Citizens can call or text the number 24 hours a day, seven days a week to talk to trained crisis workers free of cost.

The three-digit number proposed by Congress in 2018 will accompany the current 10-digit National Suicide Prevention Lifeline with officials believing an easier to remember number may serve the public in a wider capacity.

“We know that remembering a three-digit number beats a ten-digit number any day, particularly in times of crisis,” said Department of Health and Human Services (DHHS) Secretary Xavier Becerra.

The current Lifeline phone number at 1-800-273-8255 will stay in operation even after 9-8-8 is launched.

Funding and Alabama usage

To assist the transition to the new text and call number from the former system, the DHHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) has invested $282 million into personnel training and infrastructure for new communication channels, with funds consolidated from the 2022 fiscal budget and the 2021 American Rescue Plan to help ease the move.

Funds were split into two categories for the new 9-8-8 system in the SAMHSA 9-8-8 Appropriations report:

• $177 million to strengthen network operations with expanded staffing for employee backup, training, data research, telephone infrastructure and support for chat and text centers.
• $105 million to strengthen local crisis center call and visitor capacity with increased response rates, increased staff, follow up and follow through so individuals are actively engaged with local mental health services, sufficient resources to train staff and volunteers and sufficient funds to pay staff.

Alabama residents called the 10-digit National Suicide Prevention Lifeline 35,095 times in 2020, and out of the over 35,000 calls placed, 9,006 callers pressed “1” to be transferred to the veteran’s crisis line, or 26 percent of all who those phoned in.

High on the call sheet, veterans are also at a much higher risk for suicide than non-veteran citizens. On average, 31.6 veterans commit suicide out of 100,000 people each year, compared to 16.6 non-veterans committing suicide out of the same size group.

“Too many veterans are experiencing suicidal crisis or mental health-related distress without the support and care they need,” Bob Horton, Assistant Commissioner of Outreach and Engagement for the Alabama Department of Veterans Affairs, told the Alexander City Outlook.

“The new 9-8-8 Suicide and Crisis Lifeline takes a comprehensive approach to behavioral health by connecting Veterans to compassionate, accessible care and support if they are experiencing mental health-related distress such as suicide, substance use crisis, or any other kind of emotional distress.”

Horton was one of 17 representatives from various state agencies that served on Alabama’s 9-8-8 Crisis Services Committee in April 2020, paving the way for the addition of the new system with the creation of a commissioned study on the 9-8-8 Comprehensive Behavioral Health Crisis Communication System. The state’s first and only 9-8-8 legislation to date.

“Veterans contacting 9-8-8 will be offered follow-up services to facilitate on-going support and crisis care as needed. The public can also call 9-8-8 if they are concerned about a loved one who may need crisis support,” Horton said.

A plan in motion

Alabama Governor Kay Ivey approved two new Crisis Centers for Tuscaloosa and Dothan in May, citing a need for increased support for Alabamians with mental health challenges.

“During my time as governor, I’ve placed a renewed focus on finding innovative ways to support Alabamians that find themselves battling mental health issues, and I have no doubt that these two new facilities are going to change lives for the better,” Ivey said in a statement.

With the addition of the two new crisis centers, Alabama will now house six crisis centers in a few of the highest populated cities in the state such as Huntsville, Birmingham, Montgomery and Mobile.

Crisis centers house a regional call center, a mobile crisis team to support individuals wherever assistance is needed, crisis peer support, crisis case management and a co-response of emergency medical personnel and law enforcement for hospitals. First responders and law enforcement officers are encouraged to take individuals suffering from mental health or substance abuse crises to a center when applicable to the situation, where individuals can receive stabilization, evaluation and psychiatric.

The call center referral service to local treatment programs is free of charge and those who are uninsured will be referred to state-funded treatment programs when available.

Individual treatment services vary for pricing on a case-by-case basis depending on insurance coverage, but no one will be denied care if they are uninsured.

“Crisis centers are here to serve people regardless of their ability to pay,” said the Alabama Department of Mental Health.

“(The individual’s) coverage and their income are taken into consideration for any subsequent billing after treatment.”

Alabama has made significant changes to the approach to mental health during Ivey’s tenure as governor, opening the state’s first three crisis centers in May 2021 before an additional center was built in Birmingham in October of the same year.

“The state of Alabama is proud to continue doing its part to offer top notch crisis care to people in need,” Ivey said.

The Alabama Crisis System of Care’s first progress report of mobile crisis units tallied 1,809 total interventions and 210 individuals who avoided jail admission, with only seven individuals being dropped off at a crisis center for further intervention during the 2021 fiscal year.

In May to October, 85 individuals were dropped off to Crisis Centers by law enforcement officers in the state instead of being booked into jail for processing, exemplifying the Centers’ mission to decrease engagement and reliance on police services. In 2015, 23 percent of all police-related civilian deaths in the United States were people who had evidence of mental illness, while the National Institute of Mental Health estimates that just 4.2 percent of the population has a serious mental illness, a discrepancy among those killed in police interactions, according to a study titled Deaths of People with Mental Illness During Interactions with Law Enforcement, published in the International Journal of Law and Psychiatry in 2018. The Alabama Crisis System of Care seeks to reduce the number of arrests and preventable tragedies with their mantra of "right care, right rime, right place".

Birmingham's Crisis Center answered 4,852 of the state's calls in 2021 and generated $3,389,605 from government grants, non-government grants, program events and United Way allocations, with $3,155,405 of that revenue being spent on program services and general administration and fundraising. The difference is donated back into the Crisis Center as a non-profit corporation.

Cell providers mandated to comply

On the provider side of things, the Federal Communications Commission (FCC) has made requirements for cell providers to support text messaging and calls to 9-8-8, in anticipation for the new change and challenge on providers and call center employees and volunteers. Every cell provider in the United States is required to allow text and calling to the 9-8-8 number by July 16 by order of the National Suicide Lifeline Designation Act of 2020.

The public law requires the designation of 9-8-8 as the “universal telephone number for suicide prevention and mental health crisis online” and allows states to pass legislation to impose and collect fees on calls to the lifeline, similar to a 9-1-1 fee that users currently pay in most states nationwide. Alabama currently has the highest police call fee out of all 50 states at $1.86 per call, but no current plans to implement a fee for 9-8-8. Future legislation could approve of fees, however. 

The Alabama 9-1-1 Board, the state agency that oversees the effectiveness and reliability of 9-1-1 calls, met at the Summit on Federal Initiatives Impacting 9-1-1 in July 2021 to assess various measures for a successful integration of 9-8-8, including: capacity expansion for 24/7 availability of texts and phone calls, study of 9-8-8 bills in other states to prepare for legislative action, public awareness campaigns, evaluation of current call volume, staffing and funding of Alabama’s current Crisis Centers.