and for a car seat — a device that's supposed to protect your kid — informed readers with words and images that a model baby was “properly positioned” relative to the top of the headrest “structure” when more than one inch from the top. Just pixels away, the same model, slumped further down, was deemed improperly positioned: “The headrest should not be more than 1” from the top of her head,” it said, in tension with its earlier instructions. Which was it, more than one inch or not? So we fiddle and hope for the best.
I acknowledge this sounds like new-parent paranoia. But we're not entirely crazy: Manuals are important, and ones for baby products “are notoriously difficult to write,” Paul Ballard, the managing director of 3di Information Solutions, a technical writing firm, told me.
Deborah Girasek, a professor of social and behavior sciences at the Uniformed Services University of the Health Sciences, told me that for decades, for the young and middle-aged alike, unintentional injury has been the leading cause of death. That's drownings, fires, suffocation, car crashes. The USU is a federal service academy training medical students destined for the armed services or other parts of the government.
Some of these deaths are caused by lack of effective communication — that is, the failure of instruction about how to avoid injury.
And these problems stretch from cheap devices to the most sophisticated products of research and development.
It's a shortcoming that's prompted several regulatory agencies charged with keeping Americans healthy, including the Consumer Product Safety Commission, the Food and Drug Administration, and the National Highway Traffic Safety Administration, to prod companies into providing more helpful instructions.
By some lights, they've had success. NHTSA, for example, has employees who actually read manuals. The agency says about three-quarters of car seats' manuals rate four or five stars out of five, up from 38% in 2008. Then again, our car seat's has a five-star rating. But it turns out the agency doesn't evaluate online material.
Medical product manuals sometimes don't fare too well either. Raj Ratwani, director of MedStar Health's Human Factors program, told me that, for a class he teaches to nurses and doctors, he prompted students to evaluate the instructions for covid-19 tests. The results were poor. One time, instructions detailed two swabs. The kit had only one.
Technical writers I spoke with identified this kind of mistake as a symptom of cost cutting. Maybe a company creates one manual meant to cover a range of products. Maybe it puts together the manual at the last moment. Maybe it farms out the task to marketers, who don't necessarily think about how manuals need to evolve as the products do.
For some of these cost-cutting tactics, “the motivation for doing it can be cynical,” Ballard said.
Who knows.
Some corners of the technical writing world are gloomy. People worry their jobs aren't secure, that they're going to be replaced by someone overseas or artificial intelligence. Indeed, multiple people I spoke with said they'd heard about generative AI experiments in this area.
Even before AI has had its effect, the job market has weighed in. According to the federal government, the number of technical writers fell by a third from 2001, its recent peak, to 2023.
One solution for people like us — frustrated by inscrutable instructions — is to turn to another uncharted world: social media. YouTube, for instance, has helped us figure out a lot of the baby gadgets we have acquired. But those videos also are part of a wild West, where creators offer helpful tips on baby products then refer us to their other productions (read: ads) touting things like weight loss services. Everyone's got to make a living, of course; but I'd rather they not make a buck off viewers' postpartum anxiety.
It reminds me of an old insight that became a digital-age cliché: Information wants to be free. Everyone forgets the second half: Information also wants to be expensive. It's cheap to share information once produced, but producing that information is costly — and a process that can't easily or cheaply be replaced. Someone must pay. Instruction manuals are just another example.
——————————
By: Darius Tahir
Title: Oh, Dear! Baby Gear! Why Are the Manuals So Unclear?
Sourced From: kffhealthnews.org/news/article/baby-product-instruction-manuals-confusing-technical-writing/
Published Date: Fri, 03 May 2024 09:00:00 +0000
Kaiser Health News
California Floats Extending Health Insurance Subsidies to All Adult Immigrants
Jasmine Aguilera, El TÃmpano
Fri, 03 May 2024 09:00:00 +0000
Marisol Pantoja Toribio found a lump in her breast in early January. Uninsured and living in California without legal status and without her family, the usually happy-go-lucky 43-year-old quickly realized how limited her options were.
“I said, ‘What am I going to do?'” she said in Spanish, quickly getting emotional. She immediately worried she might have cancer. “I went back and forth — I have [cancer], I don't have it, I have it, I don't have it.” And if she was sick, she added, she wouldn't be able to work or pay her rent. Without health insurance, Pantoja Toribio couldn't afford to find out if she had a serious condition.
Beginning this year, Medi-Cal, California's Medicaid program, expanded to include immigrants lacking legal residency, timing that could have worked out perfectly for Pantoja Toribio, who has lived in the Bay Area city of Brentwood for three years. But her application for Medi-Cal was quickly rejected: As a farmworker earning $16 an hour, her annual income of roughly $24,000 was too high to qualify for the program.
California is the first state to expand Medicaid to all qualifying adults regardless of immigration status, a move celebrated by health advocates and political leaders across the state. But many immigrants without permanent legal status, especially those who live in parts of California where the cost of living is highest, earn slightly too much money to qualify for Medi-Cal.
The state is footing the bill for the Medi-Cal expansion, but federal law bars those it calls “undocumented” from receiving insurance subsidies or other benefits from the Affordable Care Act, leaving many employed but without viable health insurance options.
Now, the same health advocates who fought for the Medi-Cal expansion say the next step in achieving health equity is expanding Covered California, the state's ACA marketplace, to all immigrant adults by passing AB 4.
“There are people in this state who work and are the backbone of so many sectors of our economy and contribute their labor and even taxes … but they are locked out of our social safety net,” said Sarah Dar, policy director at the California Immigrant Policy Center, one of two organizations sponsoring the bill, dubbed #Health4All.
To qualify for Medi-Cal, an individual cannot earn more than 138% of the federal poverty level, which currently amounts to nearly $21,000 a year for a single person. A family of three would need to earn less than $35,632 a year.
For people above those thresholds, the Covered California marketplace offers various health plans, often with federal and state subsidies, yielding premiums as low as $10 a month. The hope is to create what advocates call a “mirror marketplace” on the Covered California website so that immigrants regardless of status can be offered the same health plans that would be subsidized only by the state.
Despite a Democratic supermajority in the legislature, the bill might struggle to pass, with the state facing a projected budget deficit for next year of anywhere from $38 billion to $73 billion. Gov. Gavin Newsom and legislative leaders announced a $17 billion package to start reducing the gap, but significant spending cuts appear inevitable.
It's not clear how much it would cost to extend Covered California to all immigrants, according to Assembly member Joaquin Arambula, the Fresno Democrat who introduced the bill.
The immigrant policy center estimates that setting up the marketplace would cost at least $15 million. If the bill passes, sponsors would then need to secure funding for the subsidies, which could run into the billions of dollars annually.
“It is a tough time to be asking for new expenditures,” Dar said. “The mirror marketplace startup cost is a relatively very low number. So we're hopeful that it's still within the realm of possibility.”
Arambula said he's optimistic the state will continue to lead in improving access to health care for immigrants who lack legal residency.
“I believe we will continue to stand up, as we are working to make this a California for all,” he said.
The bill passed the Assembly last July on a 64-9 vote and now awaits action by the Senate Appropriations Committee, Arambula's office said.
An estimated 520,000 people in California would qualify for a Covered California plan if not for their lack of legal status, according to the labor research center at the University of California-Berkeley. Pantoja Toribio, who emigrated alone from Mexico after leaving an abusive relationship, said she was lucky. She learned about alternative health care options when she made her weekly visit to a food pantry at Hijas del Campo, a Contra Costa County farmworker advocacy organization, where they told her she might qualify for a plan for low-income people through Kaiser Permanente.
Pantoja Toribio applied just before open enrollment closed at the end of January. Through the plan, she learned that the lump in her breast was not cancerous.
“God heard me,” she said. “Thank God.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.Â
——————————
By: Jasmine Aguilera, El TÃmpano
Title: California Floats Extending Health Insurance Subsidies to All Adult Immigrants
Sourced From: kffhealthnews.org/news/article/california-legislation-medicaid-subsidies-all-adult-immigrants/
Published Date: Fri, 03 May 2024 09:00:00 +0000
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