ACTION NEEDED: 

Urge your members of Congress to appropriate Fiscal Year (FY) 2023 funding for the National Suicide Prevention Lifeline that is at or above the level of $101.6 million appropriated in FY 2022. Additionally, urge your members of Congress to support the passage of authorizing legislation that will support and strengthen county crisis response infrastructures.

BACKGROUND:

In 2020, Congress unanimously passed the National Suicide Hotline Designation Act, which established a three-digit dialing code (9-8-8) for the National Suicide Prevention Lifeline (Lifeline), a national hotline that would facilitate local mental health crisis service coordination. The FCC officially designated 988 as the three-digit dialing code for the Lifeline in July of 2020, which will be nationally available by July 2022. Until that time, at-risk individuals can contact 1-800-273-8255 now to receive services. The Lifeline answered more than 2.1 million calls and 234,671 chats in 2020.

In 2020, 44,834 individuals died by suicide in the United States, and evidence suggests that the COVID-19 public health emergency has only exacerbated stress on the mental health and wellbeing of many Americans. SAMHSA’s 2020 National
Survey on Drug Use and Health (NSDUH) data show 4.9 percent of adults aged 18 or older had serious thoughts of suicide, 1.3 percent made a suicide plan, and 0.5 percent attempted suicide in the past year. Among adolescents 12 to 17, 12 percent had serious thoughts of suicide, 5.3 percent made a suicide plan, and 2.5 percent attempted suicide in the past year. The findings vary by race and ethnicity, with people of mixed ethnicity reporting higher rates of serious thoughts of suicide.

The implementation of the 988 National Suicide Prevention Lifeline is a critical step in building a stronger crisis care system, by establishing a universal entry point to access needed crisis services that mirror other emergency medical services, such as 911. Lifeline crisis call centers are primarily financed by state and local level governments, who also fiscally contribute to the provision of behavioral and mental health services, with support from federal funds through the Medicaid program.

The Consolidated Appropriations Act of FY22 allocated 101.6 million in FY22 appropriations, an increase of 77.6 million above the FY21 enacted level and continued the mental health crisis system set aside under the Mental Health Block Grant at 5percent.Aside from fiscal investments, the implementation of 988 requires additional congressional action that builds local crisis capacity and ensures that an infrastructure is in place to support Lifeline users and connect them the appropriate care in their local community.

Counties urge federal policymakers should enact legislation that would support these efforts by mandating crisis services be covered by all health insurers; create 24/7 crisis call centers that serve as centralized hubs for answering calls and connecting individuals to services, assist in building the crisis response workforce that both staffs call centers and respond to calls via mobile crisis teams; and support the development of crisis stabilization programs that provide an alternative to treatment in a jail or emergency department.

COVID-19 SUPPLEMENTAL FUNDING & POLICY:

The American Rescue Plan Act of 2021 (P.L. 117-2) created a new state Medicaid option for qualifying community mobile crisis intervention services, allowing states opting to provide the service to receive an 85 percent federal match for 3 years starting April 1, 2022. The House-passed Build Back Better Act (H.R. 5376) would make this a permanent Medicaid Option if passed. Additionally, the American Rescue Plan Act invested $15 million for state planning grants to implement the new Medicaid option alongside $1.5 billion in supplemental funding for both the Community Mental Health Block Grant and the Substance Abuse Prevention and Treatment Block Grant, key funding streams for mental health services at the local level. In December 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that it would be investing $282 million in funding from the American Rescue Plan Act to supplement FY 2021 appropriations for the Lifeline. Most recently, the 2022 Bipartisan Safer Communities Act appropriated $150 million to SAMHSA to support the implementation of the lifeline. These investments, alongside FY 2022 appropriations will aid 988 efforts across the country to scale up local crisis call center operations and hire adequate staffing.

KEY TALKING POINTS:

• Suicide is the tenth leading cause of death in the United States and the second leading cause of death among individuals between the ages of 10 and 34.
• Counties are an integral part of the local behavioral health crisis care continuum and will be key implementers of the National Suicide Prevention Lifeline.
• Lifeline crisis call centers are primarily financed by state and local governments, who also fiscally contribute to the provision of behavioral and mental health services, with support from federal funds.
• Congress should appropriate FY 2022 funding for the National Suicide Prevention Lifeline that is at or above the level of $101.6 million in FY23.
• Congress should support the passage of legislation that will further support and strengthen county crisis response infrastructures.