988 -- THE FEDERAL 3-DIGIT EMERGENCY NUMBER FOR MENTAL HEALTH CRISES: 2023 Update
By Shawna Sisler, PhD, MS, MA, MAPP, APRN, C-PNP-PC
NAPNAP Partners Alliance to Prevent Youth Suicide Champion
As of July 2022, the Federal Communications Commission now requires all U.S. phone service carriers to direct 988 calls to the existing National Suicide Prevention Lifeline network.
988 is built on a three-pillar foundation --
- Someone to call - when you are experiencing mental health or substance use-related distress.
- Someone to come - enhanced crisis response services within all communities to deescalate crisis when a phone call isn't sufficient.
- Somewhere to go - connecting individuals who need additional resources or a higher level of care.
What are the major objectives for 988? The major objectives for 988 are to (1) enhance access for people in behavioral health crises; (2) reduce reliance on the police by linking Lifeline/988 centers with mobile crisis teams; (3) reduce gaps in the existing MH crisis care system; (4) relieve emergency room boarding; and (5) reduce stigma regarding mental health services.
What happens when a person calls 988? All 988 calls flow through the Lifeline system overseen by Vibrant Emotional Health. When a person calls or texts the 988 hotlines, they will be connected to a trained counselor at a crisis center closest to them. If a local crisis center is too busy to respond immediately, the call gets routed to one of 16 backup centers around the country. The network can access 180+ independently-operated and independently-funded local call centers, including 38 chat/text centers, three Spanish language centers, and nine national backup centers. This wide network is meant to ensure that there will never be a time when the call center is "too busy" or an individual in crisis is put on hold.
Who is paying for the 988 services? 988 is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). This hotline was conceived under bipartisan legislation in 2020 and is a central part of President Biden's comprehensive strategy to ramp up U.S. mental health services, with a whopping $432M for the initial investment and scaling crisis centers across the nation - an 18-fold increase from the previous $24M allocation.
State responsibilities Each state is expected to comply with 988 goals and is responsible for daily 988 operations, workforce and marketing. More than a year since the rollout of 988, states grapple with substantial call center personnel shortages, extended wait times for callers and a significant number of abandoned calls in moments of crisis.
In addition, one study found that only 13% of adults were aware of 988). Nearly two out of five in the same survey expressed significant concerns that 988 would involve law enforcement or even involuntary hospitalization, with one in four worried about ending up in jail. Finally, the report revealed confusion regarding the caller’s financial responsibility and confidentiality rights. All of these compounded have made for a rocky first year.
Despite these challenges, some states are implementing 988 by leveraging local access programs and behavioral health professionals to manage overflow calls. Although the rollout of 988 has been slower than expected, it is on track to increase the number of contacts in its first year to around 5 million, which is one million more than the previous National Suicide Prevention Hotline (Velázquez, 2023).
To gather more information about your state's implementation of 988, follow these clear steps:
- Contact Your State's Health and Human Services (HHS) Department: Reach out to your state's HHS Department and inquire about the progress of 988 implementation in your state. Request contact details for relevant offices or personnel who can provide further information.
- Consult NAMI's 988 Crisis Response State Legislation Map: Visit NAMI's resource, the 988 Crisis Response State Legislation Map, to gain insights into your state's current status in the 988 implementation process and funding details.
- Visit Your State Government Website: Explore your state's official government website to discover any available publicity and messaging related to 988 implementation.
- Engage with Local Mental Health Organizations: Contact local mental health organizations and advocacy groups to discuss 988's implementation and its implications for patients and communities in your area.
- Check the SAMHSA 988 Dashboard: Visit the SAMHSA 988 dashboard for additional insights and data on 988 implementation.
- Contact Congressional Representatives or Attend Public Meetings: If you still encounter challenges finding information, consider contacting your Congressional Representatives for guidance or attend public meetings where you can ask questions and inquire about the statewide rollout plan for 988.
For more details on the survey above, refer to the Pew Charitable Trust's survey report on 988 awareness here.