Experts say more funding needed for '988' suicide hotline to go forward
Mental health advocates said the shortened hotline number will save lives and reduce stigma, but must be sustained with proper resources
CHICAGO — An easy-to-remember, three-digit number similar to 911 for those contemplating suicide could save lives, experts say, but it also represents a symbolic shift in a still stigmatized world — that mental health emergencies are just as important as physical ones.
But the ease of the new number and improved access should also come with additional funding for mental health services, according to mental health advocates. Both concepts are represented in pending federal legislation that would eventually establish 988 as the number for the National Suicide Prevention Lifeline, which currently is longer: 800-273-TALK (800-273-8255).
“This is one step — making it easier to find help if you need it,” said Colleen Creighton, executive director of the American Association of Suicidology. “It’s one step in the right direction, but not the full solution.”
The Federal Communications Commission began studying the creation of a new three-digit emergency number for mental health crises after the passage of the National Suicide Hotline Improvement Act of 2018. And in a report released last summer, the FCC recommended the switch, saying it would improve access to lifesaving resources. Last month, the FCC formally began the process of establishing 988, also referencing a need to remove the stigma surrounding mental illness.
But that process could take 18 months or longer, given necessary communication infrastructure work, as well as the need for a public information campaign.
Bipartisan federal legislation, if passed, would also establish 988, but it would allow states to collect fees, akin to existing 911 charges on phone bills, to fund local lifeline and mental health resources.
The 988 number is “a game changer,” said John Draper, executive director of the national lifeline, referencing the significance of treating mental health crises with the same urgency as 911 medical crises. Suicide is the 10th leading cause of death in the U.S., according to the Centers for Disease Control and Prevention.
Establishing 988 as another emergency number sends the message that mental health crises are on par with physical medical issues, he said.
It also will improve care for those who can’t think of the national lifeline’s current 800 number in the midst of a crisis and instead dial 911, Draper said.
“A police officer and ambulance shows up at their door. If that’s how our society treats mental health emergencies, people aren’t as likely to report,” he said. The proposed 988 number “would not only give them the right care, but it won’t give them the wrong care.”
The FCC report estimated calls to the lifeline (which surpassed 2 million in 2018 and were expected to have totaled about 2.5 million last year, according to Draper) could double once the easy-to-memorize 988 is in place.
That means increased volume to local call centers, as well as a strain on the already under-resourced mental health care system across the country, Creighton said.
The national lifeline, based in Washington, D.C., routes calls based on a caller’s area code to about 160 local crisis centers staffed with trained counselors. Those centers, for the most part, are not run with federal dollars, but with state, local and private grants, she said. Additional state revenue through the proposed phone bill fees could fund additional centers, staff, training and other resources.
“Our concern overall ... as this moves forward, is that we need to ensure the (mental health support) systems ... get more funding,” Creighton said. “This is not a sustainable model at the funding level it has.”
“That is the crux,” said Karen Ayala, executive director of the DuPage County Health Department, which runs one of the Chicago region’s call centers that accepts lifeline calls. “If we’re going to expand access, then do we have the capacity to meet that?”
Ayala added that it’s not only having enough staff to answer the calls and immediate treatment resources, but also long-term care for those who need it.
At the DuPage County call center, which operates 24/7 and is staffed with up to six master’s-level counselors or social workers, callers are immediately assessed for their risk, said Lori Carnahan, director of behavioral health at the DuPage County Health Department.
That assessment determines if the caller needs an emergency response or hospitalization, or referral to other services, she said. Sometimes follow-up is also necessary.
In DuPage County, a federal grant provides extensive follow-up efforts that include a mobile crisis unit and an in-house, 12-bed unit, Carnahan said. But most funding for services provided by the DuPage call center is through state dollars.
If call volume increases, Ayala said, she’d hope there would be ways for the state to increase funding streams, “especially during these lean times in Illinois.”
Community Counseling Centers of Chicago is the only lifeline call center in the city of Chicago, said President Chris Carroll. The center, which provides many other services, only answers lifeline calls during regular business hours, Monday through Friday.
The creation of a 988 number would likely mean it would increase its hours, Carroll said, given that there’d be funding available. While the center offers other 24/7 crisis intervention, it does not answer lifeline calls daily as some other Illinois centers do because there’s not as much of a need in Chicago, given the other suicide hotlines available through hospitals or other nonprofits, he said.
But 988 would likely become the go-to number for those in crisis and is likely to bring in scores more calls, Carroll said.
“You can only imagine the level of distress where you’re ready to take your own life,” he said. “Can you imagine if you needed to call more numbers (than 911) to reach police? People would be frustrated about that.”
“Across the country, everybody as a kid is trained to dial 911,” he added. “That’s been in our brains for anything and everything that may be a problem. But I do think that having (988) for suicide is really great. It’s really about the people on the other end of that phone. What’s the quickest way to get help?”
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