America’s new mental health emergency hotline, 988, is just weeks away from launching in the United States.
Starting July 16, people in the United States can call or text this universal three-digit number to contact the National Suicide and Crisis Helpline, which is funded by the U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration (SAMHSA).
Once launched, 988 will become an easier-to-remember way to access the National Suicide Prevention Lifeline; but the old number — 800-273-TALK (8255) — will still be used and will direct callers to Lifeline’s call center as well.
“Having an easy-to-remember number will be a lifesaver. It’s about making sure the mental health crisis gets a mental health response,” says Hannah Wesolowski, chief advocacy officer at the National Alliance on Mental Illness (NAMI). NAMI and other organizations, such as the American Foundation for Suicide Prevention, have been involved in the development and launch of 988.
The plan is for anyone who dials 988 to be able to connect to a local 24/7 crisis call center wherever they are in the country and speak to a counselor trained to respond to a wide a range of mental health problems, whether it’s suicidal thoughts, substance abuse, depression, anxiety or other types of emotional distress, according to SAMHSA.
Calling 988 will connect people to the same services previously available through the current National Suicide and Crisis Line, but with the launch of 988 these services will be strengthened and the capacity of call centers across the country will be expanded so that there are enough counselors available to talk to callers faster than before, according to SAMHSA.
From the beginning, demand for Lifeline exceeded its capacity due to an overall lack of resources and funding, according to SAMHSA. In 2018, 21 percent of Lifeline calls had to be diverted to a national backup call center because local call centers couldn’t handle the load — and when calls are diverted, it results in longer wait times for crisis callers, SAMHSA data shows.
The Mandate of 988: It’s a long time coming
Mental health experts have been talking about an expanded, more accessible hotline for years.
The National Suicide Hotline Improvement Act of 2018 requires the US Federal Communications Commission (FCC) to study and issue a report on the feasibility of a three-digit code for suicide prevention and mental health crisis services.
The FCC has also facilitated a rulemaking process through which organizations can voice their support or concerns.
NAMI, the American Foundation for Suicide Prevention and other organizations worked with Congress on the bill that became the National Suicide Hotline Designation Act of 2020, which legally established 988, Wesolowski says. The legislation became federal law in October 2020.
Funding for 988-related operations will come from several sources, according to SAMHSA, including President Joe Biden’s fiscal year 2022 budget as well as funds from the America’s Rescue Plan, President Biden’s economic relief bill passed in 2021. in response to the COVID-19 pandemic.
SAMHSA also invested $282 million to support and expand call center staffing and infrastructure across the country, including backup call center capacity and Spanish speakers.
But there is more work to be done. The National Suicide Hotline Designation Act of 2020 simply created 988 as a mental health emergency hotline — essentially, the federal government started a universal number, but relied on states to design the rollout of services, staff the their call centers and increase mobile crisis response, Wesolowski says.
Each state will need to pass legislation and provide additional funding to ensure that there are enough local call centers to meet the demand in their state and that callers can receive emergency mental health services if needed , such as a visit from a mobile crisis response team or admission to inpatient psychiatric care, under US.
There are several ways states can choose to fund these services.
Similar to how communities across the country fund 911, each state would be allowed to establish a small monthly surcharge on all phone lines statewide that can reach 988. Funds collected from the surcharge would then be deposited into a trust fund that can only be used for 988-related operations, according to NAMI.
Individual mental health agencies across the country can also apply for grants, such as those provided by Vibrant and Emotional Health, the nonprofit organization that has administered Lifeline since its inception in 2005. These grants will help community agencies and mental health agencies across the country developing 988-related operations and infrastructure.
Are all 50 states ready for the next steps?
Despite the 988’s release date fast approaching, many have doubts that its full potential will be realized right away in the United States.
With states determining how 988 will work in their jurisdiction, there has been “disjointed implementation,” says Benjamin Miller, PsyD, a clinical psychologist and president of the Well Being Trust, a philanthropic organization dedicated to improving mental health in the US.
Much of the planning needed to ensure that enough counselors and local services, such as mental health centers, are available to all callers has not happened in many states, as indicated by NAMI’s 988 Crisis Response State Legislation Map that updates 988 of each state – related progress in real time.
“There’s a wildly inconsistent approach to preparing for [988] roll out, spread out Some states are further along than others, but actually funding is one of the biggest pieces,” says Dr. Miller, who collaborates regularly with NAMI and other mental health organizations as part of the Mental Health CEO Alliance , but was not part of 988 development or implementation.
A Rand Corporation report published in June 2022 interviewed 180 state, regional, and county directors of behavioral public health programs (who oversee the emergency mental health care continuum in their jurisdictions and some of whom were involved in planning for 988) about their 988 readiness programs; only 48 percent of respondents had short-term crisis stabilization programs and only 28 percent had emergency departments for mental health emergencies.
Additionally, 51 percent said they were not involved in developing a strategic plan related to the launch of the 988, and only 16 percent said they developed a budget to support 988-related operations.
Only four states — Colorado, Nevada, Virginia and Washington — had adopted comprehensive funding plans, and nine other states had adopted partial funding plans as of July 1, according to the State Crisis Response Legislation Map, which tracks whether states have adopted legislation to establish funding and programming. Some other states have pending legislation.
Behavioral health officials have raised concerns about a lack of funding, understaffing and the availability of adequate resources such as mobile crisis teams to deploy as needed, says Dr. Stephanie Brooks Holliday, a Rand clinical psychologist and co-lead author of the report.
Only 22 percent of regions had crisis hotlines set up to schedule admissions and outpatient appointments for patients in need, according to the Rand report.
“The concern that came from people in our interviews was, ‘What happens if someone calls a center and their capacity is overwhelmed and the wait time is too long?’ They might hang up before someone can help them, it might be less likely to call in the future,” says Dr. Brooks Holliday.
What does this mean for the future of the 988?
There will likely be growth issues as 988 launched in July and expands over time. “We’re at the beginning of the transition, not the end, and there’s still a lot of work to do,” said John Palmieri, MD, acting director of SAMHSA 988’s Office of Behavioral Health Crisis Coordination.
“[W]I expect 988 to continue to grow and develop in the coming months as more states step up,” said Dr. Palmieri, noting that Lifeline’s 200 crisis call centers were “grossly underfunded and under-resourced ” since their inception in 2005. (Palmieri did not comment on the concerns raised in the Rand report.)
Still, there are some upsides: Brooks Holliday says the Rand report found that the two-year rollout of 988 has forced health officials at the county and state level to have difficult but much-needed conversations about the future of crisis mental health care in their respective regions .
Wesolowski adds that 80 to 98 percent of Lifeline’s calls are resolved through phone counseling alone, without the need for mobile crisis teams to be deployed. And 60 to 70 percent of mobile crisis teams can help patients on the spot without moving them to crisis centers, Wesolowski says.
That statistic could ease some of the pressures they may be dealing with as they increase their efforts to provide the services provided for 988, including sufficient crisis response teams and mental health facilities, Wesolowski says.
“It was always supposed to be a long-term process, but if we can start rolling out the hotline across the country, we can handle those additional elements,” Wesolowski says.
Additional accountability from Christina Vogt.