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Implementing 9-8-8

The New Nationwide Mental Health Crisis and Suicide Prevention Number

Beginning July 16, 2022, people will use a new, easy to remember, three-digit code (988) to reach the National Suicide Prevention Lifeline. The change from a 10-digit code to 9-8-8 will provide easy access to crisis services for people with mental health and substance use issues and help reduce the stigma surrounding these conditions. The new 9-8-8 number is considered the 9-1-1 of mental health and substance use issues. The goal of 9-8-8 is to have 24/7 crisis call centers (someone to talk to), mobile crisis teams (someone to respond to crises), and crisis stabilization programs (somewhere to go).

The National Suicide Prevention Lifeline is a national network of approximately 170 local- and state-funded crisis centers. The Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration administers the National Suicide Prevention Lifeline, in partnership with the Department of Veteran Affairs, which manages the Veterans Crisis Line. While Congress signed legislation into law to create the 9-8-8 number, each state will need to implement the system and develop and maintain the infrastructure for crisis response. The National Association of State Mental Health Program Directors (NASMHPD) has model state legislation for implementing 9-8-8 infrastructure (.pdf), and APA is working in coalition with other mental health organizations to support this legislation in the states.

The change to the creation of 9-8-8 for mental health, including substance use, emergencies provides a unique opportunity to reform the nation’s crisis system. For too long many people who experience crisis may receive an inappropriate response from being arrested to boarded in an emergency department. This places unnecessary burden on people in crisis, their families, and the health and justice systems. It also deters people from seeking services for fear of police intervention, being detained, and stigmatized. To transform our system will require advocates at the state and federal levels working together to achieve better crisis services for all. Work is underway in all states and at the federal level with much needed to ensure an equitable, sustainable crisis system is developed.

Transition to 9-8-8

The Federal Communications Commission (FCC) regularly provides updates and information to help with the transition to 9-8-8 here. On July 16, 2020, the FCC adopted rules to establish 988 as the new, nationwide, easy-to-remember 3-digit phone number for Americans in crisis to connect with suicide prevention and mental health crisis counselors.

The rules require phone service providers to direct all 988 calls to the existing National Suicide Prevention Lifeline by July 16, 2022. During the transition to 988, Americans who need help should continue to contact the National Suicide Prevention Lifeline by calling 1-800-273-8255 (1-800-273-TALK) and through the National Suicide Prevention Lifeline's online chats. Veterans and Service members may reach the Veterans Crisis Line by pressing 1 after dialing, chatting online at veteranscrisisline.net, or texting 838255.

The new rules will apply to all telecommunications carriers as well as all interconnected and one-way Voice over Internet Protocol (VoIP) service providers. They provide for a two-year transition, reflecting the nature of this nationwide effort, including the need for network changes and providing time for the National Suicide Prevention Lifeline to prepare for the expected increase in the volume of calls. Under these rules, calls to 988 will be directed to 1-800-273-TALK, which will remain operational during the 988 transition and after it is completed.

Creating a Crisis Continuum

  • The Substance Abuse and Mental Health Services Administration released The National Guidelines for Crisis Care: A Best Practice Toolkit (.pdf) to supports program design, development, implementation and continuous quality improvement for crisis services. The goal is to help mental health authorities, agency administrators, service providers, state and local leaders think through and develop the structure of crisis systems that meet community needs. This toolkit includes distinct sections for:
    • Defining national guidelines in crisis care;
    • Tips for implementing care that aligns with national guidelines; and
    • Tools to evaluate alignment of systems to national guidelines.
  • Roadmap to the Ideal Crisis System: Essential Elements, Measurable Standards and Best Practices for Behavioral Health Crisis Response was released by the Committee on Psychiatry and the Community for the Group for the Advancement of Psychiatry Published by National Council for Mental Wellbeing. The report provides a detailed guide for communities to use to create a vision and direction for their behavioral health crisis systems, to evaluate their current behavioral health crisis capacities and to operationalize a strategy for implementing structures, services and processes that move toward an ideal crisis system.

Federal Funding Update

  • National Suicide Prevention Lifeline Appropriations: Annual SAMHSA Suicide Lifeline funding supports the infrastructure of network operations, including backup, specialized services and chat and text centers, data and telephony infrastructure, standards, training, and quality improvement, and evaluation and oversight. The Fiscal Year 2022 President’s Budget included $102 million for the Suicide Lifeline a significant increase from $24 million enacted in Fiscal Year 2021.
  • Community Mental Health Services Block Grant (MHBG) Crisis Set Aside: In fiscal year 2021, Congress implemented a 5% set-aside within the MHBG for states to use for investing and implementing local crisis response systems that include elements like mobile or crisis call centers, crisis stabilization programs, and developing uniform principles and best practice guidelines to follow in crisis situations. These services for patients in crisis have proven effective in reducing costly emergency department boarding, freeing law enforcement officers from managing MH/SUD patients in crisis and diverting patients with severe mental disorders away from the criminal justice system and into appropriate treatment and care. As the new 988 hotline number is implemented in 2022, resources for these crisis response services will be vitally needed. The Fiscal Year 2022 President’s Budget included $1.6 billion for the MHBG, more than double enacted in 2021, as well as an increase of 10% for the crisis set-aside.
  • Medicaid Option for Crisis Services: Announced on December 28, 2021, the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is working with states to promote access to Medicaid services for people with mental health and substance use disorder (SUD) crises. Authorized under President Biden’s American Rescue Plan (ARP), states have a new option for supporting community-based mobile crisis intervention services for individuals with Medicaid.

How to Advocate in Your State

APA is one of 40 partnering organizations in Reimagine Crisis Response, a coalition dedicated to 988 implementation in the states. APA works closely with these partners and DBs on state 988 implementation legislation. Colorado, Nevada, Virginia, and Washington passed legislation that includes fees to appropriately fund the infrastructure. Illinois, Indiana, Oregon, Utah, and West Virginia passed legislation that enacted infrastructure but did not include funding or fees to maintain that infrastructure. Alabama, Mississippi, Nebraska, New York, and Texas enacted study committees and commissions to examine 988 infrastructure, but those laws do not require the infrastructure to actually be developed. As of April 2022, there are 13 states with pending 988 legislation: Connecticut, Florida, Hawaii, Illinois, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Mississippi, New Jersey, Ohio, and West Virginia. Hawaii, Illinois, and Kansas recently had hearings on their 988 bills. APA continues to assist District Branches who are involved in 988 work, which will continue long after July 2022.

View up-to-date legislative activity on 988 implementation here. To learn more about 988 in your state, contact APA Director of State Government Relations, Erin Philp, at [email protected].

APA Resources

The American Psychiatric Association (APA), the National Association of State Mental Health Program Directors (NASMHPD), National Council for Mental Wellbeing, and American Foundation for Suicide Prevention (AFSP) hosted a webinar focused on opportunities for transforming our nation’s crisis system. The goal was to help participants:

  • Identify their role in improving crisis care at the clinical level.
  • Recognize statewide trends in improving crisis services to identify gaps in their system and how to make necessary improvements.
  • Advocate for community and state-wide changes to implement a 9-8-8 number that will better meet the needs of patients in crisis.
  • Educate patients about changes to the crisis system to encourage them to use crisis services and the 9-8-8 number instead of 911 when 9-8-8 is available.

View the webinar recording here.

Additional Resources

Online Resources to Share with Patients and Families

Implementation Recommendations

With a July 2022 launch date for 9-8-8 implementation fast approaching, significant investments are needed to improve and secure the suicide prevention, mental health, and substance use crisis care continuum.

Suicide Prevention Resources and Other Notable Organizations

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