Federal officials, including Health and Human Services Secretary Xavier Becerra, worry that most states are ill-prepared to meet the hotline’s long-term needs. Although the health agency has sent new money in recent months to help states expand crisis networks, federal officials say few states have kept their deals and committed to long-term funding.
The concerns come as the Biden administration, Congress and public health experts say mental health challenges are too often unaddressed and are at least partially responsible for the rise in drug overdose deaths. Suicides before adolescence and gun violence among other ills.
Becerra lamented earlier this month that most states — more than half of which were still sending a significant portion of their crisis calls to a backup call center as of May — still haven’t gotten the funding and manpower they need to do what’s expected. increase in calls Due to increased media attention, Once 988 goes live.
“988 is not just a number, it’s a message,” Becerra told reporters this month. “This is a signal to America that we want to consolidate this service, we want to strengthen this service and we want to make it consistent. We won’t have the luxury of decades like the 911 had to hit the ground running.”
State health officials, call center directors and attorneys general in 11 states told POLITICO that while they are ready for the initial rollout, it is difficult to predict long-term needs. Even well-prepared states that have invested in behavioral health hotlines for years have struggled to convince their legislatures to pass new taxes that would provide a predictable source of funding for staff and overhead, state officials said.
Every state now operates at least one 10-digit call center — 800-273-TALK — as part of the National Suicide Prevention Lifeline, launched in 2005 by the Substance Abuse and Mental Health Services Administration. On Saturday, the old 10-digit number will be replaced by the easier-to-remember 988.
But the ability of local centers to answer calls, texts and chats varies greatly. Some states have had 24/7 crisis call centers, while others are only now expanding to 24/7 operations. Some have more than a dozen call centers, while others have just one. Some have paid staff for a long time, while others are just now adding paid staff to their volunteer team.
While some states answer virtually all contacts, others direct more than half of their calls to the 15 out-of-state backup centers funded through Lifeline.
Mississippi, which answers 89 percent of calls — one of the highest rates in the country — has been expanding its mobile squad since they first launched in 2014 and has been working since 2017 to increase the state’s response rate. The state’s two call centers act as backups to each other, and any calls they can’t handle are forwarded to the national backup centers.
By contrast, Nevada recently began staffing its one-state call center from a mostly volunteer workforce to a mix of paid and volunteer staff, adding nearly 50 positions with state and federal dollars in the past few months. As of May, the state responded to 65 percent of calls, one of the 10 worst rates in the country, although data provided by state health officials showed that rate was as high as 82 percent in previous months.
In May 2021, the Legislature voted for the Board of Health to impose a cell phone tax to fund 988 to bring in more money to improve the program, but implementation has been delayed by bureaucratic delays and technical issues with how to transfer money from telecommunications companies. of the state.
“We’ve gone from the few states that passed legislation, oh my goodness, with a revenue stream, to being in the dark on regulatory and governmental issues,” said Robin Reedy, executive director of NAMI Nevada. Affiliate of the National Alliance on Mental Illness. “It’s disappointing, but not as disappointing as the 20 and 30 years we’ve worked to get to this point.”
This spring Becerra cited the arrival of 988 as part of it National Mental Health TourKee points to Nevada as a state that can help lead the transformation.
“This is a lifeline. It will move away from the suicide and mental health prevention lines that are available today,” Becerra said during a visit with Nevada Gov. Steve Sisolak during this tour in April. “Nevada is working with the other 49 states and territories to prepare.”
But not all states lived up to expectations.
HHS has been trying for months to get states with lower response rates and tighter funding to prepare for Saturday’s launch with special revenue streams, recently sending letters to all governors telling them how it values their mental health hotlines.
But state health officials say whether they’re ready to start 988 has more to do with securing a permanent funding source for the program. In fact, three of the four states that approved telecom taxes were the worst Response rates by country in May.
For example, Washington state passed a bill last year that would impose a 24-cent tax on cell phone lines. which will increase to 40 cents in January. It is expected to earn $36.1 million this fiscal year State forecasts. Colorado imposed an 18-cent tax, and both states are using that funding to hire additional staff to boost their statewide call response rates by 63 percent and 51 percent, respectively.
Meanwhile, other states say it’s difficult to convince their legislatures to pass fees — mostly excise taxes — to fund the program with an as-yet-uncertain annual budget, because no one knows how high demand for services will be when 988 B.C. is broadcast live.
“It’s very difficult to ask for dollars from your legislature that are a little bit unpredictable,” said Jody Manz, director of the Behavioral Health Project at the National Academy of Public Health Policy.
Even California, which does not oppose taxes and fees, has tried to get permanent funding for the 988 program, with legislation to create a telecommunications tax stalled last year and the state earmarking $28 million to run the program.
Tara Gamboa-Eastman, a senior staff attorney at the Steinberg Institute, a mental health advocacy group that advocated for California’s 988 fee, said she believes the state’s 13 centers are ready to launch on July 16, but the program won’t work as it should in the long term. Without an assumed stable income stream.
“I think California has a tremendous opportunity to be a leader in 988,” he said. “But there’s a lot of work ahead.”
In the last four months, Lifeline answered 27,000 more calls, a 20 percent increase over the previous months; 27,000 more chats, a 165 percent increase; and another 3,000 texts, a 93 percent increase, said Miriam Delfin-Ritmon, HHS assistant secretary for mental health and substance use. HHS officials aren’t sure what’s behind the spike.
While callers will still be able to get crisis help through backup centers, state health officials say in-house call centers are more familiar with local services, including the availability of mobile response teams, emergency psychiatric facilities and crisis stabilization beds. Plus, they say it can help callers understand that they’re talking close to home.
“It’s certainly reassuring for a caller to know that your call is being answered, at least in your area and, in our case, in your state,” said Matthew Wintersteen, an associate professor at Thomas Jefferson University who worked. Pennsylvania will increase its statewide response rate. “Unless they’re more local to you, like in your state, it’s harder for them to connect with the available services that might be in those communities.”
Recognizing the value of local responsiveness and easy access, Congress passed Act 988 to fund the program in late 2020, but the initiative did not see significant money until this year. $282 million Appropriated in the fiscal 2022 HHS budget And the US bailout plan, signed into law in March 2021, was 10 times the hotline’s $24 million budget last year. Congress approved another $150 million to support states in bipartisan gun control legislation that took effect in late June.
But these federal dollars are a short-term solution. Federal health officials expect states to fund 988 in the long term by imposing permanent telecommunications taxes.
“On the federal side, I think everyone would agree that we’ve been a good partner,” Becerra told reporters this month. “We just need our states, territories and tribal governments to be good partners.” Because, ultimately, 988 is not a federal program.
State and federal officials expect a surge in activity when 988 goes live, projecting 6 million calls, chats and texts to 988 in the first year, nearly double the volume Lifeline receives. The new hotline could receive as many as 12 million petitions this year as people become more aware of the hotline, an HHS official said.
Arizona, like many other states, does not plan to advertise the new number due to the volume of calls already received. Andrew Erwin, chief operating officer of the state’s Crisis Line Solar, said the regional response to an already existing phone line Makes more calls in a month than some states make in a year.
Still, Erwin expects more calls, and the state is using a $1.8 million SAMHSA grant to hire 14 new employees.
“Because of that, we’re probably not going to see something that some states haven’t really done before. [will see]. They kind of flip a switch and say, general public, now dial three digits and you’ll get access,” he said.
With the expected increase, officials across the country argue that July 16 is the beginning of the transition, not the end.
“If you are ready to turn to someone in your moment of crisis, 988 will be there. 988 will not be a busy signal and 988 will not stop you. You’re going to get help,” Becerra said. “This is an aspiration. And it doesn’t happen overnight.”
911 for mental health is here. Officials play down the launch.
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