Not going all in on the 988 hotline will ensure its failure

Time is not on our side. With fewer than 100 days until the scheduled rollout of 988, the new nationwide mental health and suicide prevention crisis hotline is unfortunately far from being ready.

Implementing the program — think of it as 911 for mental health crises — which was signed into law by President Trump in October 2020, has been hampered by a lack of sustainable federal funding to build the capacity to respond effectively to 988 calls, which is consistent with how little the U.S. has prioritized investing in the nation’s mental health.

While the aim of the new shorter number — which will be complementing the current National Suicide Prevention Lifeline number of 800-273-8255 — is to make it easier for people to find help during a mental health crisis, it has the potential to do so much more. Reaching that potential, however, will require a full, all-in commitment from national and state leaders to build a supportive infrastructure aligned with clear quality standards and supported by robust financing. That’s a commitment the 988 program has sadly, but predictably, not yet seen.

Today there are two main avenues for a person experiencing a mental health crisis: go to an emergency department or call 911. Both of these are fraught with challenges and rarely end with a successful intervention during which the person receives the care they need. Data show that people, especially children, are waiting too long in emergency departments — days, or even weeks — for a bed to become available. We must have a better response.

The 988 line has the potential to create new pathways for care and a system that is responsive to communities’ needs. But without robust financing, clear communication, and strong leadership, the consequences of not getting 988 right are severe, and lives may be lost.

State and local officials across the country continue to claim optimism about the pending launch. I and many colleagues in the mental health community, however, are gravely concerned that the hotline, intended to reduce reliance on emergency rooms and law enforcement to treat people experiencing mental health crises, does not have a strong enough foundation, with sufficient staff and funding, to deliver the intended results.

The problem isn’t the new number. The technology should work. The question is: Who will be answering the calls and is there a system in place with the capacity to take care of callers right way? There are currently long wait times for crisis lines and in-person clinic visits.

911, which began operating in 1968, has become an indispensable part of U.S. health care. It would be unthinkable today to call 911 and be unable to reach an operator who could quickly dispatch a fully equipped first responder team. But no answer may be the sad reality for someone calling 988 to get emergency mental health help for themselves or a loved one. In 2021, callers abandoned approximately 17% of calls to the National Suicide Prevention Lifeline before they received help due to extended wait times; 41% of text messages and 73% of online chats were likewise abandoned.

Congress has allocated some money to help hire and train more staff, but it may not be enough. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) anticipates that 988 could receive up to 7.6 million calls in fiscal year 2023, requiring $560 million in funding per year, less than one-fifth of which will be covered by federal entities.

Some states like Virginia are moving to fill these gaps, adding supplemental funding for 988 through new fees on wireless plans. To date, though, most states haven’t done enough. It is essential that call centers be appropriately funded and staffed with properly trained operators who can effectively answer calls and assess and manage a wide range of concerns relating to mental health, suicide risk, and substance use. Responsiveness is of paramount importance, so callers are not left waiting when in need of help.

Also needed is consistent, widely disseminated national communications to inform people about 988 and what they can reasonably expect from it. Public education about 988 has so far largely relied on state leaders providing information at their discretion. As a result, public awareness of 988 varies wildly across the country. While some states are faring better than others, as of late last year only 4% of Americans claimed to be familiar with 988, and 80% had never even heard of it. There is a very real risk of losing the public trust if this system rolls out and people are not adequately educated about what it will and will not do.

We saw the consequences of previous underfunded rollouts, like that of Healthcare.gov nearly a decade ago. Congress needs to step up and work in tandem with state legislators to ensure that millions of Americans who struggle with mental health get the 988 crisis response they deserve.

Benjamin F. Miller, a clinical psychologist by training, is president of Well Being Trust and chair of the advisory board of Inseparable, two leading mental health organizations.