For more than 40 years, the Arkansas Crisis Center has offered a lifeline to people in distress. On average, the call-and-text line operators field just under 1,000 calls per month. Now, the center is partnering with the psychiatric department at the University of Arkansas for Medical Sciences to analyze two decades of call records.
Joshua Gonzalez is president of the Crisis Center and tells Ozarks at Large’s Daniel Caruth that this effort will help get a clearer picture of mental health in the Natural State.
Joshua Gonzalez: And we started thinking about this and looking at the problem and realizing that over the past 20 years, we've had over 100,000 people call us. And when someone calls us, we get some demographic information like, what are the needs that people have? And all of this different data that's completely de-identified and all of that. So there's no privacy, but we have this resource of what's happened in Arkansas. Like, hey, what happened in COVID? What's going on with our youth? And there needs to be some looking at that, because I think right now the governor just—they're spending about $10 million on crisis intervention in Arkansas. And I think the more we can contribute with data of what's going on in our state and having kind of the gold standard of research on it, which is UAMS, we'll be able to start informing policy.
A lot of our conversations are, hey, we have this many calls. And these are really good, impactful stories. But having that research and the facts of what is going on done by an academic institution, I think, is an important part of the legislative process.
Daniel Caruth: And I mean, for you, over those past—I assume you probably haven't been with the Crisis Center for the past 20 years. But in that time, what have you guys seen changing as far as issues that people are dealing with? Mental health, new technology that's rising, trends over these past few decades. I imagine COVID was maybe an outlier, but what has changed when it comes to suicide prevention and mental health in your field over the past few decades?
Gonzalez: That question's what the research is going to answer, right? So I think to get a really good answer to that question that's academically defensible with our data is really what this is trying to do. And also, what the research is going to do is with all these new machine learning and different things, are we able to, with this data, start developing some predictive elements to suicide as well?
So there's what's going on in Arkansas, and then some of the predictive elements that can further inform care. What I can directly see from the reporting and the statistics—I mean, we're getting a lot of calls. So the demand for our service is very high. But youth has been the most sad and population that's growing the most. It's very hard to see so many youth reaching out to us.
And when we started our text service in February, we had an expectation that more youth would text us than call us. And what we discovered is, I think right now we're serving about 1,000 texts a month. And 60 to 70% of that is children under the age of 18. So that's been the most shocking thing I've been seeing. Generally, youth were less than 1% of our calls. And to add another service and see 70% and then a thousand a month demand, a thousand plus—I think it's like 1,300, but we can't answer all of them—and it's pretty extreme.
Caruth: And was that part of the reason why you guys wanted to develop this partnership with UAMS and get all of this data analyzed and use it to come up with some new techniques or to get a clearer picture? Was that part of the reasoning, just seeing these new trends and some of the volume from that text service come in?
Gonzalez: One hundred percent. And Alyssa Wilburn is also a youth psychologist as well. So she is going to be able to help us first figure out what is going on from our data—what are the big issues, and how can we better inform care. And we have relationships with school districts and all these other different community partners. And what people really want to know is what's going on. And as much to the causal element of that—what's causing this to happen? So the more we can contribute from a research point of view, that's going to help the schools, that's going to help the legislature, it's going to help other crisis centers provide more informed care as well. Because over large amounts, you can start finding those trends. And there hasn't been any research like this done in Arkansas.
Caruth: Yeah. And obviously you guys work on the end where maybe people are at a breaking point where they decide to reach out to someone. But do you do any work or, as you've started to increase your capacity to field some of those calls, have you started to work on the front end of that—getting to people before they reach that point? Or is that outside the scope of what you do?
Gonzalez: This, personally for me, is—because my staff and our other board, we're very good at our hotline. That's my biggest area of focus, and I call it the upstream prevention, right? So what can we do to prevent stuff from happening up the stream so it doesn't flow down to the waterfall of getting to a crisis call? And just to be clear, crisis can be any crisis. It does not have to be suicidal. So I want to qualify that for anyone listening. You can call in any crisis, which is self-defined to you.
But for this question on the upstream planning: we've applied for some funding, and I formed a youth board of directors and advisory board to advise us on what is going on in these schools. And I'm getting ready to launch, hopefully early next year, a youth peer teen line. So it's basically a helpline for healthy teens to help another teen. Non-crisis, right? This is pre-crisis to get the support they need.
Because what I noticed in interviewing a lot of youth was they need sometimes another youth. Because an adult perspective right now, since technology and school has changed so much, can be perceived by youth as judgmental. To us, it's helping and giving advice. But to them, we have different reference points. Like we're speaking Chinese to someone who's speaking Russian. The languages don't match up. So to the extent possible, where we can have early intervention with a healthy youth to another healthy youth, that peer-based interaction is a form of upstream planning.
We also train first responders, crisis intervention teams on suicide de-escalation. We train school districts, churches. So we do all this training to force multiply us out into the community so someone can recognize the signs of suicide prior to getting to that life-or-death crisis.
Caruth: And when it comes to policy and those resources and avenues for funding this type of research and work, are there places where you think Arkansas should be doing better? Are there places where we're dropping the ball or places you see would be maybe easy to step into to fill some of those gaps?
Gonzalez: Yeah. So two angles on this. I was up in D.C. earlier this year to meet with our members of Congress. And on the federal side, everyone’s pretty supportive. There's been no talks of cutting 988 funding. They moved the LGBTQ funding essentially into the 988 pool, so that resource wasn't completely gone. There was a slight increase in 988, which made up for that. So federally, I don't see any sign of diminishing support there, and all our members of Congress are extremely supportive.
On the state side, it's been something I've been really interested in pursuing, and I've met with several reps. And what the governor just did—they essentially answered what's going on. So they put about $10 million into a pilot crisis program. And a percentage of that is going to a call center in Arkansas. It was a bid. So we have bid for this to be the Arkansas crisis hub, the call center for the Arkansas crisis line. The award won't be confirmed for two weeks.
But the state, I do believe, is hearing it and devoting resources. And UA–Fayetteville has been charged to administer the $10 million and do research and start forming mobile crisis intervention teams. So who gets the award of the crisis line will start doing dispatches of a trained crisis intervention team versus a police department. And I'm not sure exactly when police come, when that comes—those are questions to be worked out. But we're trying to unify it in Arkansas right now. And we've applied to be the leader of the call line for that.
Caruth: And I know you guys are saying a lot of this project is about taking a broader, more holistic approach to mental health and suicide prevention. Are there any other initiatives—
You talked about that center coming in—that are part of that broader approach?
Gonzalez: There's one that's come up: the Arkansas Infant Child Death Review. So whenever there's a child that dies, and especially if they died by suicide, there's a team that goes out and reviews these cases to see, hey, what could we have done? Especially in death prevention in general, but it crosses over to mental health.
But I personally believe we're trending the right direction. And I think what people want more of is: what is going on? The more we can answer that in a factual sense, other than just being like, oh, wow, the world seems maybe a little crazier since COVID—but what's the data showing? And I think the crisis hub is also designed to answer that as well.
So I think the more eyes that get on crisis intervention in general and what crisis looks like and what's been going on, I think we'll start seeing more legislative change. But I really think it's important we have data and research, and not just anecdotal experience. It's useful, but when you're a legislator making changes for the entire state, having a statewide picture of what is going on is very helpful for them.
Caruth: So talking about that, what is the timeline for this project with UAMS? When do you think that that data can be analyzed? And what are some of the outcomes that you expect or hope will come out of this?
Gonzalez: So for the first version of this, what we're looking to do is get our dataset and then do descriptives. So basically see what demographics, what areas, what ZIP codes—just kind of basic "what is going on in Arkansas" type of data.
And another element of the initial project is when we have to do a dispatch, which means we've had to send police or somebody requested we've sent EMS or something like that—what factors can further inform maybe the allocation of resources? It can further inform trainings. So from this initial research project, that is going to be the focus.
And the long term: I'd really like to see some of the more advanced technology using artificial intelligence. And I'm not talking chatbots here or replacing humans as chatbots. None of that. But how can some artificial intelligence tools be leveraged to further inform crisis intervention statewide—nationwide would be the gold standard going forward.
Caruth: And finally, this is something you've obviously dedicated a lot of your life to. Why do you keep coming back to this? Why is this something that's important for you to address? And I know for a lot of people, it can feel there's still a lot of stigma around mental health and suicide. Why is this something that's important to talk about?
Gonzalez: Well, for suicide specifically, I've seen too many people I know die. And I think it's easy to frame as this thing—maybe it happened to somebody. I don't even know how people perceive it. But when it hits your family or someone close to you, it becomes very real very quickly. And it's final and it's ultimate. There's no post-suicide treatment. You know, there is for the family, in therapy, but it's very final.
And unlike certain forms of advanced cancer, this is pretty preventable. I think the more we can educate people on what's going on and how to intervene and how to help someone—because that was never taught in school. Nobody teaches that. So somebody has to do it. And I'm just so close to the problem. For me, I always tell myself: if not me, then who? I just have to live that way of being the change you want to see in the world.
Joshua Gonzalez is president of the Arkansas Crisis Center. He spoke with reporter Daniel Caruth last month.
