HHS Secretary on 988 Lifeline: ‘Governors Have Got to Own This’

Saturday marked the official launch of the three-digit 988 Suicide & Crisis Lifeline, which is replacing the 10-digit National Suicide Prevention Lifeline.

The Lifeline received 3.6 million calls, chats, and texts in 2021, and HHS anticipates that number will “at least double” during the first full year following the launch of 988, a press release noted.

“Suicide rates are higher than they’ve ever been, including for young people,” HHS Secretary Xavier Becerra said during a press briefing promoting the Lifeline on Friday.

According to the CDC, one person died by suicide every 11 minutes in the U.S. in 2020, when suicide was the second leading cause of death among people ages 10-14 and 25-34. More than 100,000 people died of drug overdoses from April 2020 to April 2021.

Often when people are in crisis, they don’t need law enforcement, they need a mental health or substance use disorder professional, Becerra explained. So, when someone calls for help, “we want to make sure the appropriate professional responds. 988 takes us a long way to make sure that that happens.”

Of note, the Lifeline will also link to the Veterans Crisis Line. “Any veteran out there today, any family member of a veteran, any caregiver for a veteran, if you contact us on 988 and dial one, [to reach the Veterans Crisis Line] … we will make sure that if you need care today … you will see a mental health professional today,” said Denis McDonough, secretary of Veterans Affairs, during Friday’s press briefing.

According to Kimberly Williams, president and CEO of Vibrant Emotional Health, the nonprofit that administers the Lifeline, the “historic transition to 988 Suicide and Crisis Lifeline will promote help seeking and increase awareness and accessibility to this life-saving resource. The 988 Lifeline is a vital mental health safety net for all in this country.”

A press release from Vibrant noted that “the 988 Lifeline serves as a universal entry point to this free, confidential service, which is available 24 hours a day, seven days a week. No matter where a person lives in the United States or its territories, a trained crisis counselor will respond.”

The Lifeline is the byproduct of the bipartisan National Suicide Hotline Designation Act of 2020, which authorized 988 as the chosen three-digit number for addressing suicide and mental health crises.

All telephone service and text providers in the country and the five major U.S. territories will be required by the Federal Communications Commission (FCC) to activate the 988 number “no later than July 16,” according to the HHS press release.

Despite significant increases in the number of calls, texts, and chats received, the program’s success hinges on the willingness of states to make additional investments in crisis response systems, an anonymous official said during a press call last Thursday, with many states appearing to be far from ready for the transition.

“This is not a federal program. It’s just that President Biden made a deep commitment to it,” Becerra explained.

While the federal government has contributed resources to states to help stand up operations, it’s up to states to ensure that 988 succeeds, he said. “The governors have got to own this. They’ve got to take it as something for their family. It’s got to be a responsibility that the states, the tribal governments, the territories take on.”

Currently, the federal government is helping to manage text and chat services, so that states can focus on improving answer rates for phone calls, but ultimately all services will fall to states, Becerra said, noting that many states have identified “a sustained source of funding” for the Lifeline. Colorado, for example, will tax residents’ phone bills to support its crisis response system.

Asked during the press conference whether calls will be re-routed if a person calls 911 under circumstances that are more appropriate for 988, Jessica Rosenworcel, JD, chairwoman of the FCC, said her agency is still determining the best way for the two numbers to coordinate calls.

“So, what we’re going to do, after we start tomorrow, is study who’s calling from where, what kind of responses were necessary, and then identify over time how 988 and 911 can work better together,” she said.

As of Monday morning, HHS has not responded to questions from MedPage Today on how many states were fully prepared for the launch. However, officials on a press call last week told reporters that 911 took nearly 5 decades to be brought to scale.

The current 10-digit National Suicide Prevention Lifeline (1-800-273-TALK) will remain active indefinitely, the lifeline’s sponsors said.