For all the convulsive court decisions, congressional hearings, price increases, invasions, mass killings and social media takeovers, 2022 should also be remembered as the year of 988 — the nationwide crisis line that went live in July. If the states and the federal government do their work, the number could become far more than just an easier-to-remember suicide prevention resource. It could be the foundation of a vastly improved mental health and emergency response system and an essential tool to defuse needless police violence.
Turnaround time was short, in government terms, between a 2019 proposal from the Federal Communications Commission and the system’s debut five months ago. It’s now possible to connect with a crisis center by calling 988 almost anywhere in the nation. But it’s mostly up to states to provide for crisis call centers, mobile psychiatric response teams and specialized care centers — or as system proponents put it, someone to call, someone to come and somewhere to go.
Just under half the states passed legislation this year to fund 988 services. California, to its credit, is one of the states that has committed to building out a comprehensive system by passing AB 988, also known as the Miles Hall Lifeline Act. Gov. Gavin Newsom signed the bill in September, creating enough funding to keep 13 call centers open, including the Didi Hirsch Mental Health Services center in Los Angeles County.
The missing piece is federal funding and technical assistance to ensure that the state systems are fully linked, continuously operated and coordinated with 911, the emergency response system that summons police and firefighters. Rep. Tony Cárdenas (D-Pacoima) sponsored HR 7116 to authorize five years of funding, boost Medicaid coverage for mental health counseling on the phone and in person, and require the Substance Abuse and Mental Health Services Administration to set standards for behavioral health services. Because the system requires a well-trained workforce of clinicians, counselors and other mental health professionals, the bill assists states in providing training and scholarships.
The next few days are critical. The midterm elections will put the Republicans in control of the House and alter the political dynamic in Washington. Congress, in the midst of a particularly busy lame-duck session that could run through Christmas, is trying to pass a spending bill to keep the government running while providing funding for priorities like fighting COVID-19 and assisting Ukraine’s resistance to the Russian invasion.
Members would be wise to include, in their sprint, the 988 funding and programs laid out in Cárdenas’ bill.
The United States is in the midst of a mental health crisis, already apparent when the lifeline expansion was proposed. For example, suicide is the second-biggest cause of death for teenagers, after accidents, and is also a leading killer of veterans. Under-treated emotional or psychiatric conditions contribute to homelessness and have been linked to at least some mass shootings. The problem increased with the cataclysmic events of 2020 — the pandemic, the shutdowns and resulting isolation and economic and learning loss, and a death toll that is approaching 1.1 million. Political turmoil and anxiety make matters worse. Emergency rooms have struggled to keep up with waves of critical coronavirus cases and are struggling to concurrently deal with people suffering from serious mental illness or other behavioral health crises.
For many people, phone counseling is, in itself, an important treatment, even without a mobile response or transport to a crisis center. It is often the conversation that defuses the emergency. But to be of value the service must be available 24 hours a day, seven days a week, in the language of the person in need, and with people who have the training and, ideally, the personal experience to help the caller.
When a mobile response is also needed, it’s important to have an alternative to police, who are ill-equipped to deal with psychiatric emergencies. Miles Hall, the Walnut Creek man after whom the California bill was named, was killed by police who were responding to his family’s call for help. There are too many other tragic cases, including David Ordaz Jr., shot dead by L.A. County sheriff’s deputies responding, ironically, to a call for assistance when he was feeling suicidal. And Isaias Cervantes, an autistic man shot and critically injured by deputies when his family called for help. Alternative crisis response could be the key to addressing policing, equity and mental health challenges.
But first, the funding. Congress, don’t blow the chance to keep 988 in service.
