States Prepare for Launch of 988 Mental Health Crisis Line

States Prepare for Launch of 988 Mental Health Crisis Line

July 11, 2022 / by Jodi Manz The National Academy for State Health Policy

Beginning July 16, the telephone number to reach the National Suicide Prevention Lifeline, an existing hotline composed of a network of call centers, will shift to 9-8-8 across states. In accordance with the National Suicide Hotline Designation Act signed in 2020, this three-digit number will be adopted universally and will connect individuals to call centers staffed by trained crisis workers or volunteers. Please post this information in your community.

What 988 Is

988 is an easy-to-recall number that will be available by text or phone call for individuals experiencing a mental health crisis. All communications will be routed to local call centers, depending on the area code of the caller, and if they are not able to be answered locally, they will be routed instead to the national center.

States have been working to build out mental health crisis capacity across an existing continuum of services in anticipation of 988 going live. Crisis call centers are the first component of that continuum, which also includes mobile mental health response teams when calls cannot be resolved through a call center, and facility-based care when an individual is assessed by a mobile team to need inpatient services. States are focused on expanding capacity across the continuum, with particular attention on workforce to staff call centers in anticipation of increased call volume when 988 goes live.

What 988 Isn’t

The option to call a mental health crisis line is not new, though it has been underutilized. Instead, the default response to many mental health crisis situations has been to call 911, a system that is intended to dispatch first responders. This has resulted in unnecessary police or emergency medical services (EMS) intervention, and often, overuse of both jails and emergency departments for people in mental health crises. The 988 line presents a more visible, universal option for people in crisis, and is intended to help reduce the pressures on law enforcement and hospital systems.

The 988 number is not a mental health equivalent to 911; the primary function of 988 is not to dispatch local first responders for every call. While both numbers are easy to recall and connect individuals directly to help in emergency situations, 988 calls are often able to be resolved without further intervention. When responders do need to be dispatched, they can be teams composed of individuals trained in mental health and prepared to provide clinical assessments instead of police or EMS.

How 988 Is Being Supported

While Congress provided initial mental health crisis resources to states through planning grantstargeted set-asides in mental health block grants, and cooperative agreements when they established the 988 number, they largely gave states authority to establish their own funding and policy approaches to implementing the call line. Four states have thus far enacted laws to impose telecoms fees to support the line – Colorado, Nevada, Virginia, and Washington. Several states – Alabama, Colorado, Illinois, Kansas, Mississippi, Nebraska, Utah, and Washington – have enacted legislation that required the establishment of workgroups to study various components of implementation, including funding.

Recognizing that increased call volume as a result of 988 implementation may lead to an increase in the need for mobile mental health crisis teams, under the American Rescue Plan Act (ARPA), Congress also created a mechanism to help states to fund these services through Medicaid. The Centers for Medicare and Medicaid Services (CMS) is currently accepting for review state plan amendments or waivers from states to leverage this opportunity, which allows states to receive an increased federal match on Medicaid mobile crisis services to help support crisis care over the next few years. Many states are currently developing those authorities, and twenty states received planning grants from CMS to help them consider how to do this most effectively. Enhanced funding for these services – which are delivered by mobile teams that include a clinician who can perform an assessment to determine the level of care needed for an individual in crisis – can help states build capacity for response.

Looking Ahead

States will continue to deliberate how they will ensure sustainable funding for the full continuum of care, and some state workgroups are in the process of producing recommendations to that effect. In addition to considering telecoms fees or direct general fund appropriations, states have opportunities to maximize Medicaid funding beyond the enhanced match for mobile services for things like 988 infrastructure and services along the continuum. As 988 evolves and funding needs become clearer, states can consider how both Medicaid and commercial insurance reimbursement can support services and administrative needs.

Further, the shift to 988 highlights an existing challenge for states in developing and maintaining a behavioral health workforce. A longstanding shortage of behavioral health care workers in states was – and continues to be – exacerbated by the COVID-19 pandemic. In order to enhance mental health crisis services, states will continue to be focused on building and enhancing a trained workforce prepared to provide those services across the continuum.

 

Questions?

Contact:

Laura Hofmann, MSN, RN – Director of Clinical and Nursing Facility Regulatory Services
c: 425-231-4804

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July 13, 2022