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Countdown: States Have One Year to Facilitate 988, the Nation’s First Mental Health Crisis Line

47 states haven’t passed legislation needed to support the new line by the July 16, 2022 deadline set by Congress

A new analysis by The Kennedy Forum shows only three states have passed adequate legislation to facilitate 988, the nation’s first three-digit number for people experiencing a mental health crisis. Last year, Congress unanimously passed the bipartisan National Suicide Hotline Designation Act of 2020, which created 988 as the universal number for the National Suicide Prevention and Mental Health Crisis Hotline System, as an alternative to 911. However, most states are behind in advancing critical legislation to fund their local 988 infrastructure. 

Congress mandated a deadline of July 16, 2022 for 988 to be available nationwide. The deadline is exactly one year away, and states are running out of time to fund and implement important components of the system: 24/7 call centers staffed by mental health professionals, mobile response teams, and crisis stabilization services that connect people to follow-up care. 

Too often, when individuals experiencing a mental health crisis need help, they are met by law enforcement, resulting in unnecessary incarceration, trauma, or worse. Between one-quarter and half of all fatal law enforcement encounters involve individuals with a serious mental illness. People with untreated mental illness are 16 times more likely to be killed during a police encounter than other civilians. And Black Americans are nearly 2.5 times more likely to be killed than White Americans, and Latinos are also disproportionately killed. 

Relying on police to respond to mental health emergencies also requires tremendous local resources. In 2017, an average of 10% of law enforcement agencies’ total budgets and 21% of staff time were spent responding to and transporting persons with mental illness

“Even before the pandemic, our country was in the midst of a mental health crisis with suicide and overdose rates at historic levels,” said former U.S. Rep. and founder of The Kennedy Forum Patrick J. Kennedy. “Police were never meant—or adequately trained—to deal with mental health emergencies. This antiquated approach to emergency response hurts everyone: individuals with mental health and substance use disorders, their families, and entire communities.” 

988 will be critical to managing an anticipated significant increase in call volume due to the pandemic, preventing deaths, and stopping the criminalization of mental illness. To fund this overhaul, Congress authorized states to pass user fees on telephone lines—the same source used to fund 911. Yet, few states have acted, putting their local 988 systems at risk.   

Below is a summary of state 988 activity to date:
  • Colorado, Nevada, and Washington passed strong legislation with user fees to fund the 988 system.  
  • California, Kentucky, New Jersey, and Massachusetts have legislation pending that includes user fees.
  • Virginia passed legislation, but with limited user fees that will not fund vital system components. 
  • Utah, Illinois, and Indiana passed legislation with no user fees. 
  • Nebraska, Texas, Alabama, New York, and Oregon passed legislation without user fees, but created studies or exploratory commissions (though, Oregon allocated some state dollars in lieu of user fees).
  • 34 other states and the District of Columbia have taken no steps to advance 988. 

Despite the clear intent of Congress for states to fund local 988 systems through small fees in telecommunications bills (typically, less than $.50 per phone line per month to be paid by customers), large telecom companies have objected— successfully scaling back legislation in states including Nebraska and Virginia and continuing to fight legislation in other states. 

Push back from an industry that made billions in profits during the first quarter of 2021 is hard to swallow given the countless lives already lost to insufficient mental health emergency response. Take the story of Miles Hall, a 23-year-old Black man who lived in Walnut Creek, Calif. and suffered from schizoaffective disorder. Even though his mother, Taun Hall, had proactively reached out to police to explain Miles’ condition and warn them of his sometimes-erratic behavior, the unthinkable happened after neighbors called 911. 

“When police responded to our son’s mental health crisis they shot and killed him within moments of arriving,” said Hall. “Trying to solve a public health crisis with a response from law enforcement has proven to be ineffective and deadly. 988 is a critical step toward decriminalizing mental illness—it could have saved our son's life.”  

Constituents in states that have no 988 legislation in the works can contact their State representatives and ask them to introduce or pass a bill that includes 988 user fees. They can also contact their Congressional representatives to ask them to support the state’s response.
The Kennedy Forum | 14 Central Avenue, PO Box 319 | Island Heights, NJ 08732