The promise of 988: crisis care for everyone

SUICIDE REMAINS A PUBLIC HEALTH THREAT 

Suicide remains one of the ten leading causes of death in the United States. Suicide is complicated and tragic, but it is often preventable. In 2020 over 45,000 Americans died by suicide. Approximately 1.2 million Americans attempted suicide in 2020. 

SUBSTANCE USE CONTINUES TO TAKE LIVES 

Overdose remains a leading cause of death as an unintentional injury. At the end of April 2021, there were over 100,000 drug overdose deaths in the United States. An estimated 40.3 million people have a substance use disorder. 5 million Americans used tobacco, alcohol, or an illicit drug in the past month. 

Both substance use disorders and suicide are preventable for the most part. Prevention campaigns are life-saving. Addicted.org advocates for these campaigns and has witnessed their success. In addition, we firmly believe substance use prevention is suicide prevention. These two public health problems are closely linked, and here are four significant reasons why. But first, a closer look at suicide in the United States.

By Gayle Giese, President, Florida Mental Health Advocacy Coalition

Published January 9, 2022 - BE WELL Magazine

Three little numbers could change the world of behavioral health: 9-8-8. This new behavioral health and suicide prevention hotline goes into effect across the nation by July 16, 2022.  

9-8-8 became law when President Trump signed S. 2661, the National Suicide Hotline Designation Act of 2020. Callers dialing 9-8-8 will be directed to their local National Suicide Prevention Lifeline call centers, with national backup. 

In Palm Beach, 2-1-1 Palm Beach and the Treasure Coast (211palmbeach.org) will answer the 9-8-8 calls. You can already call our local 2-1-1 and speak with a trained suicide prevention counselor, but that is not the case everywhere. With 9-8-8 national advertising, crisis calls are projected to increase a minimum of 300%.  

With this number, a third type of First Responder is being created: behavioral health experts.  9-8-8 solves a problem that has existed since the de-institutionalization of psychiatric hospitals in the 1970’s, when law enforcement was first tasked with responding to behavioral health calls. While well-meaning, officers, even those trained in Crisis-Intervention-Training (CIT), are not familiar with local behavioral health providers and resources and do not have years of study and training in de-escalation techniques. 

9-8-8 offers a better response. Based on data from the Georgia Crisis & Access Line, it’s estimated that about 85% of issues will be resolved on the phone, saving the cost of sending a first responder. Calls may also be transferred in a warm hand-off to a mobile response team that would come to your home – with workers trained to de-escalate a crisis and link you to services. 

Diverting these calls from 9-1-1 to 9-8-8 with referrals to local services will not only save dollars and lives, but also free up law enforcement to focus on public safety and solving crimes. Police can still be dispatched for high-risk situations, such as those involving weapons. Most importantly, individuals with behavioral health conditions will be linked to providers and services the FIRST time they call, ending the revolving door of hospitalizations, emergency rooms, jails, and homelessness. Early intervention means more promising prognoses. Families and their loved ones will be saved years of trauma. 

Annual U.S. deaths from drug overdoses are around 80,000 people and 48,000 die by suicide each year. Two million times a year, people with mental illnesses are booked into U.S. jails that hold many more people than our psychiatric hospitals; the cost of a day in jail in Broward County per the Broward Sheriff’s Office is $197.81. People with mental illness tend to stay longer with tragic outcomes for them and their families and no improvements to public safety.  

But Florida must be prepared. Join the Florida Mental Health Advocacy Coalition to support funding requests from the Dept. of Children & Families. Please encourage AHCA to apply for the Medicaid option to fund mobile crisis response teams and to leverage Medicaid funds as needed to support the 9-8-8 system. Please support a study to determine the capacity and coverage of mobile response teams and crisis stabilization centers such as centralized receiving centers throughout the state and commit to filling any gaps. Please promote collaboration between DCF and AHCA to ensure the ongoing success of the 9-8-8 crisis response system and establish leadership to provide accountability to improve the quality of crisis services throughout the state. 

For those of us in the Florida Mental Health Advocacy Coalition, including our NAMI, Mental Health America, and peer-run organizations, this is personal. When someone is having a behavioral health crisis, they need help – not handcuffs. People experiencing a behavioral health crisis are at high risk of death during a police interaction. According to the Washington Post’s police shooting database, 23% of people killed by police were identified as having a mental illness. 

Thirteen years ago, my 17-year-old suffered a first psychotic break. 9-8-8 would have saved us years of trauma and greatly improved his prognosis by linking him to the right services right away. 9-8-8 will help veterans and first responders with PTSD, people considering suicide, those with autism, those addicted to opioids, those in abusive relationships, those lonely due to COVID and at the end of their rope. 

A call for help shouldn't result in trauma or tragedy. Building a robust 988 crisis response system will move us closer toward a respectful, dignified and effective response to everyone who experiences a mental health, substance use or suicidal crisis.  

These are resources I used in the writing of this and other articles on 988: 

1. https://www.washingtonpost.com/graphics/investigations/police-shootings-database/
2. https://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2009.60.6.761 
3. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
4. https://afsp.org/suicide-statistics/
5. https://www.nasmhpd.org/content/crisis-now-dedicated-transforming-mental-health-crisis-systems
6. https://www.youtube.com/watch?v=M6BPxH09tqU
7. https://stepuptogether.org/the-problem https://lis.virginia.gov/cgi-bin/legp604.exe?212+sum+SB1302 

Visit nami.org for additional information on 988. 

As the demand for mental health and substance use disorder treatment has increased considerably since the start of the COVID-19 pandemic, it’s crucial that Florida lawmakers fully invest in mobile response teams (MRTs), which provide 24/7, on-demand behavioral crisis intervention services in homes, schools, emergency departments, and other settings.

A new Florida Policy Institute (FPI) analysis makes the case for using American Rescue Plan Act (ARPA) funds to supplement current state and local funding for MRTs, which would temporarily boost Florida’s Medicaid match rate and allow the state to draw down millions in additional federal dollars. These funds are available starting April 2022.

NAMI released a public opinion poll in November 2021, conducted by Ipsos, that found Americans are deeply dissatisfied with the current state of mental health treatment and overwhelmingly support policies to overhaul our response to mental health crises. For example, adults support state (85%) and federal (84%) funding for 988 call centers and crisis response services; 73% of adults would also be willing to pay a monthly fee on phone bills to support the 988 system. 

Find an overview slide deck here. You can find information to leverage these data points in your 988 advocacy efforts here.

The federal government took the excellent step to pass 9-8-8, the nationwide crisis line for behavioral health and suicidal crises, which will also serve as a veteran’s crisis line. It's easy to remember and 9-8-8 is more than a number. See NAMI’s Vision. If adequately funded, it will create 24/7 crisis call center hubs with the ability to respond effectively to callers, dispatch mobile crisis teams, connect to crisis stabilization programs, and follow-up after the call. 

It will promote behavioral health mobile crisis teams that include police as co-responders only as needed in high-risk situations —reducing law enforcement involvement in mental health crises. It will establish crisis stabilization programs in a home-like environment that provides short-term (under 24 hours) acute services and warm hand-offs to follow-up care.

However, there is much work to do in a short amount of time. The Florida Mental Health

Advocacy Coalition (FLMHAC) urges Florida to be prepared for the implementation of 9-8-8 in our state, which becomes effective in July of 2022. 9-8-8 will link to local call centers. To help facilitate planning, Vibrant, which runs Lifeline (network of call centers), has offered non-competitive grants available to every state.

NAMI National has prepared model legislation, which would:

• Create robust 988 crisis hotline centers.
• Ensure access to appropriate and high-quality crisis response.
• Authorize monthly fees for phone users and develop a fund to support 988: All phone bills would be assessed a small monthly fee to help fund the 988 network and services, which would be put into a 988 Trust Fund.  
• Provide for planning and oversight: A new or existing state body would oversee planning and implementation, facilitate cross-agency collaboration and establish implementation timeframes.

The Florida Mental Health Advocacy Coalition will engage our state legislators and pursue sponsorship to ensure effective behavioral health crisis response in our state.

9-8-8 is not fully implemented yet. Anyone in crisis can call their local mental health crisis line or mobile crisis response team, or call 211 or 911 and request a CIT-trained officer. They can also text “NAMI” to 741741 or call the existing National Suicide Lifeline at 1-800-273-TALK (8255).