Amid growing concerns about the pandemic’s impact on Americans’ mental health, and the launch of a new three-digit National Suicide Prevention Lifeline number this summer, advocates say local call centers across the country remain underfunded and staffed for an expected surge in call volumes.
Despite efforts to improve the system, they say, people in crisis may experience delays — or may not have access to a counselor at all.
On July 16, Lifeline will switch from its current 10-digit hotline number to the easy-to-remember 988, similar to the 911 emergency number for police and firefighters.
The 24-hour hotline has been in service since 2005, and in that time it received more than 20 million calls from people looking for help.
“What we’re building on is an existing, proven service that is shown to reduce emotional distress and suicide,” Dr. John Draper, CEO of Lifeline, told ABC News. “It’s basically scaling up this service to make sure we’ll be able to reach more people and serve them more effectively.”
When possible, calls are received by the nearest crisis center, but if a local center cannot handle them, they will be routed to one of the many national support centers that receive federal funding to maintain staff.
“And the more that happens, the longer people wait. And that’s something you don’t want for people in crisis,” Draper said, “that’s what happens when there isn’t enough money.”
The Substance Abuse and Mental Health Services Administration (SAMHSA), which allocates federal funding for the program, estimates a 25% increase in lifeline callers for fiscal year 2022. The 988 will only be operational for the last three months of that period.
During the first full year of the 988 application, fiscal year 2023, SAMHSA estimates incoming calls will reach 7.6 million, which is more than double the most recent metrics recorded.
This year, the federal government has committed $282 million through SAMHSA to implement 988, an amount that stakeholders call “unprecedented.”
The organization has two main goals to support the Lifeline Crisis Center network, according to John Palmieri, acting 988 Team Leader and Behavioral Health Crisis at SAMHSA.
“One is making sure that there is a safety net infrastructure in place at the national level, so that when individuals call, if for some reason those calls are not received at the local level, there is a safety net to support those individuals in crises.”
$177 million is earmarked for support center funding, with another $105 million for states and territories to support local crisis centers.
“We really feel that from the point of view of an individual in a crisis, it is really better that they be in touch at the local level to the degree possible, that they are better integrated with the local care system, that we provide comprehensive services and so on,” Palmieri said.
An internal 2021 survey of Lifeline Network’s local crisis centers found that only about 43% were funded explicitly to answer Lifeline’s calls, according to Draper.
“They were simply volunteering their services because their organization and the mission of their agency align with our mission,” Draper said. “So they were basically borrowing employees from other lines of business, who were dedicated to other lines of business, to help answer calls that weren’t funded. And that’s the very steep hill we have to go up.”
Since its inception, Lifeline has been underfunded, according to Draper. As the transition to a three-digit number approaches, more funding is needed to ensure centers are staffed with the right staff to accommodate the expected increase in callers.
As it stands, Draper says about 20% of calls that need to be answered locally are currently picked up by the national backup network. Even with a national backup network, the SAMHSA report shows that at its current capacity, Lifeline can only handle about 85 percent of calls.
Because local crisis centers are funded at the state level, resource allocation and funding sustainability are inconsistent across state lines.
The National Academy of Government Health Policy (NASHP) has been tracking statewide legislation on implementing 988.
“States are all over the map on this,” said Kitty Borrington, senior program director at NASHP. “And I think there are a lot of countries that haven’t really dealt with what sustainability looks like going forward.”
When Congress enacted legislation to designate 988 as the new lifeline number in 2020, that law included a provision allowing states to tax cell phone bills to support service. Similar taxes are used to support emergency medical services and law enforcement services through the 911 call center.
Few countries have enacted these taxes yet. A few others have implemented exploratory committees or provided some funding to publish the new figure.
“It’s going to be some time to build on that,” Borrington said. “And it’s likely to be something that states will be doing for years.”
She compared the transition to the implementation of emergency services through 911 call centers.
People say  “It took 60 years for him to truly establish himself,” Borrington said. “It took decades for people to really understand and for 911 to really be the right number. So, this wouldn’t be like flipping a key.”
Mental health stakeholders remain optimistic, despite the program’s lack of funding. “Ultimately, 988 is more than just a number,” said Laurel Stein, vice president for public policy at the American Foundation for Suicide Prevention.
“It’s an opportunity to reimagine the behavioral response system to health crises,” Stein said.
Stein says the vision for the ideal 988 system would include well-resourced crisis centers across the country, the ability to provide follow-up care as needed, mobile mental health crisis response teams, and crisis stabilization centers.
“We totally understand that a lot has to happen,” Stein said. “There are countries that are well-equipped that have mobile crisis teams and they have good resources and there are other countries that are not. So the level of local preparedness is diverse.”
The public need is urgent.
US Surgeon General Vivek Murthy has sounded the alarm to lawmakers about the increase in suicide attempts among young people during the pandemic.
President Joe Biden called mental health a priority in his State of the Union address earlier this month, saying, “Let’s get the mental health services all Americans need.”
If you are experiencing thoughts of suicide or are concerned about a friend or family member, help is available. Call the National Suicide Prevention Lifeline at 1-800-273-8255 [TALK] For free, confidential emotional support 24 hours a day, 7 days a week.