988 Suicide & Crisis Lifeline

211 is a non-emergency number for finding community resources, such as food banks and shelters. 911 is currently used for all emergencies, including mental health emergencies.

Mental health crisis calls may result in potentially dangerous and traumatizing outcomes when police are called, especially in historically marginalized communities. Despite their best efforts, 911 dispatchers usually have not received specific training on how to handle mental health and suicide-related calls. Although law enforcement response is often not necessary or appropriate for mental health crisis situations, police are typically the first responders activated by 911 calls.

988 is a mental health crisis number, and calls are handled by National Suicide Prevention Lifeline counselors. These counselors are highly trained to assist people in emotional distress or suicidal crisis. In fact, based on data provided by Lifeline call centers, approximately 98% of answered Lifeline calls do not require an emergency response. Of the 2% of the calls that do require emergency response, over 60% of those calls are ones where the caller agrees that emergency services are needed and collaborates with the Lifeline counselor to receive those services.

Vibrant Emotional Health, an MHA affiliate and administrator of the National Suicide Prevention Lifeline, has provided recommendations and defined the vision and mission of 988 as follows:

• Vision: 988 serves as America's mental health safety net. We will reduce suicides and mental health crises and provide a pathway to well-being.
• Mission: Everyone in the US and its territories will have immediate access to effective suicide prevention, crisis services and behavioral healthcare through 988.

For many people with mental health and substance use conditions, particularly people of color and people in the LGBTQ+ community, a law enforcement response to a mental health emergency has ended in tragedy or poor outcomes, including death and incarceration. Just as current calls to the Lifeline are answered now, calls to 988 will be answered by someone trained in mental health crisis response, who can often resolve the situation by phone, text, or chat.

The new Lifeline number holds the promise of an equitable health care response to a health care issue with better outcomes as people receive the services and supports they need to remain in their communities and thrive. This promise will only be fulfilled if adequate resources are available to accommodate increased call/chat/text volume, as well as the continuum of crisis care services that can stem from the 988 call. Crisis care services are more impactful when they include and are informed by individuals with diverse backgrounds, including lived experience, who are trained to respond in an empowering and culturally responsive manner.

For example: 988 presents an opportunity to invest in mobile crisis teams that can be deployed to respond instead of police. People in crisis may need an appropriate place to go for assessment that is not jail or a hospital emergency department, which are often the only options for law enforcement to offer. 988 provides the opportunity to invest in resources, such as crisis stabilization centers, crisis beds, or peer respite centers, which allow for individuals in need to receive mental health evaluation and resources.

• Find out what legislation has been passed for funding in your state using this interactive map.
• Advocate for sustainable funding.
• Join or start a 988 coalition to coordinate and build out services in your community.

The National Suicide Hotline Designation Act allows states to pass legislation assessing small monthly fees on cell phone bills to support 988, as is often done to support 911 services. Even if your state does not assess a 911 fee, legislation can be introduced for 988 assessments in state legislatures. The National Association of State Mental Health Program Directors (NASMHPD) developed a model law.

Here is MHA's version of the NASMHPD model law. We emphasized a behavioral health response to crisis first, as well as only involving law enforcement in very limited circumstances as co-responders. We also added some provisions to ensure equity and expanded the partnership agreements beyond community mental health or behavioral health centers (CMHCs) because many MHAs do not have that designation.

It is important for advocates to enact state legislation assessing a fee because local member centers within the Lifeline network are currently underfunded and additional resources will be needed to meet the increased demand on call centers.

Assessing this fee is also critical as the law allows states to generate funding for "the provision of acute mental health, crisis outreach and stabilization services by directly responding to 988." This means that this funding can be used in part to create a crisis response system that does not rely on law enforcement and provides the continuum of appropriate crisis care.

If you're interested in supporting the 988 Lifeline or becoming a part of this life-saving work, there are volunteer and job opportunities available at our 200+ crisis centers across the country. Training is provided. Visit here to learn more: www.samhsa.gov/find-help/988/jobs.

• SAMHSA 988 toolkit
• Action Alliance 988 messaging framework
• MHA and Vibrant FAQ: Understanding 988 and how it can help with behavioral health crises
• FCC 988 fact sheet
• NAMI Reimagine Crisis Response
• The Kennedy Forum call-to-action toolkit