The United States is facing a mental health care crisis on multiple fronts. Need, for years inadequately addressed, is surging after a year and a half of collective trauma, with access and coverage both scant. And people in crisis all too often find themselves dealing with the police instead of health professionals.
Will 988 be the secret code? The one that synchronizes the political will to improve mental healthcare and crisis response in communities everywhere?
That’s the number for the new mental health crisis hotline, as mandated by the National Suicide Hotline Designation Act passed by Congress last year. The idea is to create an alternative to the 911 emergency number that can respond to a broad range of mental health emergencies—from suicide concerns to substance-use problems—with mental health professionals and other appropriate care. As we’ve written previously, some philanthropic funders are taking an interest to ensure its success, and advocates are calling for more yet to get involved.
Proponents hope that a strong 988 hotline can more successfully get people the help they need. Just as importantly, it may get police, courts and prisons out of the mental healthcare business. According to a report by the University of Chicago Urban Labs, “Estimates suggest that upward of 80 percent of individuals with mental illness have an encounter with law enforcement at some point in their lives, and in 2015, one-quarter of the individuals fatally shot by police had experienced mental illness.”
While the feds may have passed the law, much of the actual implementation is now up to states and communities who must fit public and private entities into a connected and cooperative whole, and get the system running by the July 2022 deadline. But that won’t be easy, say mental health funders and advocates, and there are several roles philanthropy can play to improve the odds of success.
“988 will only be effective if we have adequate crisis response services across the continuum of care,” said Barbara Ricci, executive director of Mindful Philanthropy, which works with and advises philanthropies on the design of mental health programs and funding.
But in communities across the country, gaps in mental health services have contributed to a decades-long national health crisis, including rising rates of substance use and suicide among both children and adults. As Inside Philanthropy has noted previously, the need for improved mental health and substance use issues has long been under-addressed in philanthropy—even funders who focus on health devote only a tiny percentage of all giving to mental health.
Now, say funders, philanthropy can help by shifting more funding to address those gaps, while foundations and organizations with longer experience in mental health can coordinate planning between the many public and private entities—including police, mental health counseling professionals, outpatient care, among others—that will be involved in crisis response and mental healthcare.
“Philanthropy’s role is to ask, ‘What is the continuum of care in a community for someone in crisis? And how does a community invest in that and build that out?’” said Tyler Norris, chief executive of Well Being Trust, a national foundation that focuses on mental, social and spiritual health.
This would not be the first time philanthropy played a central role in the birth of emergency response hotlines. Most people today can barely remember a time without the familiar 911 emergency medical services number, but in fact, it wasn’t developed until the late 1960s and was not put into broader nationwide service until the 1970s. In 1973, as one of its first acts, the Robert Wood Johnson Foundation, just established in 1972, committed $15 million to expand the then-nascent 911 system into national use. At around the same time, Congress passed the Emergency Medical Services Systems Act, providing an initial $185 million to incentivize the development of coordinated trauma care in most of the country. Now, 911 dispatch workers in thousands of centers across the country dispatch medical, fire and police services in emergencies every day.
But, if 911 dispatches emergency medical services everywhere, why do we need 988? With rates of death related to alcohol, opioids, and suicide doubling every decade, pointed out funders, there is a clear need for improved response to crises and mental health more broadly, through the creation of the continuum of care that advocates have long called for. The COVID-19 pandemic, which brought additional economic and emotional stresses to so many people, only made things worse, all contributing to recent statistics showing an actual reduction in the average lifespan of American people.
Philanthropy can ensure that the many moving parts of mental health crisis care come together to form an effective system, a fitting role for funders that have the potential to work across sectors. Specifically, says Ricci of Mindful Philanthropy, areas where needs and opportunities for philanthropic support include:
- Ensuring adequate federal and state funding for 988 call centers, including their appropriate connection to 911 systems and community-based crisis response care;
- Addressing gaps in 988 regulations and improving federal oversight;
- Building out the data in support of more “evidence-ready” interventions and scaling existing evidence-based mental health crisis response and support systems;
- Evaluating and/or setting up structures to evaluate 988’s implementation, including data standardization, collection, aggregation and transparency;
- Publicizing the advent of 988, particularly within vulnerable communities.
Philanthropy must use its “superpower” of convening disparate stakeholders to develop the sort of ecosystem of care purpose-built to address the many factors that contribute to mental health issues and crises, said Rick Kellar, president of Peg’s Foundation, a mental health funder based in Hudson, Ohio. “You want law enforcement leadership involved, you want governmental leadership, you want family advocacy groups, people with lived experience, you want hospitals, IT experts. As a foundation, we can’t build a crisis center in every county, but we can pay for a lot of convening of local and state partners.”
In recent months, we have already seen some grantmaking relevant to the 988 mission from funders that have mental health on their radar, like Ballmer Group’s recent $38 million commitment to mental health needs in Washington State, mainly for scholarships and education to expand the behavioral health workforce—with a particular awareness of crisis response needs. Sozosei Foundation, a relative newcomer to philanthropy, has made 988 implementation a cornerstone of its work and recently announced an initial $1 million round of grants to groups focusing on advocacy, research and workforce development
The 988 initiative has also captured the interest of funders and advocates of racial equity. Often, 911 dispatchers respond to emergency calls by sending in police, and while this may be an appropriate response at times, for many people of color, immigrants and Indigenous communities, police presence can be a threat instead of a helping hand, too often ending in arrest or violence, with Black and brown Americans shot by police at much higher rates than white Americans, according to Washington Post data.
“It’s the wrong people rolling,” said Norris, of Well Being Trust. “And secondly, from an equity consideration, for too many Americans that are disproportionately struggling from mental health challenges, calling 911 could be an escalation of the problem rather than a de-escalation.”
But some funders hope the same sort of measures required to make 988 a success could serve as a sort of legislative Trojan horse, igniting the political will to build out the mental healthcare and related resources people need to treat addictions or manage other chronic mental health conditions more comprehensively—not just for crisis response.
“If we do a good job with 988, we can transform the mental healthcare system,” said Glenn Schneider, chief program officer at Horizon Foundation, a mental health funder based in Howard County, Maryland. “It’s a real opportunity for us to get this right.”