California Mental Health Crisis Hotline Debuts- CalMatters

In summary

The new federal number is billed as an alternative to 911 for people experiencing mental health emergencies. A bill would allow California to fund call centers with new rates on phone lines.

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Starting Saturday, people experiencing mental health crises need to remember just three numbers to call for help: 988.

The new federal number, which will debut in California and across the country this weekend, is billed as an alternative to 911 for people experiencing mental health emergencies. Here, advocates say the shortcut will make it easier for people in crisis to access the statewide network of 13 National Suicide Prevention Lifeline call centers.

The plan has been in the works for nearly two years.

In October 2020, then-President Donald Trump signed a bipartisan bill to establish 988 as a national number. That law also gave states the option to fund call centers and mental health crisis services by adding new rates to phone lines. So far, only four states have made it; California may soon be poised to be fifth.

With additional funds from those fees, along with federal, state and county investments, the architects of 988 ultimately envision leading to an expansive national overhaul of the mental health delivery system, one in which callers take advantage of a crisis response system that keeps police out of the equation.

At this point, that larger system, first pioneered by the federal government, remains mostly just a vision. But mental health leaders in California say they hope a plan for the project, including the means to fund it, will begin to materialize next year.

Others warn that large-scale implementation in the state’s 58 counties may prove difficult in the long run, given that the state distributes mental health funds and services at the county level.

Compared to many other states, California appears to be in relatively good shape to welcome an influx of new callers as word of 988 spreads, according to some mental health leaders.

“It’s important, it’s necessary, it’s going to happen,” said Le Ondra Clark Harvey, executive director of the California Council of Community Behavioral Health Agencies, which includes four of the state’s 13 call centers. “When that proverbial switch is flipped, our centers are ready to hit the ground running.”

Between 2016 and 2020, California’s National Suicide Prevention Lifeline call centers saw a 67% increase in calls, a figure that increased even more as the pandemic progressed. Despite this, call centers in the state have been able to answer 90% of callsaccording to data from the National Suicide Prevention Lifeline.

By comparison, in Vermont, which state response rate is 52%; in Texas, 40%; and in Wyoming, 16%display group data.

“When that proverbial switch is flipped, our centers are ready to hit the ground running.”

Le Ondra Clark Harvey, California Council of Community Behavioral Health Agencies

Having an answer in the state is important because local call centers are more familiar with available resources than national call centers that take calls if no one is available locally.

Call centers in California say they are anticipating an influx of calls and have been investing in infrastructure and training to prepare. To support this, the state Department of Health Care Services authorized $20 million last fall. This year’s budget includes an additional $8 million to fund call centers.

An invoice going through the Legislature would raise additional funds for the program by adding a fee to cell phone lines. Other federal bill it would also bring in additional funding for the hotline and crisis services, if approved.

Jonathan Porteus, executive director of Sacramento-based WellSpace Health, which runs a suicide prevention crisis hotline serving much of the state, estimates that calls to his center may triple in the coming months. As word spreads and more people seek help, he said he is confident in his organization’s ability to take calls and texts.

But he worries about what comes after that. What if a suicidal caller requires immediate in-person mental health support in a location that has none? What if they are in a remote rural location? Or snowy?

“For the most part, resources are stretched very little,” he said. The state’s county-level patchwork approach to mental health care will likely mean some counties may offer significantly less than the public anticipates, said Michelle Doty Cabrera, executive director of the Behavioral Health Directors Association of California.

“The silver lining is that 988 is pushing all of us to dream big about what could be and the possibilities,” he said.

The challenge is especially acute in rural counties that are struggling to recruit mental health workers. Cabrera points out that in Mono County, in the Eastern Sierra, even the sheriff’s department closes between midnight and 6 a.m. system?

“If we want that kind of system on the mental health side, it costs a lot of money and requires a lot of bodies.”

Phebe Bell, Nevada County Director of Behavioral Health

Some, like Porteus, suggest that a regional approach might help. But that strategy also has limitations, says Phebe Bell, director of behavioral health for Nevada County, which stretches from the hills near Sacramento to the Nevada border. If her county is clustered with other counties and the closest mobile crisis team is located 90 miles away, it will be difficult for them to respond quickly enough, she said.

“If we want that kind of system on the mental health side, it costs a lot of money and requires a lot of bodies,” he said. “And if we don’t, let’s be clear, it’s not going to be the same everywhere.”

By contrast, in Los Angeles County, mobile psychiatric response teams are already available between 8 a.m. and 2 a.m., said Connie Draxler, acting deputy director of the county mental health department.

In the coming weeks, the county plans to contract with outside vendors to fill in remaining gaps in order to have a 24/7 mobile response system, he said. The extent to which the rest of the system can be built depends, in part, on the funding streams that are raised.

Across the state, counties are keeping an eye out for pending legislation that could help.

The bill that would add the fee in California, AB 988, was originally introduced last year by Democratic Assemblywoman Rebecca Bauer-Kahan, who named the bill the Miles Hall Lifeline Act to honor a young man in her East Bay district. what was it killed by police during a mental health crisis.

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Last year, the bill faced opposition from the telecommunications industry and was introduced. Months of negotiations between industry representatives and the author and sponsor this spring finally led to a significant reduction in the fee cap, lowering it from 80 cents originally to 30 cents in the current bill. The industry has now abandoned its opposition.

Janus Norman, president of the California Cable and Telecommunications Association, said the companies he represents know the importance of improving access to mental health.

“Honestly, again, we don’t operate in a vacuum,” he said. “My companies are made up of professionals who live in society and experience things. We deal with mental health issues among our employees. We see the impacts the pandemic has had by highlighting some of these concerns. If we can find a reasonable place to be a part of a situation that is helpful, we want to do it.”

Bauer-Kahan says she is “surprised” by the unanimous bipartisan support this year for a bill she describes as a “labor of love.”

“I’m a mom,” she said. “I understand the need for this and I understand that we are failing families and we are failing people who are suffering.”

She emphasizes that the hotline is available to people of all ages, including children and teens in crisis.

“If we can find a reasonable place to be a part of a situation that is helpful, we want to do it.”

Janus Norman, California Cable and Telecommunications Association

Other states are watching California.

Stephanie Pasternak, director of state affairs for the National Alliance on Mental Illness, says passing the bill here “would be a huge boost” to similar efforts nationwide.

But even if the cell phone fee is passed, many mental health leaders in the state say the effort to truly transform the system is still in its early stages. A state task force is supposed to return to the Legislature in the coming months with a more concrete proposal on what comes next.

“In an ideal world, when 988 was released, it would be a complete continuum ready to go,” said Tara Gamboa-Eastman, senior advocate for the Sacramento-based Steinberg Institute, which sponsored AB 988.

While that’s not the case, he said, he’s still optimistic about the direction the state is taking in responding to people in crisis. She expects all counties to have an operational crisis response system in place by January 2029.

“Long term, I think we’re starting to see the pieces coming together,” he said.

For the record: This story has been revised to show that the California Council of Community Behavioral Health Agencies represents four of the state’s call centers.

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