Starting July 16, people in the United States can call or text this universal three-digit number to connect with the National Suicide and Crisis Lifeline — 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 in service and will direct callers to the Lifeline’s call center, too. “Having an easy-to-remember number is going to be lifesaving. It’s about making sure a mental health crisis gets a mental health response,” says Hannah Wesolowski, the chief advocacy officer at the National Alliance on Mental Illness (NAMI). NAMI and fellow organizations, such as the American Foundation for Suicide Prevention, have been involved in developing and rolling out 988. The plan is that anyone dialing 988 will be able to connect to a local crisis call center 24/7, wherever they are in the country, and speak to a counselor trained to respond to a wide range of mental health concerns, whether it’s suicidal thoughts, substance abuse, depression, anxiety, or other kinds of emotional distress, according to SAMHSA. Calling 988 will connect people with the same services previously available via the current National Suicide and Crisis Lifeline, but with the launch of 988, those services will be strengthened, and the capacity of call centers around the country expanded, so that there are enough counselors available to speak with callers more quickly than before, per SAMHSA. Since its inception, the demand placed on the Lifeline has exceeded its capacity, owing to an overall lack of resources and funding, according to the SAMHSA. In 2018, 21 percent of calls to the Lifeline had to be rerouted to a national backup call center because local call centers couldn’t handle the load — and when calls are rerouted, this leads to longer wait times for callers in a crisis, SAMHSA data shows.
The 988 Mandate: 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 required the U.S. Federal Communications Commission (FCC) to explore and issue a report about the feasibility of a three-digit code for suicide prevention and mental health crisis services. The FCC also facilitated a rule-making process by which organizations could 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, per SAMHSA, including President Joe Biden’s budget for the fiscal year 2022, as well as funds from the American Rescue Plan, President Biden’s economic relief bill passed in 2021 in response to the COVID-19 pandemic. SAMHSA is also investing $282 million to support and expand staffing and infrastructure of call centers across the country, including backup call center capacity and Spanish language speakers. But there’s more work to be done. The National Suicide Hotline Designation Act of 2020 simply established 988 as the emergency mental health hotline — essentially, the federal government set the stage for a universal number, but is counting on states to design the rollout of services, staff their call centers, and increase mobile crisis response, says Wesolowski. Each state will need to pass legislation and secure additional funding to ensure there are enough local call centers to meet the demand in their state, and that callers are able to receive emergency mental health services if needed, such as a visit from a mobile crisis response team or admission to inpatient mental health care, per NAMI. There are several ways states can choose to fund these services. Similar to how communities across the country fund 911, each state will be permitted to establish a small monthly surcharge on all phone lines throughout the state that are capable of reaching 988. The funds gathered from the surcharge would then be deposited into a trust fund that can be used only for 988-related operations, according to NAMI. Individual mental health agencies throughout the country can also apply for grants, such as those provided by Vibrant and Emotional Health, the nonprofit that has administered the Lifeline since it was founded, in 2005. These grants will help public and mental health agencies throughout the country develop operations and infrastructure related to 988.
Are All 50 States Prepared for the Next Steps?
Despite 988’s quickly approaching rollout date, many have doubts that its full potential will be realized right away across the United States. With states calling the shots on how 988 will operate in their jurisdiction, there’s been a “disjointed rollout,” says Benjamin Miller, PsyD, a clinical psychologist and the president of Well Being Trust, a philanthropic organization dedicated to improving U.S. mental health. Much of the planning needed to ensure that enough counselors and local services, such as mental health care centers, are available to all callers hasn’t happened in many states, as indicated by NAMI’s 988 Crisis Response State Legislation Map, which updates each state’s 988-related progress in real time. “There’s been a wildly inconsistent approach to preparing for [988] rollout. Some states are further than others, but really the funding is one of the biggest pieces,” says Dr. Miller, who collaborates regularly with NAMI and other mental health organizations as part of the CEO Alliance for Mental Health, but was not part of the 988 development or rollout. A Rand Corporation report published in June 2022 interviewed 180 state, regional, and county behavioral public health program directors (who oversee the continuum of emergency mental health care in their jurisdictions and some of whom have been involved in planning for 988) about their programs’ preparedness for 988; only 48 percent of the respondents had short-term crisis stabilization programs, and only 28 percent had urgent care units available for mental health emergencies. Furthermore, 51 percent said they weren’t involved in developing a strategic plan related to launching 988, and only 16 percent said they developed a budget to support operations related to 988. Only four states — Colorado, Nevada, Virginia, and Washington — have enacted comprehensive funding plans, and another nine states have enacted partial funding plans as of July 1, according to the Crisis Response State Legislation Map, which tracks whether states have passed legislation to establish funding and programming. Some other states have legislation pending. Behavioral health officials have expressed concern about the lack of funding, staffing shortages, and having adequate resources like mobile crisis teams to deploy when needed, says Stephanie Brooks Holliday, PhD, a Rand clinical psychologist and the co-leader of the report. Only 22 percent of regions had crisis hotlines prepared to schedule intake and outpatient appointments for patients in need, according to the Rand report. “The concern that came from the folks 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, they might be less likely to call in the future,” Dr. Brooks Holliday says.
What’s Does This Mean for the Future of 988?
There will likely be growing pains as 988 is launched in July and expanded over time. “We are at the start of a transition, not the end, and there is still a lot of work to be done,” says John Palmieri, MD, the acting director of SAMHSA’s 988 Behavioral Health Crisis Coordination Office. “[W]e expect 988 will continue to grow and evolve in the coming months, as more states start to step up,” Dr. Palmieri said, noting that Lifeline’s 200 crisis call centers have been “massively underfunded and under-resourced” since their inception in 2005. (Palmieri did not comment on the concerns raised in the Rand report.) There are some silver linings, though: Brooks Holliday says the Rand report found that 988’s two-year rollout forced health officials at county and state levels to have difficult, but much-needed, conversations about the future of mental health crisis care in their respective regions. Wesolowski adds that 80 to 98 percent of Lifeline calls are resolved via 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-site, without moving them to crisis facilities, says Wesolowski. These statistics may alleviate some pressure states may be dealing with as they ramp up efforts to provide the services envisioned for 988, including enough crisis response teams and mental health care facilities, Wesolowski says. “It was always assumed this was going to be a long-term process, but if we can start with getting the hotline running nationwide, we can tackle these additional pieces,” Wesolowski says. Additional reporting by Christina Vogt.
