Q&A: Adrienne Breidenstine, Behavioral Health System of Baltimore on 988 rollout


Nicole Pasia


Adrienne Breidenstine, MSW, is the Vice President of Policy and Communications at the Behavioral Health System of Baltimore (BHSB), a nonprofit organization that manages Baltimore City’s care system for individuals with substance use and mental health disorders. 

In this Q&A, Breidenstine discusses the recent launch of the 988 Suicide and Crisis Lifeline on July 16th, and how BHSB plans to expand its services to reach the unique needs of Baltimore City and surrounding county residents.


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State of Reform: How does BHSB specifically serve the behavioral health needs of Baltimore City residents, and how has the recent launch of 988 affected your operations?

Adrienne Breidenstine: “Population type varies across our state and is definitely something we’ve been looking at and have had more experience in, just through the diversity and variation of the ways we provide crisis services outside of just an urban setting. Some of that is through the [Greater Baltimore Regional Integrated Crisis System] partnership that we are also involved in. It is a regional project that includes Baltimore City, Baltimore County, Carroll County, and Howard County, where we’re looking to expand services. 

One of the things we are doing is actually regionalizing the 988 helpline services. We know we need to take into account the different types of populations across different geography. We’ve got urban, suburban, and when you start reaching out to Carroll County, you’re getting more rural. We are building out 988 helpline services to be able to respond to all people with all types of concerns that they might be calling for. 

These crisis hotlines have been around in our communities for decades, more than 20 years in fact. 988 simply is just the phone number change. It’s changing that number to the National Suicide Prevention Lifeline to 988. The Lifeline has been supported by local call centers for decades. So the call centers that were looking to regionalize across that interjurisdictional region have been around and have been doing this work for a really long time. With 988 coming in additional [state] resources that are coming as a result of that, we’re expanding our call center capacity so we have more people to answer the phone.”

SOR: Responses have varied on how prepared each state would be to implement 988, but it seems like Maryland already did have that infrastructure in place. 

AB: “There are 8 call centers across our state that were part of that national network of call centers. We, at least regionally across Baltimore City, Baltimore County, Carroll County, have been planning for this [transition] for 2 years. So the minute the Federal Communications Commission made this designation we started planning. So we do feel that we’re ready and we are doing what we can to staff up so that we can be prepared to answer the calls. Nobody really knows what the expected call volume will be, but we expect it will increase over time.”

SOR: What would you say is your average call volume right now, or prior to the implementation of 988?

AB: “It’s only been a week, but we have been tracking call volume and we’ve seen a minor uptick. It’s hard to tell if it’s a result of 988, because our call volume does fluctuate day by day. Based on what’s happening over the course of the year, in Baltimore City we got over 40,000 calls to our call centers. As we look to regionalize the call center services for those 4 jurisdictions, we think we could get 124,000 calls annually just in the first year, so that’s what we’re looking at.”

SOR: There’s been an ongoing health care workforce shortage in Maryland during the pandemic—how is BHSB continuing to work through any challenges from that? 

AB: “It’s definitely a challenge. Our field is not unique in that we are experiencing this challenge as well. Our call centers have gotten creative, one of the things they learned during the pandemic is that people who work as our call center operators who are professional counselors, we can work from our home. With the technology and routing, we can have people working from their homes still answer calls. So that is certainly something that our call centers have been using to really prop up and show the advantage and use that for recruiting.”

SOR: Looking ahead to the next few months, what are you hoping to achieve? Are there ways that the state can better support the call centers as they adjust to the 988 implementation?

AB: “In the next few months, what we’re hoping to achieve is to very closely watch the call volume. We’re hoping that it will gradually increase. One of the things that we also did start one or two years ago, is trying to figure out how we should best be marketing 988 locally. So we did two years’ worth of market research and community engagement. We now have a pretty solid 

‘Call 988’ hotline brand. One of the things that we’ve been doing with our many, many partners over the last several months is getting the word out about this resource. It’s a great resource that has again been around for decades, but the previous number has not been easy to remember. One of the things we learned from our community engagement is 988 is helpful for a lot more people because it’s an easy number to remember. The feedback we got is ‘Yeah, I’ll remember this so that should reduce the barrier.’ People were really thrilled to learn that when they call they’ll get immediate help to get connected to a professional counselor.”

This interview was edited for clarity and length.