Advocates are citing growing mental health concerns during the pandemic and the implementation of a 2020 law for a new national suicide hotline as reasons to attach suicide prevention resources to an infrastructure or appropriations bill. 

A bipartisan 2020 law designated the three-digit phone number 9-8-8 as the new number for the National Suicide Prevention Lifeline, a 24/7 crisis hotline that will connect callers with immediate counseling or referrals for local mental health services.

The new number is set to take effect on July 16, 2022, but advocates want to build crisis care infrastructure and add resources before then, including funds for specialized services for high-risk populations.

The current National Suicide Prevention Lifeline received about 2.4 million calls in 2020. Experts predict that number will increase with the simplified number next year.

Chuck Ingoglia, president and CEO of the newly renamed National Council for Mental Wellbeing, said the change in the number is just part of the update. 

“We’re also reconceptualizing what’s now a suicide hotline to be a mental health or behavioral health crisis line,” he said. “We anticipate that as 988 gets put into place, as people begin describing it as a crisis hotline, that there will be more calls and we’ll need to shore up that entire kind of infrastructure.”

The emergency phone line, 911, is funded in part through user fees. To help pay for operating 911, telecommunications companies collect a small state-mandated fee for wireless and landline numbers that varies by state. Similar fees could fund 988 and follow-up services, Ingoglia said.

Multiple congressional committees held recent hearings on improving mental health resources. On Tuesday, the Senate Health, Education, Labor and Pensions Committee approved two bills intended to improve suicide prevention.

Increasing need

Recent data underscores the need for increased suicide prevention resources, especially for youth.

Researchers writing in JAMA Pediatrics on June 28 called for additional research on disparities in suicide and suicidal ideation rates among Black youth, an issue raised by the Congressional Black Caucus in 2019.

In June, the Centers for Disease Control and Prevention published two studies that worry mental health experts. The first showed higher rates of suspected suicide attempts among teen girls in 2020 compared with the previous year. The second found that 1 in 12 public health workers reported suicidal thoughts between March and April 2021.

Multiple studies also highlight specialized resources for LGBTQ populations. A June report from the Williams Institute at UCLA School of Law found that 42 percent of transgender people reported suicide attempts at some point during their lives.

The Trevor Project, a nonprofit focused on suicide prevention among LGBTQ youth, estimates that more than 1.8 million LGBTQ youth seriously consider suicide per year. 

Sam Brinton, vice president of advocacy and government affairs at The Trevor Project, said text access is especially important for young LGBTQ individuals who may need a safer way to reach resources without involving their families.

The Federal Communications Commission is currently seeking comments on enabling texts to 988.

The Trevor Project wants $7 million in appropriations for LGBTQ-specific resources. “If we’re going to be ready when July hits, we really need to start working on this now,” Brinton said.

Funding requests

Crisis hotline resources are primarily funded at the local level, but advocates say the shift to simplify the process requires more federal funding.

Advocates want federal appropriations for crisis infrastructure, including for staff to man hotline phones, training for staff and volunteers, and technology and operations upgrades to field the projected increase in call volume.

The House-passed Labor-HHS-Education spending bill and accompanying report would provide $113.6 million for the lifeline for fiscal 2022, a bump of $89.6 million above the enacted level.

The House bill would also direct SAMHSA to set aside 10 percent of Mental Health Block Grant funds for crisis care programs, up from 5 percent. Advocates pushed for this increase to provide crisis care to the expected influx of callers.

Vibrant Emotional Health, a service that operates the National Suicide Prevention Lifeline, estimates the cost to operate call centers for the first year of 988 implementation at $441 million nationwide — an average $64 cost per phone call.

That funding would take into account federal and state funding and be split over two fiscal years. 

More than two dozen organizations asked Congress in May for a larger long-term funding increase.

“Significant investments are needed to develop an infrastructure to successfully stand up an effective 988 crisis response system, especially given the upcoming July 2022 timeline,” the groups, including the National Alliance on Mental Illness, wrote in requesting $10 billion in an infrastructure package.

This larger sum would cover a number of areas, including technology and training operations at call centers. It would expand behavioral health workforce training programs, broaden eligibility for federal loan repayment programs to include call center staff, mobile crisis teams and health clinics, and expand grants for stabilization.

Sarah Corcoran, vice president of government relations for Guide Consulting Services, said recent funding from the March COVID-19 relief law was a good sign that this is a priority. That law offered an enhanced 85 percent federal match for three years for states to cover mobile crisis intervention services and provided $15 million in grants to states for crisis services and $20 million for youth suicide prevention.

“We’re just looking to build on that and to make sure that the focus doesn’t come off of this,” she said.  

Next steps

States are considering different ways to fund local operations of the hotline.

An analysis from The Kennedy Forum, a behavioral health nonprofit, said 34 states and the District of Columbia have not taken any action toward 988 implementation.

Becky Stoll, American Association of Suicidology crisis services division chair and vice president of crisis and disaster management at Centerstone, said states and territories are working to ascertain what volume to expect. 

The process by state varies, and states are hoping for federal appropriations. Multiple states are also considering phone bill user fees. 

Advocates also want more than just a funding bump in preparation for next year.

The Senate Health, Education, Labor and Pensions Committee advanced by voice vote two suicide prevention bills on Tuesday. The House passed its companion legislation in May.

The first bill, by Sen. Maggie Hassan, D-N.H., would implement student suicide awareness and prevention training policies in schools. 

The second, by Sen. Jack Reed, D-R.I., would authorize $113.6 million per year from fiscal years 2022 through 2024, including $50 million for a pilot program to improve suicide prevention through technology. 

Advocates also are pushing for broader suicide prevention legislation, such as a bipartisan bill to establish standards for the crisis continuum of care, or behavioral health resources during and after a crisis to prevent the problem from escalating.

The bill, by Sens. Catherine Cortez Masto, D-Nev., and John Cornyn, R-Texas, would broaden access to crisis care and require all federally regulated health plans to cover behavioral health crisis services by making it an essential health benefit.

While mental health is generally covered, most health plans offer limited or no coverage of crisis intervention services like 23-hour stabilization, short-term residential care and behavioral health urgent care facilities. 

“One of the things that our organization is very concerned about is how do we make sure that this crisis system is connected to the rest of the service continuum so that people just don’t keep having crisis after crisis, so that they could actually get some ongoing support,” said Ingoglia.

988 is not yet active, so if you or someone you know is facing a suicidal crisis, please call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to be connected to a trained counselor.