If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”
Overcome by worries, Lynette Isbell dialed a mental health hotline in April 2022. She wanted to talk to someone about her midlife troubles: divorce, an empty nest, and the demands of caring for aging parents with dementia.
“I did not want to keep burdening my family and friends with my problems,” Isbell said.
But she didn’t find the sympathetic ear she was hoping for on the other end. Frustrated, she hung up. Little did she know ending that call would set off events she would regret.
Police arrived at her home in Terre Haute, Indiana, handcuffed her, and had her committed to a hospital, records show, resulting in more than $12,000 in hospital charges.
“The whole thing was an absolute, utter, traumatic nightmare,” she said.
Isbell’s call for help represented the need for a new approach to crisis calls just as the nation was readying to flip the switch to a revamped response system for mental health. Using just three digits — 988 — people could call or text for help from anywhere at any time starting in July 2022. Federal officials viewed the launch of 988 “as the linchpin” to reenvision the mental health crisis system. The idea was to reduce the reliance on police and the burden on emergency rooms, while eliminating the stigma of seeking help.
But recent federal funding and staffing cuts undermine the future of the 988 program and threaten to erase progress made in Indiana and elsewhere, mental health advocates said.
The Trump administration cut staffing at the Substance Abuse and Mental Health Services Administration, the federal office that oversees 988, in recent weeks. It also ended $1 billion of its grants that a number of states relied on this year to help fund their 988 systems, said Stephanie Pasternak, state affairs director of the National Alliance on Mental Illness. While a judge temporarily paused grant cuts for 23 states that contested them, the trims to other states — including Indiana — have moved forward.
Between the SAMHSA cuts and potential reductions to Medicaid, another crucial funding stream for these services, Pasternak and others are concerned about what this means for 988’s future.
Any disruption to federal funding streams is “gravely impactful,” said Zoe Frantz, CEO of the Indiana Council of Community Mental Health Centers. “We have put a lot of time, talent, and treasure — from the state to providers — in trying to build the system,” Frantz said. “We can’t go back.”
After Isbell hung up her call, a member of the Suicide Prevention Hotline, the crisis line formerly available, phoned the Vigo County Sheriff’s Office and told a dispatcher Isbell was “thinking of committing suicide,” according to the sheriff’s report obtained by KFF Health News.
Years later, Isbell maintains she never said this. “I’ve never been actively suicidal.”
But two officers drove to Isbell’s home.
When they arrived, Isbell was sitting on her back porch on a sunny day with trees just starting to bud. The officer’s report alleged she admitted to thinking about driving her car into a tree, wanting doctor-assisted suicide, and fantasizing about a semitruck hitting her.
She contends active suicidal ideation with a plan is different than the overwhelmed feelings she had that day.
“It was like a childhood game of telephone, only not at all funny,” she said. What she said became distorted and left her no recourse.
The officers walked her to a squad car, where they handcuffed her before transporting her to Terre Haute Regional Hospital, according to dashcam video obtained from a public records request. Neighbors watched as she was taken away.
“I don’t know why I needed to be handcuffed,” she said. “It was demoralizing.”
The Vigo County Sheriff’s Office did not respond to requests for comment about Isbell’s case.
Isbell said being hospitalized against her wishes humiliated her and forced her to battle confusing medical bills for months. An itemized bill shows the hospital charged $12,772 for her overnight stay. After insurance, Isbell was on the hook for roughly $2,800. By comparison, a one-night stay in the presidential suite at the new Terre Haute Casino Resort is $2,471. Terre Haute Regional Hospital spokesperson Ann Marie Foote said Isbell’s bill was “discounted down” to $1,400.
“Our highest priority is always the safety and well-being of patients,” Foote said.
According to Isbell’s medical records, doctors there said “she was very stressed” and “just wanted to speak to someone” and reiterated “she was not suicidal.” They said her anxiety “is increased and made worse by being in here.”
She had “anxiety” and a “depressed mood,” and, according to medical records signed by a psychiatrist there, “she does not meet current criteria for involuntary hospitalization.” She was discharged the next day.
Upset by how she was treated, she contacted 988, the sheriff’s office, and the hospital.
In response to KFF Health News’ questions about Isbell’s experience, Michele Holtkamp, a spokesperson at the time for Indiana’s Family and Social Services Administration, said that before the launch of 988, “the state did not have oversight of individual crisis lines and how they responded.”
After 988 began, Isbell received a follow-up email from an executive with Mental Health America, introducing her to the director of Indiana’s 988 hotline, Kara Biro.
“I shared your story with her and we agree that we would love to get you to help with a training video,” wrote Brandi Christiansen, CEO of Mental Health America-Wabash Valley Region. She explained it would provide workers an opportunity to understand the real-life implications an “outcall can have on a human being.” The video has yet to happen, Isbell said.
The sheriff’s department also asked for her input to improve the process, she said.
Isbell saw those as signs of a turnaround. For mental health leaders in Indiana, 988 represented a “springboard to transform and build” a new response system, according to a 2022 Indiana Behavioral Health Commission report. Too often, the report said, Indiana’s “ineffective and inefficient” system had relied heavily on police and emergency rooms.
Before 988, the state hotline also relied almost entirely on volunteers, complicating efforts to standardize responses, said Jay Chaudhary, a former director of Indiana’s Division of Mental Health and Addiction, who led the state’s transition to 988.
“When somebody makes the really brave step to seek help with mental health care, that system better be ready to catch them,” he said.
Today, Indiana ranks among the 10 states with the highest 988 answer rates, a sign it can handle the demand, said Laurel Stine, chief advocacy and policy officer with the American Foundation for Suicide Prevention.
In Indiana, behavioral health professionals now lead the response via mobile crisis teams, not law enforcement, such as the officers who handcuffed Isbell.
As of July, mobile crisis teams were available to 4.8 million people living in 65 of Indiana’s 92 counties, reaching roughly 71% of residents, according to a 2024 report from the behavioral health commission. In the first half of last year, mobile crisis teams were dispatched 3,080 times for help. Law enforcement officers were involved in about 1% of those cases and roughly 10% resulted in a trip to the emergency room, according to the report.
Similar efforts have occurred nationwide since the 2022 launch. The 988 hotline received 4.8 million calls, texts, and chats during its first year, which is roughly nine times a minute, according to Substance Abuse and Mental Health Services Administration data.
But the federal government has terminated numerous grants earmarked for Indiana and other states to tackle mental health and substance use issues. Still, SAMHSA spokesperson Danielle Bennett said the 988 hotline is a “critical function” and that the federal government “will never compromise” protecting people experiencing a crisis. The hotline, Bennett said, “continues daily, life-saving work.”
The Indiana agency tasked with overseeing 988 had more than $98 million in SAMHSA grants but received 73% of that as of March 24, when the grants were terminated, according to a government list of cuts. That leaves Indiana $26 million short.
Some federal grants were passed through to local organizations, including one group that received grant money for “mobile crisis units,” according to an online grant summary. In a statement, Indiana Family and Social Services Administration spokesperson James Vaughn confirmed it received notice of the terminated SAMHSA grants but declined to provide details other than to say it is “working to minimize the impact to Hoosiers.”
Isbell hopes the 988 option doesn’t disappear for those who need a hand, not handcuffs.
She dealt with the fallout of that fateful call for a long time. After more than a year, she said, she paid the $1,400 bill to put the ordeal behind her.
