Collin Shumate, M.D.,
Former APAF Public Psychiatry Fellow,
Resident at University of California Davis
A Life Saving Idea, Part 2: Working against the clock to implement 988
At the time of writing this blog, it is only four weeks until the new 988 Suicide and Crisis Lifeline is launched – July 16, 2022. Suicide is an epidemic that the American Psychiatric Association (APA), the APA Foundation, and many other organizations focused on mental health are working tirelessly to prevent. The CDC estimates that one person died by suicide every 11 minutes in 2020. As discussed in my first blog, the federal government - along with states and non-profit organizations - are working against the clock to stand up a working 988 Suicide Lifeline. Expected to field millions of calls, text messages, and online chat requests per year, this lifeline will be a crucial component of crisis mental health care in our country. In the beginning of June, APA Psychiatric News covered a survey of behavioral health directors who stated they did not feel ready for this roll out – suggesting there is much work to be done. Clearly, the full implementation of the ideal mental health crisis system will continue beyond July 16.
Where’s the Money?
While the creation of the 988 phone number was significant, the 2020 law designating it as the Suicide Lifeline (S. 2661) did not fund the call centers that callers would be directed to, nor the services rendered if additional support was needed. Instead, the law authorized states to pass their own laws to add a fee to phone lines to fund the call centers; there was no clear direction on how to fund mental health or substance use related crisis services. As of late May 2022, only 13 states have enacted laws regarding the 988 lifeline. According to the latest information from NAMI (summarized in this helpful map) only 4 states have passed comprehensive legislation providing for funding for call centers and crisis services. This leaves a lot of work to be done in most of the states to fund call centers on an ongoing basis.
Members of Congress have introduced bills to remedy the funding gap and to assist in the implementation of the 988 Suicide Prevention Lifeline and crisis care. One example is the 988 Implementation Act of 2022 (H.R. 7116), introduced by Rep. Tony Cárdenas (D-CA), which has not yet passed in the House. However, through the American Rescue Plan Act of 2021, President Biden has awarded nearly $105 million to states and territories to strengthen crisis call centers before July.
Additionally, I am encouraged that the Fiscal Year 2022 Omnibus Appropriations Bill (the budget and appropriations bill for the federal government) funds a portion of the gap for the near future. Through the omnibus, President Biden and Congress invested nearly $102 million in the Suicide Lifeline, an increase of 77.6 million; $5 million to create a new Behavioral Health Crisis and 988 Coordinating Office within the Substance Abuse and Mental Health Services Administration (SAMHSA) to implement 988; and $38.8 million in suicide prevention grants for colleges.
Additionally, $10 million were authorized to help communities create mobile behavioral health crisis response teams, and Certified Community Behavioral Health Clinics (CCBHCs) received $315 million. Members of Congress, and mental health advocates, hope for much more funding for crisis services in the upcoming fiscal year 2023 budget. Members in the House continue to support efforts to fund crisis services in advance of the 988 launch. The American Psychiatric Association has consistently advocated for funding to fully implement 988 and the crisis continuum of care.
What is all the money for?
A significant amount of the money for 988 implementation will go to purchase or lease property and equipment for call centers and for staff training and salaries to maintain the 24/7 lifeline. Some of these expenses may be “one-time” expenditures through Congress, but the long-term functioning of 988 requires ongoing stable funding from other sources, such as fees on phone lines or state governments’ general funds.
However, as described above, a significant portion of the money is devoted to the care that comes after a 988 call. While 988 is conceptualized as, first and foremost, a suicide lifeline – it is also expected to be the “go-to” mental health crisis number for clinicians and families. If a person calls in a mental health crisis, and the person’s mental health crisis can be handled over just the phone, an ideal service might be able to connect patients to a doctor’s office where they can be seen as soon as possible. If a caller requires a higher level of care, they would be contacted by a mobile crisis team or go to a crisis stabilization center, which would utilize mental health clinicians to respond to emergencies. The hope, from APA and many other mental health advocates, is that these services would help to reduce unnecessary emergency room visits and unnecessary interactions with law enforcement for mental health crises. Diverting nonviolent mental health crises from law enforcement is crucial to save lives – more than 1 in 5 people fatally shot by police have mental illness, and people with untreated mental illnesses are also 16 times more likely to be killed by law enforcement according to the Treatment Advocacy Center.
Implementing 988 won’t be easy. As a country and as a psychiatric workforce, we will continue to have to advocate for funding of mental health services and training more psychiatrists, nurses, social workers and other providers. But the 988 Suicide and Crisis Lifeline has the potential to be a transformative mental health crisis service that connects more patients to mental health care in a timely manner. The APA has joined a coalition of other organizations to drive awareness and support among mental health professionals for a nationwide transition to the new 988 hotline. As a budding psychiatrist, I am optimistic that within a few years, 988 can live up to its full promise.
More Information
Thanks for reading! Future blogs will include further discussion of mental health crisis services, and further federal and local efforts to implement 988. If you need help, dial 988.
If you are interested in reading in more depth about the implementation, the American Psychiatric Association has a helpful resource at this link. Additionally, here is a Psychiatric News article about the opportunity to transform crisis care.