The clock never ticks the same way twice for those answering the phones at the state’s Rapid Response Access Point. Certain calls end within 20 minutes, while others stretch up to two hours as agents provide support to callers navigating a mental health crisis.

The state helpline, which launched in January – six months before the national 988 hotline – was designed to be a lifeline for New Hampshire residents seeking support during times of grief, fear and the urgent need for intervention in suicidal crisis cases.

In its initial six months of operation, the helpline’s call volume was more than double the expectations, said Eric Eason, the state’s Crisis Account Director at Carelon Behavioral Health, the company overseeing the helpline’s operations.

When the national suicide hotline was updated to the three-digit 988 to make it more accessible for those experiencing a mental health crisis, more calls were diverted to the New Hampshire helpline.

“We soon realized the actual call volume was significantly higher, and it has remained significantly higher than that initial expectation,” said Eason.

The helpline, which can be reached by dialing 833-710-6477, receives more than 3,500 calls each month just from people calling the Rapid Response Access Point 10-digit number. The total figure is much higher when the 988 calls are combined.

This month marks the one-year anniversary of the 988 suicide prevention hotline, which received 5 million phone calls, text messages and chats from people all around the country.

When people dial 988, their calls are routed to their local answer point based on the area code they are calling from. The local answer point varies from state to state. In New Hampshire, there are two local answer points, including Head Rest and the Rapid Response helpline.

Law enforcement agencies seeking assistance with a mental health call typically reach out to the state helpline, instead of dialing 988, to get a faster response.

How does the helpline work?

Every day, the helpline receives an endless range of calls. Some people reach out because they are overwhelmed with feelings of sadness or anxiety, while others are dealing with major life changes. Then there are those who contact on behalf of others, seeking assistance and guidance.

Depending on the conversations, call agents make the decision to dispatch mobile crisis units or refer to mental health resources in their community

But some calls go unanswered because of the way the system is set up.

When handling calls, the helpline uses a 20-second cutoff time to distinguish between abandoned and dropped calls. Calls that are disconnected within the first 20 seconds of waiting are not marked as abandoned. An abandoned call is one that sits in the helpline’s system for more than 20 seconds without receiving a response.

Eason explained that abandoned calls, where the call gets disconnected before reaching a live person, pose a challenge because the agents have no information about of the calls or the callers’ situation. As a result, connecting with the caller is impossible.

However, for calls that reach a call agent but are then dropped, the agent will take action if they believe the disconnection was unintentional or if additional collaboration with the caller is required. They will attempt to contact the caller again.

If the caller requests not to be reconnected, the helpline will not make any more calls.

The helpline’s rate of abandoned calls was within nationally acceptable crisis line standards, said Eason.

Helpline records show call abandonment rates are higher during after hours.

While Eason agreed that more calls went unanswered after hours, he couldn’t explain why.

From its inception, a total of 2,122 children and 7,542 adults who contacted the helpline directly were connected with clinicians at one of the 10 affiliated community mental health centers of the New Hampshire Community Behavioral Health Association.

In addition, over 100 children and 600 adults whose calls to 988 were routed to the helpline were connected to their local community behavioral centers.

While some callers request to be connected to a specific associate they’ve spoken with previously, the way the helpline operates cannot guarantee that a specific associate will be readily available.

This practice is generally not considered the best approach, said Eason.

“Therapeutically, we really want folks to see us as a resource and as a support; we really also want them to be sure that they’re focusing their energy on developing relationships with appropriate therapeutic resources in their community,” said Eason. “We are not a replacement for an ongoing therapy relationship with a therapist, so we’re a little careful about those types of requests.”

Reducing involvementof law enforcement

A significant highlight of this helpline’s services is the utilization of mobile crisis response teams to address mental health emergencies, providing an opportunity to reduce the reliance on law enforcement involvement.

Starting from January 2022 to June of this year, the helpline received 209 inquiries, initiated by law enforcement agents on behalf of a person in crisis, according to the helpline.

“Law enforcement does occasionally call us to request services. And that might be to request for us to help de-escalate the person, it may be for us to set up an appointment or it may be for us to dispatch mobile crisis,” said Eason, clarifying that the inquiries do not directly relate to the number of mobile crisis dispatches that occur when law enforcement is engaged in a situation.

Ensuring timely intervention during a mental health crisis is crucial, and the helpline’s primary objective is to have a response team reach the affected location within one hour. However, meeting this target can be challenging because the teams do not use lights and sirens while responding, like first responders, and they are thinly spread across the entire state.

Like with all systems, the helpline is transforming and needs time to get to 100%, said Bernie Seifert, deputy director of the National Alliance on Mental Illness New Hampshire.

“The good thing with this new system is that if a certain region’s mobile crisis team is unable to respond, they’re able to look to the abutting region to see if they can get another mobile crisis team to respond,” said Seifert. “So they’re backing each other up, which is really helpful.”

Call associates at the helpline revealed that their personal experiences in dealing with callers have been relatively smooth. However, they said that it can be emotionally challenging to listen to callers discussing the various barriers they face in accessing treatment.

The frequently mentioned issue by callers is the long waitlists for appointments at local mental health centers.

However, helpline employees said that they can usually schedule an urgent appointment within a day or two, and in the meantime, they connect clients to peer support groups.

“Our job is to refer to other resources, and so we’re referring to the set of resources, which continues to develop,” said Eason. “So sometimes I think we feel there’s a feeling that we’re eager for to see the development of a menu of resources that we’d like to refer to.”

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