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The long-term vision is that someone experiencing a mental health crisis or suicidal ideation can dial 988 to reach a local call center for support or to dispatch a mobile crisis team. Many of the 180 local call centers across the country struggle with funding. “Mental health has been underfunded for decades — we get pennies here, pennies there,” says Hannah Wesolowski, NAMI CAO. “The 911 system took decades to build but because of the pandemic, our need is high and we need to move as quickly as possible.” Congress did not mandate federal funding for 988, rather leaving it up to the states. Wesolowski says that due to the patchy funding, there won’t be a widespread marketing campaign for 988. “We don’t want people to call and not get connected,” she says. “The real fear is people losing trust in the system before the system is off the ground.”

Virtual health care has exploded during the COVID-19 pandemic, and new data indicates digital tools targeting the behavioral health needs of children and teenagers are no exception. While clinicians and health executives say these tools could offer some solutions for young people, they also come with challenges. It’s important to establish long-term relationships for children’s mental health care because it can be difficult for them to be “fully present and engaged” in treatment through a screen, said Dr. Christine Crawford, NAMI associate medical director. For particularly young children, “it may be really tough for the mental health provider to do a thorough assessment of the child if they’re frequently getting up and running around.” Crawford, for one, stressed that the advent of virtual care for pediatric mental health should mean patients have more options, not that digital care fully replaces in-person treatment. “For some people who may have more significant mental health-related concerns, it may be beneficial for them to meet with a therapist or meet with the psychiatrist in person,” Crawford said. And they shouldn’t “feel as though it’s any sort of failing or shortcoming on their part if they’re not able to get all of their needs met in one of these virtual apps.”

In advance of the July launch of 988, mental health experts worry about workforce capacity issues and the ability to provide 24/7 crisis care. "Fortunately, most [states] are taking this as an opportunity and are working towards increasing their Lifeline call centers within the network," said Hannah Wesolowski, NAMI CAO. "But when somebody calls in, and they wait, and they hang up — we have one chance to get this right for a person. Lives are literally at risk. These are people who are in crisis, might be having suicidal ideation. It's incredibly risky when those calls don't get through." Wesolowski explained that local call centers connect people to mental health care providers in their communities, as well as other resources, while the backup centers may not be able to provide that service. "We want to deescalate the immediate crisis, which is what those trained crisis counselors do, but we also want to connect them to resources so they stay well," Wesolowski said. "We don't want to just have them keep cycling into crises — crisis after crisis — it's really important that they get connected to needed care so they can get well and stay well beyond that crisis situation. So it's those local crisis counselors that can really make those connections. When there's not that local capacity. It's a huge concern."

The hope with 988 is that those who are in a mental health crisis will be able to be receive fast and safe help. "We believe strongly that people who are in a mental health crisis deserve a mental health response, not a criminal justice response," says Jennifer Snow, NAMI national director of government relations, policy, and advocacy. A survey conducted by NAMI found that 46% of people would not feel safe calling 911 for help if their loved one were experiencing a mental health or suicide crisis. The reason is likely in part due to police interactions have been dangerous and at times deadly. In fact, per NAMI, one in four fatal police shootings between 2015 – 2020 involved a person with mental illness. "Is it going to be perfect nationwide, come July? Absolutely not," Snow says. "But I'd like to say that it's getting better every day and more communities are expanding the ability to have that mobile crisis so that people can get the response they deserve." No. "It will never cost anybody to call the lifeline," Snow says.

Finding a therapist — let alone one who is a good fit — can take time and determination, especially during the pandemic, when many therapists report they cannot keep up with demand and must turn away patients. If there is a crisis, do not wait. The National Alliance on Mental Illness has information on various types of mental health crisis services, like mobile crisis teams and crisis stabilization units.

For an on-camera interview, Dr. Christine Crawford, associate medical director at NAMI, discusses the increased ER visits by young people or suicidal thoughts and behavior, and the lack of mental health providers to meet the increased demand for children in need of mental health care.

(CW: Suicide) The decline in the nation’s suicide rate during the first year of the COVID-19 pandemic may suggest advancements in preventative programs and treatment, but stakeholders contend a closer look reveals a complicated picture — one that raises questions on why the decline did not occur evenly across racial and ethnic groups. Dr. Christine Crawford, associate medical director at NAMI, says a potential positive that as a result of the pandemic is the increased willingness among people of all racial and ethnic groups to talk about their mental health and well-being. She hopes such openness can lead to new opportunities for expanding mental health care supports and services within underserved communities. “I think more people are able to better appreciate just how significantly impairing depression and anxiety and other mental health symptoms really are,” Crawford says. “My hope for the future is that not only can we normalize conversations around mental health and emotional wellness, but we can also normalize conversations around mental health treatment.”

Even though Congress created 988, Congress didn’t fund it. Right now, when people experiencing a mental health crisis call 911, most of the time they end up in a hospital or in jail. “More than 2 million people each year with a mental illness are booked into our nation’s jails and prisons. It’s a huge number,” says Hannah Wesolowski, NAMI CAO. Advocates like her see 988 as a chance to significantly shrink that number. “We have funded mental health this way for decades. It is pennies here, pennies there. It is out of the goodness of people’s hearts that organizations are there to support people experiencing mental health conditions. I’m hoping policymakers make the investments that we know we need to make,” said Wesolowski.

After stopping my anxiety medication too quickly, I needed expert assistance quickly. I have good health insurance, but finding an appropriate professional became a lengthy, frustrating process. The lack of current or reliable online information for mental health was a big problem, even for me — and I’ve worked in health care. In 2021, a research survey from the National Alliance on Mental Illness revealed growing dissatisfaction with online mental health information. The survey involved both individuals with mental health conditions and those seeking assistance for family members. Eighty percent of responders who used navigational tools to find treatment or services reported difficulties with data availability and accuracy.

“This is a once-in-a-generation opportunity to fundamentally transform part of the mental health system that for far too long has been underfunded and under supported,” said Hannah Wesolowski, NAMI CAO. “There’s a lot to happen between now and calling it a success.” Last week, bipartisan legislation was introduced to provide federal funding and guidance for states to rev up their 988 crisis response infrastructure. The Administration plans to request nearly $700 million for launching 988 in its upcoming federal budget.