With 9-8-8 mental health hotline about to launch, massive funding gaps remain

On Saturday, 9-8-8 — the new three-digit version of the National Suicide Prevention Lifeline — will go live, becoming the go-to number to dial during mental health emergencies. But despite significant federal investments, the majority of the country isn’t prepared to reap the full benefits of 9-8-8. To expedite this historic debut, state leaders must immediately enact the basic phone bill fee laws needed to pay for it.

Our home state, Colorado, is one of just four states across the country that have passed such a law, establishing the long-term cash flow needed to cover the call centers, response units, and staff this new hotline will rely on to save lives.

As driving forces behind Colorado’s 9-8-8 rollout efforts and phone fee legislation, we know that passing this sort of bill is often no small feat. But it’s also abundantly clear to us that enacting a capped surcharge on 9-8-8 callers’ monthly phone bills helps to ensure that money for 9-8-8’s implementation doesn’t run out.

A reliance on alternative funding options — such as one-time federal grants from the Department of Health and Human Services — simply won’t provide the volume of funds needed to meet this country’s vast mental health needs. Take, for instance, a one-time grant of $250,000 to Delaware’s Division of Substance Abuse and Mental Health: It’s a great start, but it won’t even cover the cost of getting a single call center off the ground. Nor will a one-time grant of $250,000 to North Dakota’s State Department of Health and Human Services pay for the fleet of vehicles and extensive expert training needed to reach and triage mental health emergencies in the state’s most rural areas for perpetuity. These sorts of band-aid funding solutions simply aren’t up to the task of meeting demand for mental health services in this country.

And the herculean undertaking of providing for America’s mental health needs has never been greater. While the push to institute 9-8-8 began within the last decade, the system has been broken for much longer. Today, millions of 9-1-1 calls are placed each year due to mental health emergencies, and the youth mental health crisis has only exacerbated this trend.

Unfortunately, many of the well-meaning loved ones and bystanders who witness mental health emergencies and call 9-1-1 for help actually inadvertently place those suffering from mental health challenges in harm’s way. People with untreated mental health needs are 16 times more likely to be killed during a police encounter than other civilians engaging with law enforcement, and as many as 80 percent of the 11.2 million people who are incarcerated in the U.S. each year have some form of unmet mental health need.

The new 9-8-8 hotline offers a simple, but elegant solution to this dire situation: Shorten the mental health emergency hotline to just three digits, thus empowering Americans to efficiently place calls directly to teams of professionals who are trained specifically in compassionate mental health response protocols.

Unfortunately, given the hyper-local nature of placing, routing, and responding to emergency calls, we need action at the state level to ensure that 9-8-8’s promise to deliver care — not cuffs — to those with unmet mental health needs is kept. As it stands, one in six calls to the National Suicide Prevention Lifeline end without the caller connecting with a counselor, and that will not change without heightened funding.

Only Virginia, Nevada, Washington and Colorado have enacted the full suite of state funding laws needed to have 9-8-8 in working order by Saturday. And the crown jewel of these critical legislative packages are the aforementioned phone bill fee laws. It’s worth noting that these phone fees are quite low. Colorado’s, for example, is 18 cents per caller per month, and is capped at 30 cents per caller per month under the state’s 988 Suicide Prevention Lifeline Network law, which went live Jan. 1 of this year. Other state caps range from 25 to 75 cents per bill. 

What makes it particularly egregious that leaders in 46 states haven’t created similar funding mechanisms is that mental health support and suicide prevention appears to be one of the few things that all of us — Democrats and Republicans alike — can agree on.

Take for instance, the bipartisan gun reform bill, which President Biden recently signed into law. The new bill will appropriate $1 billion to meet Americans’ mental health needs via community behavioral health centers, telehealth services, suicide prevention, school-based mental health support and provider training. This bipartisan act at the federal level feels nearly miraculous given our hyper-partisan political environment, but it does give us hope that states with mixed political ideologies can pass 9-8-8 caller fee bills as well.

Elected officials in the remaining 46 states must expedite the passage of 9-8-8 service user surcharge laws, or risk further delays to 9-8-8’s historic debut and — more importantly — risk losing lives due to inadequate call response bandwidth.

Moe Keller served as a Colorado state senator for 8 years and as a Colorado state representative for 8 years before that. She co-authored Colorado’s 9-8-8 state legislation, which implements the suicide prevention call line. She is retiring as director of advocacy for Mental Health Colorado.

Vincent Atchity, Ph.D., is president & CEO of Mental Health Colorado, a state affiliate of Mental Health America. He has worked nationally to disentangle mental health and criminal justice, and has served on two Colorado governors’ behavioral health task forces and the Colorado Opioid Epidemic Symposia Steering Committee. He currently serves on the Colorado Public Defender Commission, the Colorado Jail Standards Commission, the Denver District Attorney Advisory Council on Mental Health, the Colorado School of Public Health Behavioral Health Initiative Advisory Board, as well as on the board of STRIDE Community Health, a Federally Qualified Health Center (FQHC) serving Metro Denver. Follo0w him on Twitter @atchityCO