Nov 18, 2021 - Technology

Suicide hotline's text upgrade could strain system

Illustration: Aïda Amer/Axios

A federal move to promote texting the national suicide hotline for help could strain crisis center capacity.

Why it matters: Texting can make reaching help more accessible for vulnerable communities, including young people and members of the LGBTQ community, but many insist the system will need more resources.

Driving the news: The FCC is expected to vote Thursday to require phone companies to route "988" text messages to the National Suicide Prevention Lifeline.

  • The FCC voted in July 2020 to establish 988 as the three-digit number to connect calls to the Lifeline.
  • If approved as expected, cell phone service providers would be required to meet a July 2022 deadline to deliver both texts and phone calls made to 988 to the Lifeline.
  • "For young people in particular, that's their native language, it's not picking up the phone and talking," Acting FCC Chairwoman Jessica Rosenworcel said of texting during her Senate confirmation hearing Wednesday for a permanent post to lead the agency.

Yes, but: There is widespread support for the move, but also concern about whether crisis centers have the capability to meet the expected increase in outreach.

  • "We don't want somebody to text and not get a response," said Hannah Wesolowski, interim national director of government relations, policy and advocacy for the National Alliance on Mental Illness. "That is something that will really need to be scaled up."
  • "[W]e know people are going to start texting as soon as they learn about 988. So it's important that we start offering it, and work simultaneously to make sure that that capacity need is addressed."

By the numbers: The Substance Abuse and Mental Health Services Administration, which oversees the National Suicide Prevention Lifeline, told the FCC this summer it handled more than 33,000 texts from August 2020 through May 2021 when it began incorporating texting capabilities in select centers.

  • But demand for text services exceeds capacity, with an unanswered text rate of 31% as of May, SAMHSA said in comments to the FCC, adding that "expanding text capacity would clearly be needed in the event the FCC requires texting to 988."
  • A SAMHSA spokesperson told Axios the unanswered text rate generally refers to when a person abandoned the exchange before the answer could be sent to them.
  • Vibrant Emotional Health, which administers the Lifeline, told the FCC that when there's a wait to reach a crisis counselor, scheduled texts are sent to the individual seeking help every 10 minutes to let them know they're still in the queue.

The big picture: There's a broader movement among mental health advocates to make 988 an alternative to calling 911 for mental health crises.

  • A recent Ipsos poll, on behalf of NAMI, found that 4 in 5 Americans believe mental health professionals should be the primary first responders in a mental health crisis, rather than law enforcement.
  • 73% said they would be willing to pay a monthly fee on phone bills to support the 988 system, similar to the fees for 911 service.
  • "Unfortunately, very few communities have robust crisis services in place and that leads to law enforcement often being the only in-person response available," Wesolowski told Axios. "And this causes a lot of avoidable trauma and tragedy."

What's next: Four states have already implemented fees, ranging from an estimated 15 cents to 40 cents, on their residents' phone bills to collect funding for crisis services, Wesolowski said.

  • The Senate's Suicide Prevention Lifeline and Improvement Act, which would authorize the funds to support the Lifeline and funding for coordinating and support crisis centers, was advanced out of committee in August.
  • The Build Back Better Act would provide $75 million in funding for the Lifeline and the new 988 number.

The National Suicide Prevention Lifeline currently can be reached at the toll-free number, 1-800-273-TALK(8255).

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