9-8-8: A New 9-1-1 for Mental Health

The National Suicide Prevention Lifeline—currently a number few would remember without saving it in their phone—will soon become more accessible. Starting July 16, 2022, individuals will only need to dial 9-8-8—the brand new, three-digit number for mental health emergencies—to access crisis counseling services.

However, few states and localities are ready for what is expected to be a surge of demand for services: The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that calls to 9-8-8 will be roughly twice that of calls currently coming into the Lifeline, and that the increased demand will also produce a wider variety of behavioral health needs.

Behavioral health crises can affect anyone, at any time, and without adequate federal and state coordination, individuals in crisis may find themselves calling a lifeline that cannot meet their immediate needs. Too often, these crises are met with delay, detainment, and even denial of service. That can cause diversion of these individuals to emergency departments , law enforcement officials and other first responders who may be underprepared in behavioral health response, and local justice departments.

That is why the launch of 9-8-8 is such a critical step toward building the infrastructure needed to ensure that people in crisis can receive the services that address their mental health needs beyond the moment of crisis. As the Lifeline transitions to 9-8-8, the nature of patient needs from those calls will shift and produce a higher demand for core services across a crisis continuum of care comprised of:

• regional crisis call centers accepting all calls and dispatching support based on the assessed need of the caller
• 24/7 mobile crisis teams dispatched to wherever the need is in the community (not hospital emergency departments)
• 23-hour crisis receiving and stabilization facilities that serve everyone that comes through their doors from all referral sources

Against this backdrop, the Bipartisan Policy Center has been preparing policy recommendations to optimize the federal government’s role in the behavioral health crisis response system. These recommendations will be featured in an upcoming report to be released in May 2022, before 9-8-8 becomes operational nationwide. Overall, these recommendations will target the structures that comprise the nation’s existing crisis response system and will place a particular focus on rural communities, which are especially under-resourced. In particular, the recommendations will focus on enhanced federal support for the crisis response continuum across three distinct policy areas: implementation, workforce development, and financing.

• Implementation: To ensure that the services delivered match the needs of patients in crisis, implementation is critical. This subset of recommendations will focus on the federal government’s role in bolstering the continuum of care. They highlight the federal government’s role in assisting states—which have the most influence over the continuum of care—to both strengthen and standardize their crisis response systems, while encouraging trust and utilization among the general population. These recommendations will also suggest data sets which can be used to enhance surveillance and program evaluation.  

• Workforce: In recognizing the ongoing behavioral health provider shortage, this set of recommendations will focus on the importance of building the workforce by increasing the number of providers and offering the appropriate training. The recommendations aim to increase funding for workforce development programs, such as various loan repayment programs, and identify opportunities for leveraging behavioral health paraprofessionals and first responders (e.g., law enforcement). Proper education and training for personnel responding to behavioral health crises is a necessary component of ensuring long-term sustainability. 

• Financing: Without sufficient federal funding for each part of the continuum of care, states are ill equipped to build their crisis response systems. This subset of recommendations will note that call centers, which are already understaffed, may establish new funding mechanisms to ensure that they are self-sustaining. Mobile crisis teams have received more discretionary funding in recent years and, as such, the recommendations will include opportunities to complement these with mandatory funding, like provider reimbursement. With many patients ending up in ED, the recommendations seek to further expand funding streams for crisis stabilization facilities for more appropriate crisis care delivery. 

Federal Response

While rates of behavioral health issues among youth and adults were already high prior to the COVID-19 pandemic, recent data suggest that these rates have only increased since the pandemic began. In 2021, the Surgeon General issued an advisory depicting the ways in which the COVID-19 pandemic and its impacts have corresponded with rates of psychological distress among youth, including increases in symptoms of anxiety, depression, and other mental health disorders. Fortunately, this crisis has not gone unnoticed in Congress, where there have been multiple hearings held and several pieces of bipartisan legislation introduced related to elements of 9-8-8 in recent weeks. One key piece of bipartisan legislation is the 9-8-8 Implementation Act of 2022, which would address gaps within the continuum of care. The legislation would:

• designate federal funding for states to build crisis response infrastructure
• ensure individuals have access to crisis care by mandating all health insurance plans include crisis services
• support state initiatives to develop crisis care workforces
• establish a national suicide prevention awareness campaign, to promote awareness of the 9-8-8 crisis hotline

Such legislation is a step toward adequately equipping the 9-8-8 program once it becomes operational. The federal government will need to consider additional details to ensure that they are providing the appropriate support to states and local communities. This would include how federal funding is used in each part of the continuum of care, mechanisms for building the crisis care workforce, and the role of the federal government in providing ongoing guidance and surveillance.

Moving Forward

Although Americans are beginning to enter a new sense of normalcy as the impacts of the COVID-19 pandemic wane – at least temporarily—there is no expectation that rates of mental illness will do the same. Congress’ recent push for bipartisan legislation to support individuals experiencing a behavioral health crisis are steps in the right direction. BPC’s upcoming report is intended to provide bipartisan policy solutions that can improve the full behavioral health infrastructure so that 9-8-8 successfully addresses mental health crises and helps people access the stabilization and treatment services they need to keep from cycling repeatedly through the crisis system.