988 is an important resource for suicide prevention – if it has the local infrastructure in place to support it

Suicide is a public health crisis and a leading cause of death in the United States.

Since 2005, those experiencing suicidal thoughts have been able to call the National Suicide Prevention Lifeline at 1-800-287-TALK. The federal government recently launched the 988 hotline to make the resource more accessible and easier to remember. However, without proper funding and staffing, this vital resource could go to waste.

Critics say many states and communities may be ill-prepared to implement 988 or to handle the anticipated influx of calls. Some have gone as far as warning others on social media to avoid dialing the number. Despite the Lifeline’s important work in suicide prevention, local call centers have typically received little federal funding, depending more on state and local funds as well as private and individual donations. With the 988 initiative, states are called to invest now more than ever. According to the U.S. Department of Health and Human Services (HHS), “The success of 988 now rests heavily on the willingness of state, territorial and local leaders to make additional investments in shoring up the crisis care continuum.”

Currently, just under half of adults with mental illness receive treatment and the rate is even lower among communities of color. Without treatment, symptoms can worsen and lead to crises. The 988 initiative seeks ambitious change in how we address mental health and mental health crises as a society. The vision for 988 is to be a life-saving resource available in times of mental health emergencies, linking people to a continuum of mental health services. Although law enforcement may still be needed in high-risk situations, 988 is designed to decrease mental health crises currently managed by law enforcement and local emergency departments who may not be equipped or able to handle these situations in the most appropriate manner. If done right, 988 will forever change how our society handles and responds to mental health crises.

To support implementation, per the American Rescue Plan, HHS awarded more than $100 million to states and territories to strengthen crisis call centers, build workforce capacity, and improve call center policies and practices. For this grant, there was wide variation of funding awarded to states and territories, with amounts ranging from $250,000 to over $14 million. Current call volume to the Lifeline was a key criterium used to determine the amount awarded to states, but it does not appear that suicide rates were taken into account. States and territories with fewer than 4,300 calls to the Lifeline were only able to apply for $250,000. Some of these states include South Dakota, North Dakota, Delaware and Wyoming, all of which had higher rates of suicide than Minnesota. Here in Minnesota, the Department of Health received $1.8 million for 988 implementation, with a goal of responding to 90% of 988 calls, chats and texts. This is a lofty goal considering that only 10 percent of calls from Minnesota to the Lifeline in 2020 were answered by someone in the state.

A major hurdle facing states for the success of 988 is future funding. Since January 2021, The Biden Administration has designated $432 million towards the crisis center initiative and looking ahead, the proposed fiscal year 2023 budget calls for another $697 million for 988 and Behavioral Health Services program. While these initial federal investments in 988 are incredible, it is unclear to what extent the federal government will support local crisis call centers in the future and to what extent that support will be distributed fairly to states, territories and tribal communities. Building and maintaining a well-trained workforce to meet expected 988 call demands will be a daunting challenge for many states. To date, only four states have passed legislation to fund the 988 crisis phone service in their state.

Now that 988 has launched, there is much work to do. While leaders in behavioral health work alongside important community partners to enhance mental health systems and resources that support 988, community members can play a role in making 988 a success. Here’s what you can do:

1. Follow and support 988-related legislation. Right now in Minnesota, bills are under discussion to implement a $.12/month fee on telephone services to fund 988 (HF 4398, SF 4014) and to create a Department of Behavioral Health as well as expand adult mobile crisis services (HF 4706, SF 4410). Contact your local Minnesota legislators and express your support for these bills.
2. Get involved in mental health promotion within your community by joining or creating a mental health task force, volunteering at a mental health organization, or becoming qualified to volunteer or work for your local crisis call center.
3. Consider ways you can promote and normalize mental health help-seeking and self-care, as well as 988 services through your daily conversations and interactions with others. A great place to get inspired is reimaginecrisis.org.

Although 988 faces implementation challenges ahead, we all can play a role in supporting its success and offering mental health hope and support to others.

If you or someone you know needs help, you can call or text the National Suicide Prevention Lifeline at 988 or 800-273-TALK (8255). You can also text a crisis counselor by messaging the Crisis Text Line at 741741.

Amy Hedman-Robertson is a professor of Health and Exercise Science at the University of St. Thomas Morrison Family College of Health.