The idea behind the move to what is now called the 988 National Suicide & Crisis Lifeline was to make help more accessible to those in crisis.
“This cross-government effort has been years in the making and comes at a crucial point to help address the mental health crisis in our country, especially for our young people,” said Federal Communications Commission Chairwoman Jessica Rosenworcel in a press release the day before the switchover.
The change has also brought with it a pile of new federal funds flowing into states and nonprofits. Since 2021, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) announced at least $432 million in investments going to 988 implementation, according to Vibrant Emotional Health, the national administrator of the Lifeline network. Vibrant is the recipient of most of these funds. In 2021, for example, Vibrant received $177 million, about 63 percent of the initial funding round.
“This unprecedented increase in resources for centers providing these national backup services builds a stronger Lifeline overall,” said John Draper, who leads the 988 Lifeline at Vibrant, in a press release.
The transition to 988 was first recommended by the FCC in 2019 in a report to Congress, which passed the National Suicide Hotline Designation Act in 2020, authorizing the use of 988 for this purpose. Since then, the FCC has instituted rules requiring phone providers to recognize and activate the toll-free number, and states throughout the U.S. have passed supporting legislation to prepare for increased use of the Lifeline.
But the switchover highlighted the challenges faced by states and the nonprofit call centers that facilitate these calls from people in need.
UPGRADES IN SOUTH CAROLINA'S ONLY CALL CENTER
These new funds, as well as those from pandemic-era funding packages, have allowed some call centers to upgrade their technology. In South Carolina, calls to the Lifeline are answered by staff and volunteers at Mental Health America of Greenville County (MHAGC), a nonprofit based in the northeast of the state. South Carolina once had four call centers responding to suicide prevention hotline calls, but over the years that number has fallen to just one.
When a call comes from a South Carolina area code, it is usually routed to MHAGC, though if they are at capacity, the call may be routed out of state. South Carolina has one of the lowest in-state answer rates of any state in the country, a key performance indicator tracked by Vibrant Emotional Health.
But Mental Health America of Greenville County has taken steps to both meet the need for crisis calls and also improve the services they offer once someone in crisis is on the line.
Using funding from the pandemic-era stimulus package, MHAGC was able to upgrade their facility to install a new MyTel phone system and introduce resilience measures.
“We were lucky in that our phone system was landlines and now we’re on a VoIP system,” said MHAGC Executive Director Jennifer Piver. “The switch was as smooth as could be.”
The new facilities accommodate more on-site workers and allow for an “infinite amount” of remote workers, though Piver says that in rural South Carolina, finding workers and volunteers with broadband fast enough to support VoIP can be challenging.
Using a grant made possible through CARES, MHAGC funded the VoIP transition and new backup call center. This should allow for more options in the case of interrupted service at the main office.
“Should there be a disaster here in our main office, we can drive 20 minutes down the road,” said Piver. “There’s virtually no downtime.”
South Carolina’s Department of Mental Health has also announced its intention to create a second call center in Charlottesville to be opened later this year. MHAGC will not operate this location, though Piver said they will help get the center set up.
INCREASED DEMAND, SYSTEMWIDE
Outside of South Carolina, the Lifeline network has seen a sharp increase since the rollout of 988. The system saw more than 371,000 calls, texts and chats in December 2022, the most recent month from which data is available. This is a 33 percent increase from the year prior, when the system saw 261,000 calls, texts and chats, according to data from Vibrant Emotional Health.
The most dramatic increase in growth came from texts to 988. While texting has been an option for the system for years, it was not advertised as heavily as calling. In December 2022, the system saw 59,400 incoming text conversations compared to 7,000 the year prior.
Interestingly, thanks to expanded interest in and funding for Lifeline call centers, the system has actually gotten better at answering calls. Fewer calls were “abandoned,” meaning the caller hung up before their call was answered, in November 2022 compared to the year prior.
With the changes made to the 988 system nationwide, one thing is clear: The funding has improved the situation. In November 2021, states and territories had an average in-state answer rate of 69 percent. In 2022, it was 84 percent.
NEW NUMBER, NEW FUNDS, NEW IDEAS
In many places, the increased attention on mental health has meant that state-level lawmakers and executives are looking to fund new efforts to support mental health.
Returning to South Carolina, perhaps the most interesting new development is the state’s partnership with RapidDeploy, a GovTech 100 company known for its mapping services provided to public safety answering points answering 911 calls.
“Right now, when a call comes in to 988, we don’t get the same data that 911 does,” Piver said.
RapidDeploy will help provide MHAGC with a caller’s location information as well as a new platform for mapping resources and landmarks relative to that location, such as hospitals, medical facilities and food banks.
Piver stressed that involving law enforcement is not the goal of the Lifeline and that less than 2 percent of calls require intervention beyond a phone call or text chat. Over half of those interventions are voluntarily initiated by the caller, according to Piver.
The partnership, announced in November of last year, is the first of its kind, according to RapidDeploy.
At the federal level, SAMHSA has been giving significant funds to states and territories to expand or enhance their 988 systems. In October 2022, they announced $59.4 million to be awarded in FY 2023 through their Mental Health Block Grant Program, and another $50 million in grants to supplement previous funds from the American Rescue Plan Act.
“The transition to 988 in July was an important step forward, but it is only the beginning of a continuing drive to achieve our vision of comprehensive, responsive mental health and substance use care services nationwide,” said Miriam Delphin-Rittmon, the head of SAMHSA, in a press release when those funds were announced.
Several states are already putting the funds made available in recent years to use. In Maine, which has one of the highest performing 988 systems, the state is investing $230 million in state and federal funds over their 2022-2023 budget cycle to mental health, including funding a new brick-and-mortar crisis center in the state’s largest city.
It remains an open question whether these one-time grants and investments are an indication of longer-term funding increases for mental health and 988 services or if they are the result of temporary political interest in the subject.
