By July, the United States will switch to an expanded suicide hotline for which people can call a three-digit number — 988 — to get help.

Easier to remember than the 800-273-TALK number now in use, 988 is meant to emulate 911 in simplicity and seriousness.

It’s also hoped that 988, not 911, will eventually become the number called when a person is experiencing a behavioral-health crisis, obviating the need for police to show up at the scene of an emergency for which they may not be trained.

Behavioral-health professionals believe that a 988-like system might have prevented the death of Walter Wallace Jr., 27, a mentally distressed West Philadelphia man who was killed by police last year. Wallace was armed with a knife when police shot him.

An estimated 30% of all calls to 911 would be more appropriate for 988, according to Kristen Houser, deputy secretary of Pennsylvania’s Office of Mental Health and Substance Abuse Services, which will oversee the implementation of 988 in the state. The office is part of the Department of Human Services.

The 988 line was established by Congress in October 2020 in the bipartisan National Suicide Hotline Designation Act. The legislation establishes July 16, 2022, as the official start date, and stipulates that individual states must come up with legislation to show how the service will be funded and implemented. So far nine states have done so. New Jersey has a bill under consideration. No such legislation yet exists in Harrisburg, though Gov. Tom Wolf’s office has proposed a bill without information on funding.

Though U.S. suicide rates appear to have gone down during the pandemic, there were still roughly 2 million calls to the 10-digit National Suicide Prevention Lifeline last year. The streamlined, easier-to-remember 988 line will garner 24 million calls, texts, and online chat requests by 2027, the Pew Charitable Trusts predicts. About 46,000 people died of suicide in 2020.

Continuum of care

Once fully functional, 988 will be seen as much more than a suicide hotline. What separates it from the current option is a “continuum of care” that will, behavioral-health experts hope, kick in to better support someone in anguish. A person first speaks on the phone with a trained responder in a call center; then, depending on the situation, a mobile crisis team may show up at the person’s doorstep; if needed, the person is taken to a crisis-stabilization site in a non-hospital setting; and the person continues to receive follow-up care.

“The continuum can keep people out of courts, prisons, and emergency rooms,” said Ann Torregrossa, executive director of the Pennsylvania Health Funders Collaborative, a group of 40 foundations headquartered in Swarthmore. “With our existing hotline, we really don’t have a call system that can address all of this.

“It’s long overdue and could be extraordinary.”

However, the way forward may not be smooth.

For starters, 988 is expected to be expensive, though no one can yet say how much. Congress has stipulated that states can offset costs through added fees on phone lines.

That’s the major source of revenue for 911. In Pennsylvania, phone customers are assessed a fee of $1.65 per month to help underwrite the emergency line to call police, fire, and ambulance services, according to figures from the Pennsylvania Emergency Management Agency (PEMA).

In 2020, that surcharge generated $318 million, PEMA figures show. Together, the state’s 911 lines cost $416 million, a difference of about $98 million. In Pennsylvania, each county has the responsibility for providing 911 service in its jurisdiction, so the 2020 shortfall was paid by county general funds or other county revenue sources, a PEMA spokesperson said.

Other funding for 988 could come from Medicaid reimbursements for mental-health care, as well as from federal block grants, according to an October Pew report.

Americans like it

Americans seem to back the idea. Around 70% of people surveyed said they’d be willing to pay a fee to underwrite 988, according to Hannah Wesolowski, a director at the National Alliance on Mental Illness, an advocacy group in Arlington, Va.

In press releases, the telecommunications industry is saying it’s supportive of 988 as well. CTIA, the lobbying arm of the wireless telecommunications industry, issued a statement in 2020 backing implementation of 988 “to ensure that Americans have increased awareness about the support and services needed to prevent suicide.” CTIA even said it has switched on 988 already in many locations, although it connects only to the existing national suicide hotline system, without any of the proposed 988 features in place.

The organization listed Verizon, T-Mobile, and AT&T as being enthusiastically on board with 988.

But in testimony in Colorado in April to discuss proposed 988 legislation, a CTIA official said any telecommunications fee should pay for call centers only, and “should not fund the response” — mobile-crisis teams and stabilization and follow-up services.

That’s drawn the ire of Congress, including Senate Finance Committee Chair Ron Wyden (D., Ore.) and colleagues who wrote to CTIA in July saying they’re “gravely concerned” that the telecommunications industry “is actively working to limit the states’ implementation of this critical lifeline for Americans in crisis.” The senators added that mobile-crisis teams and crisis-stabilization services “are all fundamental to breaking the cycle of suicide.”

CTIA officials did not respond to a request for an interview.

Pennsylvania State Rep. Michael Schlossberg (D., Allentown), co-chair of the Legislature’s mental-health caucus, agreed that telecommunications companies “are not too keen to increase their fees to pay for 988.” But, he added that 988 “is an important elevation of the issue of mental health.” Personal experience informs his current efforts in the Legislature to get a bill underwriting 988 passed, he said, adding, “I’ve been suicidal at points in my life and that’s why I’m more into this role.”

Not ready

The lack of legislation in Pennsylvania that would delineate how 988 will work is worrisome to some.

“We’re not where we need to be to be ready by July,” said Joe Pyle, president of the Thomas Scattergood Behavioral Health Foundation, a grant-making organization in Center City. “There is no true champion of mental health in Harrisburg.”

Still, Houser of DHS said, “nobody is flat against legislation,” which behavioral-health advocates believe is a sign that the project will get done. Still, experts say, it could take as long as two years for the ambitious continuum-of-care model to be completed.

Houser said there are plans to market 988 closer to the July roll out. Not even many local health professionals are aware of the project. One exception is Thomas Jefferson University, where researchers are helping set up the new line, according to people familiar with the work. A research official at the university declined to be interviewed.

Ultimately, 988 — if carried out as planned — can “divert people from completing suicide and reduce [drug] overdoses as well as in-patient psychiatric visits,” said Joni Schwager, executive director of the Staunton Farm Foundation, a Pittsburgh nonprofit that distributes grants to benefit behavioral health.