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Wednesday, October 27, 2021

Q&A: How will California’s new 988 mental health line actually work?


If you or someone you know is in a crisis, call the National Suicide Prevention Line at 1-800-273-TALK (8255) or call the Crisis Text Line by texting HOME to 741741.

In September 2020, Congress passed a bipartisan law creating a three-digit national suicide hotline: 988. Think of it as an alternative to 911 for mental health emergencies.

The system is designed to facilitate seeking immediate help during a mental health crisis. Instead of calling 911 or the 10-digit national hotline, Americans can theoretically speak to a qualified counselor by calling 988 from virtually any telephone line.

Federal law allows states to raise funds for these efforts by charging additional fees for monthly mobile and landline phone bills. The money can be used to support specialized call centers, pay for trained mobile response teams to replace armed law enforcement officers, and support stabilization services for people in crisis.

The states require some version of system 988 to be up and running by July 2022. But the actual form it takes varies from state to state.

In September, the California Department of Health announced that it will spend $ 20 million to launch System 988. AB 988 is a law that will set up to 80 cents per month on statewide telephone lines – both wireless and landline – to provide ongoing funding for the system and related services. The bill has met with opposition from the telecom industry, which argues that fees should be capped at 10 cents and only cover the cost of routing 988 calls to the appropriate crisis center. The bill passed the Assembly and is expected to be considered by the Senate next year.

Assemblyman Rebecca Bauer-Kahan, a Democrat from Orinda, is the primary author of AB 988, which she dubbed the Miles Hall Rescue Act after a 23-year-old man who was fatally injured by police in Walnut Creek during a mental health crisis. His family said he was diagnosed with schizoaffective disorder.

Bauer Kahan, a Bay Area attorney, spoke with Jenny Gold of KHN about efforts to launch 988 service in California and the capabilities of the new system. Conversation edited for clarity.

Q: New federal law requires each state to have a 988 telephone system installed by July. How is California, and will we be ready?

I hope that it will be so. We definitely have a lot to work on. In September, we committed $ 20 million to cover the start-up costs of building call centers. The data shows that an increase in the number of calls should be expected by about 30%. [for California’s 13 suicide prevention call centers] when the 988 rolls out in July. So it is very important to make sure that call centers have the ability to staff and train people so that we are ready.

Q: Why is it important to have an emergency system dedicated exclusively to mental health?

This is a public health issue, but it is currently viewed as a public safety issue. And this leads to a number of problems. I would say the biggest problem is that [an estimated] 25% of all executions with the participation of officers are people in critical condition. This tells us that we are not getting the support we need for the people who need it.

Our law enforcement agencies have been incredible support for this effort because they know there are people who are better equipped to manage people in crisis. The largest mental health provider in the country is the Los Angeles County Jail, and this is the most annoying thing I’ve heard. People cannot be treated in our prisons.

Q: What does the complete 988 system look like?

Federal law required 988 calls to be answered by certified suicide prevention centers. We have 13 of these call centers in California, so they will be the people to answer.

Behind the call, the county you live in will listen and determine if you need a shipment. We believe that in fact a good percentage of callers will be served by telephone only. But for those who need a response on the ground, there will be a warm transfer to the district services.

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People who have law enforcement agencies today will instead get a mobile crisis team to support them in that moment of crisis. They will then be referred to mental health stabilization and long-term care services.

Q: What happens after the emergency responders answer the call to 988? Will the patient be referred to a system that is different from the one we have now, where people are so often taken to the emergency room or prison?

The goal is yes. They will not go to jail because the law enforcement agencies will not answer. Thus, our prisons will not remain our largest providers of mental health services, but we will create a network of services.

Some people do require inpatient care that cannot be provided outside the hospital, and we need to make sure we have [necessary] beds that we don’t have today. If someone needs to talk to someone on a weekly basis, the district can provide these services.

[We need to ensure that] the counties that really need to be service providers have the resources to help those in need. And at the present time, we are simply terribly inadequate in the services that we can provide. The bill does allow counties with appropriate funding to create a system that works for the good of society.

Q: We have a crisis that goes far beyond police intervention, given that we don’t have places to treat people during mental health emergencies. Is this part of Vision 988, or is it mainly related to a very specific moment of first contact?

As I pondered this law, I have always said that this is a small piece of the puzzle. I will not say that I address mental health issues in one piece of legislation. I am really focused on this piece that the law enforcement agencies are responding to inappropriately today. How do you turn this into a public health response?

So, do we need a complete, reliable health and mental health system? Yes. Am I creating this all through 988? No.

So I think this will take a lot of work. I think this is an incredible step in the right direction, but I by no means believe that it will solve all our problems. The ultimate goal is to provide complete, continuous care so that counties can provide the services everyone needs to get them to a healthy place.

Q: Is there a way to raise funding through 988 to help along this broader continuum?

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