In 2019, members of the Hall family of Walnut Creek, California, placed a call to 911 to get help for Miles Hall, a 23-year-old Black man in the throes of a mental health emergency. But instead of getting assistance, Hall was shot and killed by police in the street near his home. 

Incidents like that, which have become common across the country, were part of the impetus for the creation of a different three-digit number, 988, that was authorized by Congress in 2020 as a way for people to seek help during a mental health emergency by calling a crisis number that isn’t designed to dispatch police.

“If we had a 988 line to call on June 2, 2019, it might have saved Mile’s life,” his mother, Taun Hall, said yesterday. She spoke at a video press conference announcing the introduction of new federal legislation that would boost funding for the emergency line that is slated to go into effect in July. 

The 988 Implementation Act, introduced by Rep. Tony Cárdenas (D-Calif.), builds on the 2020 legislation that designated 988 as the new three-digit number for the National Suicide Prevention Lifeline. That bill authorized states to add surcharges to the monthly telephone bills of consumers to help fund the line but provided no other funding to states to run it. 

So far, according to the National Alliance on Mental Illness (NAMI), only four states (Washington, Nevada, Colorado and Virginia) have done so. Some others, including California, have provided initial funding, while five states (Idaho, Montana, Kentucky, New Jersey and Florida) have defeated funding legislation. A dozen states have 988 funding bills pending in their state legislatures. (A state-by-state map prepared by NAMI can be seen here.)

Some federal funding was made available to states through last year’s American Recovery Act and last week’s funding bill for fiscal year 2022 but advocates say the amounts provided don’t come close to the levels needed to deliver on the promise of 988. They say 988’s potential is threatened by a lack of federal and state funding and inaction by state governments and are pushing for modest state telephone surcharges of less than 80 cents a month per phone line, along with new federal funding.

“It’s going to take federal investment as well as state and local leadership to make a 988 crisis continuum available to everyone,” said Hannah Wesolowski, NAMI’s chief advocacy officer. “While Congress gave states this mechanism for a new funding stream, it is discouraging to see so few states leverage the opportunity.”

Rep. Tony Cárdenas (D-Calif.) is the lead sponsor of the bill.

Cárdenas agrees. “988 represents a turning point in American history,” he said at the press conference. “Right now America’s default for people who need immediate help when experiencing a mental health crisis is calling 911. And the default treatment facilities are jails and emergency rooms.”

He also cited research that found people with mental illness are 16 times more likely to be killed in encounters with police than are other people. “Being mentally ill is not a crime. Being suicidal is not a crime. Having a substance use disorder is not a crime. The fact is we need to stop criminalizing mental illness and get people in crisis the help they need.”

The bill currently is co-sponsored by seven Democrats and one Republican, Rep. Brian Fitzpatrick of Pennsylvania, a co-chair of the Bipartisan Addiction and Mental Health Task Force. “Now more than ever, it is imperative that we provide crucial support and expand resources for the millions of those struggling with mental health in our country,” he said in a statement.

The new act would provide states access to federal funding from various streams, as well as guidance on how to get ready for the designated launch of the 988 hotline in July. It encourages states to develop coordinated mental health care systems, which include mobile mental health crisis teams, community-based crisis centers to handle emergencies, short-term stabilization programs where people can go to recover from a mental health emergency and referrals for people needing continued mental health support.

The bill would nearly triple to $2.2 billion the amount of money authorized for the mental health block grant, which was funded at $857 million in the budget bill signed this week by President Biden. That money goes to states for a variety of mental health services for adults and children. It would also double from 5% to 10% the portion of the block grant that is devoted to crisis services.

It would provide $441 million for technology, training and operations of about 250 local and regional call centers that will handle 988 calls and up to $240 million to ensure that 988 is accessible to a range of people with special needs, including people who have impaired hearing and to offer specialized services to youth, veterans, people of color, LGBTQ people and other underserved groups.

Finally, the bill would provide $100 million for grants to states to enable communities to set up mobile crisis response programs that bring mental health workers to the scene of mental health crises to provide assistance. It would double to $10 million the amount of money allocated to set up a Behavioral Health Crisis Coordinating Office in the Department of Health and Human Services to coordinate 988 activities. And it would provide another $10 million for a national suicide prevention campaign that would boost awareness of 988.

The 988 hotline could have made a difference in Delaware, where 124 people killed themselves in 2020, the highest rate since 2014, Rep. Lisa Blunt Rochester (D-Delaware), said at the press conference,  “For all of those we’ve lost, we know there are countless more locked in their own struggle,” she said.

Blunt Rochester is particularly interested in the bill’s funding for round-the-clock mobile crisis teams, which she says have clear returns. “Data shows that 24-hour mobile crisis teams are 23% more cost-effective in responding to crises than law enforcement,” she said. “And it will save lives.” The response teams, she said, should be composed of people from the community they serve “because it’s important that people trust the people who are providing the services.”

The press conference also included a call for action from veterans, whose suicide rate is almost double that of civilians, according to the Department of Veterans Affairs.

Those numbers are reflected in a recent survey of veterans, said Brian Dempsey of the Wounded Warrior Project. “In our most recent annual survey of the post 911 veterans we serve, nearly one in four warriors reported that they had suicidal thoughts in the past 12 months, and many more continue to struggle with suicide risk factors like PTSD, depression, and hazardous drinking,” Dempsey said, speaking at the press conference in support of the legislation.

The bill would help police too, said Brian Peete, chief of police in Montpelier, Vermont. “This bill will not only help connect callers in crisis to professionals and services appropriate for the nature of their emergency, but it will make our community safer by freeing up law enforcement to be more responsive to public safety needs.”

Rob Waters

Rob Waters, the founding editor of MindSite News, is an award-winning health and mental health journalist and contributing writer to Health Affairs. Waters has worked as a staff reporter or editor at Bloomberg...