Federal officials, including Secretary of Health and Human Services Xavier Becerra, are concerned that most states are ill-equipped to handle the hotline’s long-term needs, which could prevent states from quickly responding to crisis calls with operators familiar with local resources. While the health agency has sent new funds in recent months to help states expand their crisis networks, federal officials say few states have kept their end of the bargain and implemented long-term funding.
The concern comes at a time when the Biden administration, Congress and public health experts say that mental health issues are too often overlooked and are at least partly responsible for the increase in drug overdose deaths. preteen suicides and gun violence among other diseases.
Earlier this month, Becerra lamented that most states, more than half of which were still sending a significant portion of their crisis calls to an out-of-state backup call center as of May, still have not secured the necessary funding and manpower for the expected burst of calls due to increased media attention once 988 goes live.
“988 is not just a number, it’s a message,” Becerra told reporters this month. “This is a signal to America that we want to consolidate this service, we want to strengthen this service, and we want to make it consistent. We won’t have the luxury of a 911 to get on the ground and launch.”
State health officials, call center directors and attorneys in 11 states told POLITICO that while they feel ready for the initial launch, long-term needs are hard to predict. Even well-prepared states that have invested in behavioral health hotlines for years are struggling to convince their legislatures to charge new fees that would provide a predictable source of staff and overhead funding, state officials say.
Each state now operates at least one call center with a 10-digit phone number – 800-273-TALK – as part of the National Suicide Prevention Rescue Network, which was launched by the Substance Abuse and Mental Health Administration in 2005. On Saturday, the old 10-digit number will be replaced by the easier-to-remember 988.
But the ability of local centers to answer calls, text messages and chats varies considerably. Some states have crisis call centers open 24/7, while others are just now transitioning to 24/7 operation. Some have more than a dozen call centers, others have only one. Some have been paying their employees for a long time, while others are just now adding paid workers to their volunteer teams.
While some states answer virtually every contact, others direct more than half of their out-of-state calls to 15 Lifeline-funded emergency centers.
Mississippi, which responds to 89 percent of calls — one of the highest rates in the nation — has been expanding its mobile crisis response teams since they first launched in 2014, and has been working to improve response rates across the state since 2017. The state’s two call centers serve as backups for each other, and any requests they can’t process are routed to the national backup centers.
Nevada, by contrast, has just begun moving staff at its only statewide call center from primarily volunteers to a mix of paid and volunteer staff, adding nearly 50 state and federal positions in the past few months. As of May, the state has responded to 65 percent of calls, one of the worst 10 in the nation, although data released by state health officials shows that rate as high as 82 percent in previous months.
In May 2021, the legislature voted to allow the Department of Health to set a mobile phone fee to fund 988 in order to raise more money to improve the program, but implementation stalled due to bureaucratic delays and technical issues related to transferring money from telcos . the state.
“We’ve gone from being one of the few states to pass a permissive law since — oh my God! affiliate of the National Alliance on Mental Illness. “It’s disappointing, but not as bad as the 20 and 30 years we’ve been working to get to this point.”
This spring, Becerra touted the 988 offensive as part of his national mental health toureven pointing to Nevada as a state that could lead the transformation.
“This is a lifeline. It will replace the patchwork of suicide prevention and mental health lines that are available today,” Becerra said during a visit to the Nevada governor. Steve Sisolak during the April tour. “Nevada is working with the other 49 states and territories to prepare us.”
But not all states lived up to expectations.
For months, HHS has been trying to urge states with lower response rates and tighter funding to prepare for Saturday’s launch with dedicated revenue streams, recently sending letters to every governor announcing their mental health hotline rankings.
But state health officials say the 988’s readiness to launch is about more than whether they secure a permanent source of funding for the program. In fact, three of the four states that approved telecommunications fees were among the worst. national response rates in May.
The state of Washington, for example, passed a law last year imposing a 24-cent charge on cell phones. which will increase to 40 cents in January. It is expected to bring in $36.1 million this fiscal year. government forecasts. Colorado has introduced an 18-cent fee, and both states are using the funding to hire additional staff to boost in-state call response rates by 63 percent and 51 percent, respectively.
Other states, meanwhile, say it has been difficult to persuade their legislatures to introduce a levy — essentially an excise tax — to fund a program with an as-yet-undetermined annual budget, as no one knows how high demand for services will be when 988 goes into live.
“It’s very difficult to ask the legislature for slightly unpredictable dollars,” said Jody Muntz, director of the National Academy of Public Health Policy’s Mental Health Project.
Even California, which is not opposed to fees and taxes, has struggled to secure continued funding for the 988 program, as telecommunications charging legislation was suspended last year and the state instead provided $28 million to launch the program.
Tara Gamboa-Eastman, senior attorney for the Steinberg Institute, a mental health advocacy group that has campaigned for California’s 988 fee, said she believes the state’s 13 centers are ready to launch on July 16, but that the program won’t work as assumed in the long run without a stable income stream.
“I think California has a huge opportunity to be the leader in 988,” she said. “But there is a lot of work ahead.
In the last four months, Lifeline has answered 27,000 more calls, up 20 percent from previous months; 27,000 more chats, up 165%; and 3,000 more, up 93 percent, said Miriam Delfin-Rittmon, HHS Assistant Secretary for Mental Health and Substance Use. HHS officials are not sure what is behind the surge.
While callers will still be able to receive crisis care through emergency centers, state health officials say call centers in states are more familiar with local services, including the availability of mobile response teams, psychiatric emergency rooms and crisis stabilization beds. Plus, they say it can help callers know they’re talking to someone close to home.
“For callers, it’s certainly comforting to know that your call is being answered, at least in your area and, in our case, in your own state,” said Matthew Winterstein, an assistant professor at Thomas Jefferson University who worked with Pennsylvania to improve response rates in the state. “Unless they’re more local to you, such as in your own state, it’s harder for them to connect to available services that may be in those communities.”
Recognizing the value of local lifeguards and easy access, Congress passed funding for the 988 program in late 2020, but the initiative did not receive substantial money until this year. $282 million allocated from the HHS budget for fiscal year 2022 and the American Rescue Plan, signed in March 2021, was 10 times the hotline’s $24 million budget last year. Congress has allocated another $150 million to support state support for bipartisan gun control legislation passed in late June.
But those federal dollars are a short-term solution. Federal health officials expect states to fund 988 in the long run by charging ongoing telecommunications fees.
“On the federal side, I think everyone should agree that we were a good partner,” Becerra told reporters this month. “We just need our states, territories and tribal governments to be good partners right now. Because, after all, 988 is not a federal program.”
State and federal officials are expecting a surge of activity once 988 is up and running, predicting 6 million calls, chats and texts on 988 in its first year, nearly double the amount Lifeline receives. The new hotline could receive 12 million calls this year as people learn more about it, an HHS spokesperson said.
Arizona, like many other states, has no plans to advertise the new number due to the high volume of calls it is already receiving. Andrew Ervin, chief operating officer of Solari’s state crisis line, says regional respondents are already calling the existing phone line. make more calls in a month than in some states in a year.
However, Erwin is waiting for more calls, and the state is using a $1.8 million SAMHSA grant to hire 14 new employees.
“Because of that, we probably won’t see the things that some people are talking about who just haven’t done it before. [will see]. They’re kind of flipping a switch and saying, general public, now dial three numbers and you’ll have access,” he said.
The expected surge is leading officials across the country to insist that July 16 is the start, not the end, of the transition period.
“If you are ready to reach out to someone in a moment of crisis, 988 will be there. 988 will not be a busy signal, and 988 will not put you on hold. They will help you,” Becerra said. “It’s an aspiration. And it doesn’t happen overnight.”