Behavioral Health Providers Scramble to Prepare for Launch of 988 Crisis Line

WASHINGTON — Americans seeking assistance in a mental health crisis will soon be able to dial 988 for help starting July 16, but concerns are mounting as to whether behavioral health providers are equipped with the tools necessary to implement the launch.

“It’s a national program coming out and there will be areas that are ready, and some that are not,” said Jonathan Cantor, an associate policy researcher at the RAND Corporation, during a phone call with The Well News.

In 2020, Congress enacted the National Suicide Hotline Designation Act to establish the three-digit number 988 for individuals experiencing mental health emergencies.

Cantor and other researchers from RAND published a working paper on June 21 which involved interviews with behavioral health directors around the country regarding the 988 line.

The findings from the report indicate that when it comes to preparedness of the 988 launch there is room for improvement with respect to strategic planning, financial preparedness and the availability of services and system coordination. 

In interviews, respondents described several sources of guidance that they have used while preparing for 988, such as resources from the Substance Abuse and Mental Health Services Administration, Vibrant Emotional Health and the National Council for Mental Wellbeing.

However, the RAND report indicates the knowledge of these sources of guidance was not necessarily associated with a greater feeling of preparedness for the transition to 988.

On the strategic planning front, behavioral health directors surveyed in the RAND report indicated a desire for more guidance from higher levels, such as state and federal levels, and more formal opportunities for information sharing. 

According to Cantor, some jurisdictions highlighted a disconnect between the guidance documents and the situation in their local region, with respect to funding, capacity and geographic barriers.

The working paper from RAND also highlights that staff at local crisis centers may not be adequately trained to meet specific demands of particularly vulnerable populations.

Of the behavioral health provider leaders surveyed in the report, nearly 55% contained staff specifically trained to interact with children and adolescents, but a minority had training to interact with other special populations, such as individuals experiencing homelessness, or LGBTQIA+ individuals.

A poll from the National Alliance on Mental Illness released on June 16 also found that with less than 30 days before the 988 launch many people are still largely unaware that this potentially lifesaving resource is on its way. 

“Intentionally there isn’t a lot of public communication about 988 yet to give states time to build up their capacity. The demand will skyrocket … some states don’t have that capacity yet, the intention has been more public communications starting in 2023,” said Hannah Wesolowski, who serves as chief advocacy officer at National Alliance on Mental Illness, during a phone call with The Well News. 

Wesolowski said that SAMHSA estimated they will probably have around 7 million callers to the 988 line between this July and next.

Starting July 16, when anyone in a mental health crisis dials the number 988 they will be given a prompt to choose between crisis line services for veterans, Spanish-speakers or otherwise be routed to a local crisis center based on their area code.

The people answering the calls are specifically trained in crisis de-escalation and suicide prevention services.

“We know there will be a significant increase in the number of calls. About 80-95% of these calls can be de-escalated over the phone,” said Wesolowski.

“That remaining 5-20% might require an in-person response. Ideally, we want that to be a mobile crisis team providing a mental health response,” continued Wesolowski.

Wesolowksi said mobile crisis teams are not yet available everywhere, but a crisis team will help to avoid a trip to the emergency department for many in need of mental health services. 

Congress has allotted more than $280 million to strengthen network operations and capacity, and according to Wesolowski there are four states which have already set a monthly fee per customer on customers’ phone bills to be collected by telecommunications companies for funding the 988 line and related crisis services.

The four states are Virginia, with a fee of up to 12 cents per month, Colorado up to 30 cents, Nevada up to 35 cents, and Washington which is currently 24 cents, but will increase to 40 cents in 2023. 

“This year, $105 million in grants were given to states to expand call center services, with expectations about response rates and capacity. This will be an important way for SAMHSA to collect more data and set clear standards and expectations across states,” said Wesolowski.

Public health leaders in Georgia have been working hard to prepare for the rollout in July, but have experienced challenges when it comes to staffing and funding. 

“Georgia, like other states, currently has a shortage of trained and licensed professionals to support individuals experiencing behavioral health crises. As we anticipate the rollout of 988 will increase demand for services, we are laser focused on strategies that will help us address our current staffing needs and build a pipeline of professionals who will be able to serve the mental health needs of Georgians for years to come,” said David Sofferin, the marketing director at the Georgia Department of Behavioral Health and Developmental Disabilities, in an email with The Well News. 

“Additional funding, expansion of our behavioral health workforce and integration of services and support across crisis continuum stakeholders will be critical to enhancing our system to meet this increasing demand,” continued Sofferin. 

Sofferin said that current projections indicate that the rollout of 988 will result in a 100% increase in call volume to Georgia’s crisis call center by the end of the first year. 

Mobile crisis teams in Georgia cover all 159 counties, but Sofferin said in rural areas it may take longer to access services, due to local bed availability and the distance between service centers. 

“There are 533 state-funded crisis beds statewide, and we anticipate we’ll need another 500 beds if projected demand is reality,” said Sofferin. 

The Georgia General Assembly prioritized expanding bed capacity in theFY23 budget with additional bed space in Atlanta, Augusta and Columbus.

“Much like the implementation and evolution of 911, which took more than 30 years and several billion dollars in state and federal funds to cover more than 90% of the country, 988 will be a long-term construction and capacity building project, which will require investments for decades to come,” said Sofferin.

Alexa can be reached at [email protected]