Answering the Call, Part 1: America’s New Mental Health Crisis Line
February 3, 2022
Photo by Norah Tahiri
Starting July 16, 2022, anyone in the U.S. experiencing a mental health crisis will be able to dial 988 for help. We explore what it will take for this new nationwide hotline to meet the needs of millions of people struggling with suicide, addiction and mental illness.
This is Part 1 of a special series about 988 that we will be reporting throughout 2022. You can find Part 2 here.
Listen to the full episode below, read the transcript, or scroll down for more information. An adapted version of this story was published on Slate.
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Content warning: This episode includes mentions of suicide. If you or someone you know is having thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK).
The Problem: America’s Costly Failure to Care for People in Crisis
For decades, 911 has been America’s best known number for people in crisis, from heart attacks to homicides to house fires. But for people in the midst of mental health emergencies, dialing those three digits can be dangerous — even deadly. That’s especially true for people of color, who are already more likely to be killed by police.
Without a safe, easy way to get immediate help during a mental health crisis, many people go without it. Research shows failing to properly care for people in crisis can drive up avoidable spending on health care and incarceration — and even cost people their lives.
The Opportunity: A New Nationwide Hotline for Mental Health Emergencies
In October 2020, Congress created 988, a new three-digit number that anyone in the U.S. or the territories can call for help in a mental health crisis. Mental health advocates see the launch of this new number as a rare opportunity to connect millions more people in crisis with faster, safer and easier access to help during the moments they need it most.
But creating a new phone number is not as simple as flipping a switch, especially when people experiencing serious mental health crises are at one end of the line.
The Challenges: A National Number Lacking Federal Funding and Guidance
Less than six months from 988’s launch on July 16, 2022, answers to basic questions about the line’s operations are still evolving, and vary widely depending on where a caller lives.
1) Who Will Answer the Line?
Crisis Counselors
All 988 callers will be routed to what is currently called the National Suicide Prevention Lifeline, an existing crisis line that has offered counseling and referrals through a 10-digit number (800-273-8255) since 2005. That line is staffed by a mix of volunteer and professional crisis counselors at more than 180 local call centers whose standards, staffing and funding models vary widely.
Those call centers already had challenges responding to the roughly 3 million calls, texts and chats the Lifeline received in 2020, raising concerns about the network’s ability to handle the up to 12 million calls, texts and chats that 988 could receive in its first year.
First Responders
Researchers who have studied local crisis systems, such as Arizona’s, estimate roughly 80% of crisis calls can be resolved by phone alone. For the remainder of calls, an emergency response team will typically be dispatched to the caller’s location.
In some communities, that in-person response could look very similar to 911, with police responding to the bulk of calls. In other places, so-called mobile crisis teams might be available, and could include a combination of mental health professionals, medics and/or police officers specially trained to handle mental health crises.
2) Where Will Callers in Crisis Go?
It Depends
Currently, America’s default treatment facilities for people experiencing mental health crises are jails and emergency rooms. Advocates hope 988 provides an opportunity to divert people to other types facilities, such as sobering centers, crisis stabilization units and mental health urgent care clinics, that cost less and provide more appropriate care.
However, the range of facilities and services available to 988 callers will vary widely depending on where they live. The federal law creating 988 did not include requirements specifying the types of services that must be available or new funding to help communities increase that capacity. The facilities that do exist in many communities are already struggling with long waitlists and workforce shortages.
3) How Will This All Be Funded?
Federal Government
Congress did not include any new funding in the law it passed establishing 988. But, in December 2021, the Department of Health and Human Services (HHS) committed $282 million to “shore up, scale up and staff up” the existing National Suicide Prevention Lifeline infrastructure, while also acknowledging far more funding will be needed in the future.
States
States and counties are scrambling to cobble together a variety of funding streams including federal mental health block grants, Medicaid and state general funds. They plan to use this funding to bolster their local crisis care systems, which can include mobile crisis teams and treatment facilities, among other things. Congress also gave states the power to tack new fees onto residents’ cell phone bills to raise additional 988 funds, but those fees must first pass through state legislatures, where the politics have been difficult so far.
Insurers
Mental health advocates are pushing for the Behavioral Health Crisis Services Expansion Act, a bipartisan bill that would require nearly all payers, including private insurance plans and Medicare, to reimburse a much wider spectrum of crisis services. The bill also directs HHS to set federal standards defining each type of covered crisis service.
Looking Ahead
As part of an ongoing special series, Tradeoffs will be reporting throughout 2022 on the launch of 988 and the successes and challenges that follow.
Have a tip or a suggestion for our ongoing 988 coverage? Something going wrong or right in your community’s preparations for 988? Email producer Ryan Levi at rlevi@tradeoffs.org.
This episode is part of a series on 988 supported, in part, by the Sozosei Foundation.
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Episode Resources
Additional Research, Reporting and Resources on 988 and Crisis Care:
State Legislation to Fund and Implement ‘988’ for the National Suicide Prevention Lifeline (NASHP, 1/18/2022)
U.S. suicide hotline 988 is set to go live, but many states may not be ready (Barbara Goldberg, Reuters, 1/14/2022)
Building a sustainable behavioral health crisis continuum (Richard G. Frank and Vikki Wachino, USC-Brookings Schaeffer Initiative for Health Policy, 1/6/2022)
Phone-Bill Fees to Fund Suicide Hotline Spark Statehouse Debates (Ryan Tracy, Wall Street Journal, 1/5/2022)
988 Appropriations Report (SAMHSA, 12/2021)
Most States Have Not Yet Acted to Support New 988 Behavioral Health Lifeline (Tiffany Russell and Josh Wenderoff, Pew, 10/26/2021)
Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies (Margaret E. Balfour, Arlene Hahn Stephenson, Ayesha Delany-Brumsey, Jason Winsky and Matthew L. Goldman; Psychiatric Services; 10/20/2021)
Suicide Prevention and 988: Before, During and After COVID-19 (Madelyn S. Gould and Alison M. Lake, NASMHPD, 9/2021)
Decoupling Crisis Response from Policing – A Step Toward Equitable Psychiatric Emergency Services (Eric Rafla-Yuan, Divya K. Chhabra and Michael O. Mensah; New England Journal of Medicine; 5/6/2021)
Behavioral Health Crisis Alternatives (Jackson Beck, Melissa Reuland and Leah Pope; Vera; 11/2020)
Episode Credits
Guests:
Andrea Harrison, Helpline Specialist, First Choice Services
Madhuri Jha, LCSW, MPH, Director, Kennedy-Satcher Center for Mental Health Equity, Morehouse School of Medicine
Ben Miller, PsyD, President, Well Being Trust
Hannah Wesolowski, MPA, Chief Advocacy Officer, National Alliance on Mental Illness
The Tradeoffs theme song was composed by Ty Citerman, with additional music this episode by Blue Dot Sessions.
This episode was reported by Leslie Walker, mixed by Andrew Parrella and edited by Cate Cahan.
Additional thanks to:
Lata Menon, Kelsey DiPirro, Kenzie Leffingwell, Shatarra Stroman, Amy Watson, Matt Goldman, Ayesha Delany-Brumsey, David Lloyd, Ted Lutterman, Angela Kimball, Jon Goldfinger, Eric Rafla-Yuan, Laura Evans, Joe Pyle, Lisa Pollak, the Tradeoffs Advisory Board and our stellar staff!