The ‘9-1-1 for Mental Health’ Will Launch Next Month. Why Won’t We Fund It?

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At a time of great division, it’s worth remembering that Americans can unite to solve problems.

One of the universally successful public policy efforts of the last 50 years was the launching of 9-1-1 in the late 1960s as a universal emergency telephone number. As NENA, a nonprofit devoted to improving 9-1-1, explains in this history, the idea was born in 1957 when the National Association of Fire Chiefs recommended the use of a single number for reporting fires.

A decade later, the Federal Communications Commission (FCC) asked AT&T to find a solution, and the company chose 9-1-1 “because it fit the needs of all parties involved.”

First, and most important, it met public requirements because it is brief, easily remembered, and can be dialed quickly. Second, because it is a unique number, never having been authorized as an office code, area code, or service code, it best met the long-range numbering plans and switching configurations of the telephone industry.

In the 1990s, many cities in North America, beginning with Baltimore, Maryland, began using 3-1-1 as a central hub for residents to inquire about city services. As Akron, Ohio, describes the distinction: “Burning building? Call 9-1-1. Burning question? Call 3-1-1."

This summer, the United States is poised to launch a new, nationwide emergency number for mental health. The three-digit number, 9-8-8, is specifically designed to connect people in a mental health crisis to professionals expressly trained to respond to such emergencies. In effect, it’s an easy-to-remember number designed to replace the National Suicide Hotline Lifeline. Passed with bipartisan support in Congress in 2020, the law goes into effect on July 16.

But as NBC News reported this month, states that must fund the new number beyond the nearly $300 million allotted by the federal government are in no way prepared. Only 13 states have passed laws to guarantee operations.

“We have all of the technology,” Jennifer Piver, the executive director of Mental Health America of Greenville County in South Carolina, told NBC. “We do not have the funding for staff, for salaries.”

A study released by the Rand Report this month found that more than half of public health officials charged with launching the 9-8-8 line said they felt unprepared and without the necessary financing for staffing or infrastructure to handle the rollout. Only 20 states have even early-stage legislation designed to cover the costs.

Untreated mental health symptoms are a pervasive and persistent public health problem, Rand round. “Around 39 million individuals in the United States identified as having a mental illness in 2019. Of this number, fewer than one-half (45 percent) received treatment in the past year. Left untreated, individuals' symptom profiles can worsen to the point of becoming a mental health emergency.”

So what can we do to improve this disappointing situation?

Here, based on insights from mental health professionals themselves, are three recommendations:

1. Use surcharges

A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) argues that in order for the 9-8-8 number to be successful, states must work closely with the federal government.

Though SAMHSA offers grants to states, most receive only $2,500–$5,000 per year, with many states relying on volunteers to meet demands. The Rand report recommends embedding surcharges into 9-8-8 calls, which happens when callers use 9-1-1, but those charges require approval by state legislatures.

2. Emphasize texting

While dialing 9-8-8 is great, it doesn’t actually meet many users where they are. They need to be able to text 9-8-8, too. The folks at Crisis Text Line have found that three-quarters of their users are under 25, and nearly 80 percent are female. These users far prefer texts to calls because they can remain anonymous.

But in the Rand report, only a “few” of the 200 mental health professionals were confident that their states could accommodate texts.

3. Focus on diversity

The majority of respondents in the Rand report said their helpers were not trained to deal with children or adolescents, and even fewer to cope with LGBTQIA+ populations or people from indigenous communities. “Many of these groups may be especially at-risk for mental health emergencies, highlighting the importance of ensuring that providers are well trained to serve these groups and that culturally competent providers are available in the local community.”

9-8-8 has the opportunity to become a landmark piece of legislation and a unifying opportunity to address the growing mental health crisis in America. But first, we need to call 9-1-1 and ensure that our elected officials are giving the new number the $&₵ they need.

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