By Kerry Dooley Young
Federal officials and telecommunications companies are working on a new national three-digit number to make it easier for people experiencing mental health crises to find help.
There are many angles for journalists who want to track how federal agencies are working to meet the July 2022 deadline for the new 988 dialing code. This code would be operated through the existing National Suicide Prevention Lifeline, 800-273-TALK which already operates 24 hours/day, seven days a week.
It’s important in the months ahead for journalists to note in their stories that 988 is not yet a nationwide calling code. Journalists should consider the advice that a member of the Federal Communications Commission (FCC) gave in a 2020 statement. Then FCC Commissioner Michael O’Rielly warned against “giving a false promise to the public that 988 is already operational.”
Journalists should note how much effort will be needed to establish the 988 code. Deploying 988 “isn’t a matter of simply pulling a proverbial switch,” O’Rielly said.
Instead, it will require telecommunications companies to replace, update, or otherwise alter their systems, as well as changes in dialing, he said. Fully implementing the 988 code will require consumer education and coordination with state public utility commissions, he said.
“Even in the best of circumstances, such transitions can be challenging and lengthy,” O’Rielly said. “Acknowledging the work ahead doesn’t diminish the extensive work that’s been done to arrive at this point; it just reflects the reality of the transition.”
This tip sheet will explore resources for covering the work of two federal agencies involved with the implementation of the 988 code.
The FCC created the hotline regulations, working with the feedback of telecommunications companies and advocacy groups. The Substance Abuse and Mental Health Services Administration (SAMHSA) is aiding the local organizations that will respond to 988 calls. The tips provided here on covering SAMHSA’s work can also be applied to covering other federal agencies and initiatives.
SAMHSA
A December report from SAMHSA is worth at least a skim if you are looking into the launch of the new three-digit emergency code. Titled 988 Appropriations Report, it provides a history of the efforts to create the new dialing code and statistics about use of the current lifeline program.
Other highlights of the 988 Appropriations Report include:
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Details drawn from a 2020 report, “Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies,” from the National Association of State Mental Health Program Directors. This report, for example, says the Tucson (Arizona) Police Department reduced the number of SWAT deployments from 14 per year to two by changing its response to people experiencing suicidal thoughts “barricading” in their homes. The change saved $15,000 per response.
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Explanations of the immediate funding needs for the 988 launch.
SAMHSA allocated $177 million for the budget year that began in October 2021 (fiscal 2022) for strengthening network infrastructure and scaling up centralized network capacity. This includes expanding staffing and the costs of evaluation and oversight. Another $105 million is needed for strengthening local crisis call center capacity.
Why the title “988 Appropriations Report”? And what the heck are “appropriations” anyway?
The House and Senate each have an Appropriations committee. These two committees work together to create the legislation needed to run much of the federal government, known as spending or appropriations bills. Think of these bills as setting the annual operating budgets for agencies.
Many committees in Congress do some oversight of federal agencies such as scheduling a series of hearings on important topics like the opioid epidemic and drug costs. Some of the most thorough oversight occurs as part of the work done in creating the annual spending bills in the Appropriations committees.
Members of other committees often delve into an issue, but then eventually move on to other topics such as the composition and leadership of the committees change. Appropriators, in contrast, year after year look at the operations of federal agencies. And their control of the annual spending bills gives clout to try to demand some accountability from leaders of federal agencies.
Appropriators often stick with a subcommittee for many years, developing expertise on their areas of jurisdiction. An extreme case of this is Rep. Rosa DeLauro (D-CT), who is chair of both the House Appropriations Committee and its Labor-Health and Human Services-Education subcommittee. DeLauro began her service on this panel in the 1990s, according to a history of the Appropriations Committee.
DeLauro in May held a hearing titled Mental Health Emergencies: Building a Robust Crisis Response System. This looked in part at the plans underway for the July 2022 rollout of the 988-dialing code. 988 will function as an alternative to 911, DeLauro said.
“Untreated mental illness can escalate to a crisis situation where a family member, friend, or someone in the community feels they have no choice but to call 911 — which inevitably leads to situations in which law enforcement are responding to what is actually a mental health emergency,” DeLauro said in a statement for the hearing.
“Meanwhile, for the individual, arrest can cause unnecessary trauma, which can make their long-term recovery more difficult. This can lead to high rates of incarceration or even more tragic outcomes, including needless death — particularly for Black or Brown people,” she added.
There’s a video of the May Labor-HHS-Education Appropriations hearing and copies of witness testimony posted here.
The House Appropriations Committee usually holds a hearing with the HHS secretary to review the annual budget request for the department. So if you are following the implementation of the 988 dialing code, it may be worth asking the media contact for the House Appropriations Committee if DeLauro or another member of the panel will raise this issue at the next HHS budget hearing.
Indeed, if you are covering any federal agency or program in depth, it’s worth trying to find out whether any appropriator takes an interest in it. These lawmakers and their staff can be good sources. Email me at patientsafety@healthjournalism.org if you want help in finding an appropriator.
The FCC
The FCC has a good short overview of its work on the 988 code on its Suicide Prevention Hotline webpage.
More detailed and highly informative are orders that the FCC issued in 2020 and 2021 on the 988 code. Accompanying these orders were statements by FCC commissioners. The orders and statements are helpful for journalists new to this topic. These resources also could help journalists who want to add depth to their stories about the 988 code while facing tight deadlines.
Important terminology
2020 order – Designating 988 for the National Suicide Prevention Lifeline
The FCC on July 16, 2020, adopted a rule that laid the groundwork for the 988 code. According to a commission press release, these rules provide for a two-year transition, “reflecting the real challenges of this nationwide effort, including the need for widespread network changes and providing time for the National Suicide Prevention Lifeline to prepare for the expected increase in the volume of calls.”
The text of the 68-page rule itself contains a history of major U.S. efforts to improve the response to calls for help from people experiencing suicidal thoughts or other mental health crises. It also summarizes many of the technical issues involved with creating the 988 code.
The rule also noted support for text option for 988, which the FCC chose at the time not to include. It would be “premature” to mandate a text option, the rule said. In a statement included in the report, then-FCC Commissioner Jessica Rosenworcel argued the agency needed to be “more ambitious” in its approach to texting.
Suicide is now among the top causes of death for teenagers and young adults, Rosenworcel noted in a public statement on the 2020 order, citing data from the Centers for Disease Control and Prevention.
“Voice service has its benefits, but it is not native for most young people. So, I regret today’s decision is anchored in older technologies and takes a pass on developing texting capabilities with this three-digit hotline,” said Rosenworcel. “We should have done so here. I sincerely hope we can do so in the future.”
2021 Order- FCC Approves Text-to-988 Access to Suicide Prevention Lifeline
In November 2021, the FCC approved an order that requires covered text providers to support text messaging.
The order notes the results of a test of texting with the National Suicide Prevention Lifeline. SAMHSA launched a texting program in August 2020 after determining that hundreds of people were attempting to text this lifeline and failing to reach crisis help.
From August 10, 2020, to May 31, 2021, the lifeline received and responded to approximately 33,518 text messages at certain crisis centers, without advertisement of the capability. As of late 2021, 33 crisis centers provide text services for the lifeline, the FCC said.
People with disabilities and younger people tend to rely more on texting than phones, Rosenworcel said in a statement about the 2021 order.
“The bottom line is it shouldn’t matter if you make a voice call or send a text message because we should connect people in crisis to the resources they need, no matter how they communicate,” she wrote.
Here’s a final suggestion on covering the adoption of the 988 code.
Follow-up with phone companies on their progress. T-Mobile in November 2020 said it was the first major wireless provider to activate the new nationwide 988-emergency lifeline for customers. The FCC order on texting notes that Verizon Wireless and AT&T also have made 988 available to customers with mobile service well ahead of the July 2022 deadline.
