Marchuk has been in the trenches herself, one of the Careline’s first paid staff when she started in 2005. A teenager at the time, the experience made an impact.

“There are some folks that you carry with you forever, that you always wonder if they’re okay,” she says. Marchuk still answers phones occasionally to fill the round-the-clock staffing of eleven 8-hour shifts per day.

“Each operator has their individual office space,” she notes. “We have found that staff like it that way.”

Alaska’s only regional crisis center started as a local service in Fairbanks and then partnered with Tanana Chiefs Conference to provide statewide coverage. Most of its funding comes from a contract with the Alaska Division of Behavioral Health, plus some grants from the Alaska Mental Health Trust Authority.

Marchuk looks for “passion” when hiring operators. “We have PhD level clinicians; we also have folks with their GEDs doing this work, and they both are equally impactful,” she says. “Our training is really intensive but is also tailored to what skills and experience a person is coming in with, but we are not averse to building someone from the ground up.”

Dialing 988 might result in a helpful chat with a specialist at the call center, or it might, as with 911, mobilize an entire response system.

“The call center is really step one in the crisis care continuum,” Marchuk says. “We have to have a robust call center because the flow is someone to talk to; someone to respond, which is our mobile crisis teams; and from there, somewhere to go, which are the crisis stabilization centers.”

That continuum is still taking shape in Alaska, says Eric Boyer, program officer at the Alaska Mental Health Trust Authority. The mission of the trust, as a state corporation funded by a land grant, is to implement a comprehensive mental health program for all Alaskans with developmental disabilities, traumatic brain injuries, dementia, addiction, or mental illness. These are the resources to which operators in Fairbanks can refer callers from anywhere in the state.

Boyer acknowledges that the system has not been very strong, often relying on law enforcement intervention, which is not ideal. “Their options are limited,” he says. “They can take somebody to the emergency room, or they can take somebody to jail, or they can leave somebody out in the community. That’s kind of it.”

A new intervention began last year in Anchorage, a mobile crisis team that can respond instead of police or paramedics. Funded by the city’s new alcohol tax, blue-coated pairs of responders trained to deal with mental illness and trauma answer emergency calls and also make preventative check-ups. Last fall, Fairbanks got its own mobile crisis team, sometimes involving a peer support specialist—that is, a person with first-hand experience living with mental illness or addiction, either as a caregiver or patient.

It’s early, but Boyer says the system appears to be helping people. “They’re getting their needs met,” he says. “They’re not languishing in the back of a police car or in an emergency room without anybody keeping a constant vigil on them. Or they’re not in the community with nowhere to go.”

GCI helps to prevent suicide in two ways: as a telecom connecting Alaskans to the Careline and by directly supporting a variety of small initiatives statewide. For example, in 2018 its Suicide Prevention Fund awarded a grant to Nome Community Center, which used the money to train intervention workers.

GCI

The trust’s annual scorecard, published in March, shows some positive results. More incarcerated individuals received treatment for psychotic disorders in 2021 compared to the year before, and more criminal defendants were admitted to therapeutic court. Other signs are less promising: the rate of home-based or community-based care versus institutional care decreased slightly, and the rate of Alaskans who needed substance abuse treatment but couldn’t get it at a facility went up.

As for suicides, although the rate of attempts went up from 122.4 per 100,000 in 2019 to 129.4 in 2020, the rate of suicide fatalities went down. The decrease was especially notable among the vulnerable age group of fifteen to twenty-four, down 8 percent, from 57.9 suicides per 100,000 to 49.8. The rates for Alaska remain about three times the national rate.

Telecommunications may be one of the most potent defenses against suicide, but it’s not the only one. For a problem with no single cause, the remedy takes many forms, each supplied by organizations large and small throughout the state.

The Mental Health Trust distributes $24 million in grants each year. Boyer explains, “Our role is to support our partners, and our partners are the State of Alaska; our partners are providers, tribal, non-tribal that are out in the community; and the beneficiaries, our community members who have loved ones who might be needing that level of care.”

Even GCI has contributed to the effort, donating more than $600,000 since 2017 through its Suicide Prevention Fund. “We have almost 2,000 employees across the state and the Lower 48, and this is something that has touched our employee family as well,” Handyside says.

GCI has supported Opt-in Kiana, a nonprofit that connects youth in Northwest Alaska to their Iñupiaq culture; Camp Fire’s rural program for teens that emphasizes mental health and wellness; and Gold Star Peak, an organization supporting friends and families of military service members who died by suicide. This year’s recipients will be announced in September during Suicide Prevention Month.

Just as the Careline’s approach is as simple as giving people someone to talk to, these programs aim to prevent suicide by making life worth living. “It’s very difficult to track the data on this to determine effectiveness of the grants,” Handyside says, “but the anecdotal information we get back about the increased awareness or the connections that are made, it’s just very powerful.”

Connections are part of why GCI chose suicide prevention as one of its community causes. “We are all about connecting people,” Handyside explains. “Whether it’s connecting students to education and distance learning or connecting small businesses to the internet so they can expand and local economies can thrive, this connection is really powerful. We’re glad to be the platform that can provide this kind of connection that can provide healing and support.”

The Fairbanks call center has been answering around 22,000 to 24,000 calls each year, yet Marchuk expects 988 will add as many as 20,000 more in the first year of implementation. The trajectory should continue upward, not because suicidal thoughts are more common but because help is more accessible.

Anticipating growth, the Careline moved location in June from one side of Fairbanks to a new building on the east side with 2,000 square feet of additional space. That way the mobile crisis team can use the same site as a headquarters, with more room to grow.

The Careline used to be hosted by the Interior Alaska Center for Non-Violent Living, the nonprofit that supported the service for twenty years. Last year, however, the Careline spun off as an independent nonprofit.

“Careline is experiencing a significant amount of growth and really was ready to step out and become its own entity,” Marchuk says.

Future scorecards from the Mental Health Trust might look back on 2022 as an inflection point when suicide rates in Alaska begin a sharp decline. “This is a big, global, systemic change that I think will be very interesting to see what the data tells us in the coming years,” Boyer says, while warning, “Don’t be looking for data on this in six months or a year.”

The mobile crisis teams in Fairbanks and Anchorage have barely a year’s worth of data, so it’s too early to tell if the stabilization system of care is working. Boyer says the Fairbanks team responds to forty or fifty unique callers per month, and it appears to be meeting 80 to 85 percent of needs.

More people calling the Careline would extend the teams’ reach. “The transition from that ten-digit crisis call number to 988 is really the doorway for folks to be able to engage that system,” Boyer says.

If the price is dialing an extra three digits for every local call, Handyside figures Alaskans are willing to pay. “People in Alaska are really proud of the 907 area code,” she says, “so we hoped that would be an easy message.”