New National Suicide Prevention Lifeline number needs more state-level commitment: Becerra

Health and Human Services Secretary Xavier Becerra told reporters Friday that the upcoming launch of the National Suicide Prevention Lifeline's new three-digit number, 988, on July 16, "will work, if the states are committed to it."

The new number, which advocates envision as the mental health equivalent to 911, Becerra said, "Won't work well, if they're not [committed]."

The Lifeline has been in operation using a 10-digit number since 2005. In the years since, the service has received more than 20 million calls from people experiencing mental distress.

With the launch of the new number, the Substance Abuse and Mental Health Services Administration (a division of HHS) expects a dramatic increase in the call volume for the Lifeline over the first year of 988's implementation.

The Lifeline has been underfunded and understaffed since its establishment. Despite an influx of federal funding from the Biden administration, states across the nation are still struggling to develop the infrastructure required to ensure all calls are answered.

As the launch of the new number approaches, Becerra says, "Failure is not an option."

The hope for the new number, Becerra says, is, "If you are willing to turn to someone in your moment of crisis, 988 will be there. 988 won't be a busy signal and 988 won't put you on hold."

"You will get help," he said. "That is the goal. That is the aspiration. And it doesn't happen overnight."

The Lifeline network consists of more than 200 call centers nationwide, which are funded largely at the state level. When Congress first designated 988 as the new Lifeline number in 2020, it gave states the authority to levy cell phone fees, similar to those in place for 911, to fund the service.

Only four states have implemented such taxes as of June 29, according to an analysis of state legislation around 988 from the National Academy for State Health Policy. Several other states have allocated general appropriations funding to assist with the launch of the new number.

Due to inconsistencies in funding at the state level, response rates also vary across state lines -- a problem SAMHSA and HHS say they have been working to address ahead of the new number's launch.

"There's no reason, no excuse that a person in one state can get a good response and a person in another state gets a busy signal," Becerra said.

The federal government previously allocated $105 million in funding to assist states and territories in preparing for the launch of the new number. An additional $177 million went toward funding the national backup centers that field calls unable to be answered at the local level.

Congress also recently authorized an additional $150 million for the Lifeline during Fiscal Year 2022 as part of the Bipartisan Safer Communities Act — a legislative package focused on combating gun violence.

"President Biden has made it very clear" that mental health services are a "top priority," Becerra said, but added it is incumbent on states to stand this system up long-term.

Asked by ABC News about efforts to increase workforce capacity to meet the expected jump in call volume and a timeline for a consistent answer rate across state lines, Becerra said, "We went in big early to make it work."

"We need the states," he continued. "We are essentially helping the states learn to crawl, walk and run."

Dr. John Palmieri, acting director of 988 and Behavioral Health Crisis at SAMHSA, added, "States are in different places on this."

SAMHSA has set "aspirational targets," Palmieri said, of a 90% in-state response rate by 2023, "understanding that it's going to take time to get there."

While the national backup centers can take calls that local centers can't answer, advocates say a local response is ideal as it allows callers to be given follow-up resources near them after a mental health crisis.

"It's really important for us that when you call, you get someone who is near you," Becerra said.

In an effort to encourage states to bolster their own funding and workforce commitments for the Lifeline, HHS and SAMHSA have been sending letters to governors for the last few months with their call answer rates.

"We wanted to make sure they knew what they were doing," Becerra said, adding, "No governor is unaware of where their state stands."

Long term, he said, "I hope [988] does become the place that people can go to be rescued."

If you are struggling with thoughts of suicide or worried about a friend or loved one, help is available. Call the National Suicide Prevention Lifeline at 1-800-273-8255 [TALK] for free, confidential emotional support 24 hours a day, 7 days a week.