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Changing Policies on 988, the Mental Health Crisis Hotline

The final speakers for the Schroeder Center’s behavioral health policy series were representatives from NAMI, the National Alliance on Mental Illness, a public advocacy group for individuals impacted by mental illness. Stephanie Pasternak and Jodi Kwarciany, who work on NAMI’s Government Relations, Policy & Advocacy team, presented to the William & Mary community about the 988 mental health crisis hotline and putting mental health policy to practice.

One of NAMI’s highest priorities is to expand and improve upon the current crisis response structure related to mental health. Ms. Pasternak and Ms. Kwarciany described how NAMI’s advocacy helped pass legislation to establish 988 as the nationwide three-digit number hotline for suicide prevention and mental health crises. NAMI hopes that the 988 hotline, which will be available by July 2022, will serve as an alternative to dialing 911 for individuals experiencing mental health crises. (Anyone experiencing a crisis should call the National Suicide Prevention Lifeline [NPSL] at 1-800-273-8255 until July 2022.)

Ms. Pasternak’s and Ms. Kwarciany ‘s presentation focused, in part, on why NAMI believes the current response to mental health crises is inadequate.  Under the current system, for example, an individual experiencing a mental health crisis is often more likely to interact with a law enforcement officer than a medical professional. When law enforcement responds, people in crisis often end up in jails, emergency departments, on the streets, or they are harmed or killed during the encounter or die by suicide.  In fact, Ms. Kwarciany noted that one in four people shot and killed by police between 2015 and 2020 had mental illnesses; individuals experiencing mental health crises are booked into jails two million times a year; and nearly 50,000 people died by suicide in 2019.

Ms. Pasternak examined the current patchwork system for mental health crisis services across the country, and mentioned that there is no consistent expectation for the type of response people in crisis will receive when they call for help.  While National Suicide Prevention Lifeline staff are primarily trained in suicide prevention, NPSL operates with limited resources to answer current local call volumes. NAMI advocates for moving to a better and more consistent standard of care for people experiencing mental health crises.

The Substance Abuse and Mental Health Services Administration (SAMHSA), according to Ms. Pasternak, studied nationwide practices in mental health crisis care and identified the practices that were working in local communities. SAMHSA released guidelines for best practices, which recommends operating 24/7 crisis call center hubs with agents trained specifically in responding to behavioral health crises. SAMHSA recommends these call centers be available by phone, text, and chat and that they be able to coordinate services and dispatch mobile crisis teams when needed. Mobile crisis teams, staffed by behavioral health professionals, can help de-escalate situations and provide transportation to crisis stabilization centers or connect patients to other services.

In moving to these best practices to help people experiencing mental health crisis, Congress passed the National Suicide Hotline Designation Act of 2020, which created 988 as a universal number for mental health and suicidal crises, routed through the National Suicide Prevention Lifeline. The act expanded the Suicide Lifeline’s scope to include all mental health crises and allowed states to place a fee on phone bills to fund crisis services, similar to how 911 is currently funded.  If fully implemented, Ms. Pasternak noted that 988 will connect people in crisis more quickly to appropriate care, and keep them out of emergency rooms and jail. 

NAMI supports more federal funding to meet these best practice standards for mental health care.  According to Ms. Pasternak, sufficient resources are not available to fund the expanded scope of call volume to the Suicide Lifeline, and no federal resources are currently allocated specifically for local call centers. Ms. Pasternak also highlighted that there is no federal requirement, that states build crisis response systems to ensure there is an array of services available when an individual calls for help. At this point, only four states have enacted 988 infrastructure legislation, which created a monthly 988 fee on telephone bills.   

NAMI continues to work with members of Congress, federal agency staff, and other activists to develop the 988 crisis response framework. Several federal agencies, including SAMHSA, the Centers for Medicare & Medicaid Services (CMS), the Federal Communications Commission (FCC), and the U.S. Department of Justice (DOJ), work collaboratively in the rollout of this project. At the grassroots level, NAMI establishes state 988 workgroups and mobilizes advocates to contact policymakers and share stories.

Ms. Pasternak and Ms. Kwarciany concluded their presentation by inviting students to their “Reimagine: A Week of Action” event. The event aims to raise awareness of 988 by featuring personal stories of people exposed to the current crisis response system and what they wish was different about it. NAMI hopes to facilitate discussions around 988, including how racial equity intersects with 988 as well as the larger healthcare system.