A new 988 crisis number is about to go live in the US Here’s what you need to know.

WASHINGTON—The long-awaited three-digit crisis hotline known as 988 launches in the US on Saturday, a victory for mental health advocates who see the simplified number as the first step on the road to building crisis care.

But how prepared states and advocates feel about the next steps to improve mental health is more complicated.

The implementation of 988, which will direct callers to the National Suicide Prevention Lifeline, is the first in a three-step process by the federal government to develop better mental health care. The steps include the number of the crisis call center, which will answer calls and dispatch support; mobile crisis response, which will send teams to the crisis; and crisis stabilization services, or facilities to receive and care for those experiencing a short-term crisis.

Experts said that’s not unusual: 911’s implementation, funding and widespread adoption in the late 1960s and 1970s took years to accomplish, for example.

Becky Stoll, vice president of crisis and disaster management at Centerstone, a nonprofit health system that specializes in mental health and substance use disorder services, said “nothing magical” is tied to Saturday specifically.

Instead, he compared it to a launch pad.

“I almost feel like we’ve been pregnant for a long time and we’re behind schedule,” she said. “This is the beginning of what I think will be transformational for the mental health system. So I really hope there isn’t a focus on ‘We’re not ready’. … I think that sends the wrong message.”

The launch, says Benjamin F. Miller, president of the Well Being Trust, a philanthropic organization dedicated to promoting mental, social and spiritual health, will show the need for broader structural reform within behavioral health.

“We are constantly putting out fires without looking at who is starting them,” he said. “We are never actively trying to prevent these crises from happening in the first place. … That’s where I think we need to spend a little more time.”

Miriam E. Delphin-Rittmon, Health and Human Services assistant secretary for mental health and substance use, said funding from the COVID-19 relief act of 2021 allowed the lifeline, still at 1-800 -273-TALK, answered substantially more calls in May compared to February 2022, he said.

The current lifeline answered 27,000 more calls, an increase of 20 percent; 27,000 more chats, an increase of 165 percent; and 3,000 more texts, a 93 percent increase, Delphin-Rittmon said during a briefing organized by the nonprofit Educational Development Center and the National Action Alliance for Suicide Prevention.

Advocates have called for sustained funding, as state approaches to finding support for crisis centers have varied widely. Four states (Virginia, Washington, Colorado, and Nevada) have enacted comprehensive laws that can create a sliding scale of income based on state needs. As with 911, the fees would be added to phone bills.

Lauren Conaboy, Centerstone’s vice president of national policy, said she would like to see state legislatures enact legislation to authorize flexible telecom rates this session, suggesting they could look at the data collected so far and adjust it if needs grow.

But getting state legislatures to act has been a challenge, said Lauren Finke, a policy adviser at The Kennedy Forum, a mental health organization founded by former Rep. Patrick J. Kennedy. She said at least 18 states have pursued rate legislation that has been watered down, stalled or downplayed, largely due to lobbying efforts by telecommunications and cable companies.

Finke said states have also been reluctant to build crisis care systems without further guidance from the federal government clarifying whether more federal dollars are available to them.

“It is clear that states need more guidance to be compelled to act, but there is nothing stopping states from acting at this time,” he said. “I’m very concerned that as we wait for guidance to come from the federal government, that we’re really dragging our feet on something that we’re going to have to figure out as a state anyway, so I think states should get into these planning processes.”

Conaboy acknowledged that the implementation of the 988 comes at a unique time.

“We never imagined that, fast-forward to July 2022, we would be a couple of years into a global pandemic and the most historic workforce shortage we’ve ever faced and a particularly strong workforce shortage in mental health,” he said. “Then on top of that, probably the most acute mental health needs our country has ever faced.”

Executive Director of the National Council for Mental Wellness, Chuck Ingoglia, said that while participating in a webinar on 988 preparedness last week for providers, he noticed differences among the roughly 700 attendees.

“What struck me is the variety of levels of knowledge about all of this, so I still think we have people all over the place,” he said. “So it’s going to take a while.”

legislative mishaps

988’s implementation date has served as a benchmark for mental health advocates, who hoped to pass comprehensive mental health legislation by July 16 that would encompass policies related to 988 and crisis care, prevention and treatment of mental health disorders. for substance use, and a wide plate of mental health. health policies and resources.

Those efforts began last year when Senate Finance Committee leaders began drafting the legislation, though only sections of that bill have been released to date. The Senate for Health, Education, Labor and Pensions, which also has jurisdiction, is less advanced.

The House Energy and Commerce Committee’s mental health grant reauthorization package passed the House and, while it includes some 988 provisions, did not include any new spending, a necessary condition to secure Republican support.

A Senate Democratic aide described the different committees’ work on the issue as a loose alliance, with lawmakers hoping the pieces will move forward as part of ongoing discussions on reconciliation measures.

But reconciliation efforts could complicate the pursuit of a separate bipartisan bill simultaneously, and dividing up the work of different committees on the issue would require finding multiple vehicles on an already full schedule, another hurdle to passage.

The Democratic aide also said Senate Minority Leader Mitch McConnell’s threat to block a China competitiveness bill if Democrats move forward with reconciliation could also apply to a bipartisan mental health bill.

Sarah Corcoran, vice president of government relations for Guide Consulting Service, a government relations and public affairs firm, said she still hoped to see a bill ready by the end of the year.

“It’s hard to do a bipartisan, bicameral package because obviously each committee has their own and each member has their own priorities,” he said, adding that there are limited days in session through September. “I think it’s easier to do things after the election is over.”

Megan S. Herber, director of Faegre Drinker Consulting, said the initial hope was that a larger mental health package would be ready before August, which is now unlikely.

Advocates have raised concerns that the gun safety law, which includes several mental health provisions, could dampen lawmakers’ appetite for a separate mental health package, among other competing priorities.

Two lobbyists with knowledge of the discussions have acknowledged that the Finance and HELP margins set for July were delayed due to the gun discussions.

But Herber said that since that law only looked at parts of behavioral health, there’s still room for other parts.

“It intentionally didn’t include Medicare,” he said. “There is still, I think, some impetus to do something in the Medicare program, and second of all, it was also not focused on substance use disorder.”

Ingoglia also emphasized the need for more comprehensive legislation.

“We don’t want a system that can only respond to people when they’re going through a crisis,” he said. “We want to be able to prevent crises. We need people to be able to receive continuous care. There are some big things that need to happen for that to become a reality.”

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