The '988' mental health hotline is coming. But will Massachusetts be ready?

Patti Donovan answered the phone with a cheerful and reassuring tone.

“Call2Talk, we’re here to listen,” she said.

Donovan is a volunteer at Call2Talk, one of five centers in Massachusetts taking calls that come into the National Suicide Prevention Lifeline.

“Are you feeling suicidal today?” she asked the caller. Donovan paused and listened. “OK, I’m sorry that’s how you feel,” she said. “Thank you for sharing that with me.”

Donovan and the other volunteers offer what they refer to as “compassionate listening.” The goal is to help prevent suicides by allowing people to share how they’re feeling and what’s going on in their lives.

The hotline, 800-273-8255 (TALK), gets millions of calls a year nationally. And soon, it’s going to be a lot simpler for people to remember — and call in. That’s because a new three-digit number, 988, is launching on July 16.

As directed by federal legislation passed in late 2020, 988 will connect callers to suicide prevention services from anywhere in the country. Each state is tasked with fortifying its own system for answering those calls and building a system that can support the needs of callers. Massachusetts is busy getting ready for the launch — a short three months away.

The new system is coming, but state officials have yet to decide on a long-term funding plan, staffing still needs to be ramped up, additional state support services won’t be rolled out for months, and there's at least one major outstanding technical concern at the federal level. Even so, some are simply glad to see a service become more readily available to those who need it.

“More to be done”

“There’s a lot more to be done, frankly, before we’re really up and running and ready for July,” said Kathy Marchi, CEO and President of Samaritans, Inc. — one of the nonprofit centers answering calls in Massachusetts.

Publicity for the new 988 number, paired with the ongoing mental and emotional strain of the pandemic, is expected to cause a surge in calls. And while the state is set to launch additional behavioral health resources at the beginning of 2023, that leaves a six-month gap where the five nonprofit centers’ compassionate listening services will be put to the test.

Federal and state funding is helping the call centers hire more staff, but Marchi said they really need more people to volunteer to help meet an increased number of calls. And she’s concerned 988 calls could start to include all kinds of mental health emergencies. While her volunteers offer a non-judgemental ear, she says the crisis hotline centers aren’t set up to provide an in-person emergency response or a referral for mental health services.

“That will present a great challenge to us in both volume and the capacity, the skill, the training of the folks who answer our phones,” she said. “Can it be done by us? It could be, but it’s going to be different work than what we’re doing right now."

“We’re not hooked into the 911 system,” she continued. “We’re not hooked into emergency departments. We’re not hooked into, you know, a statewide system that would help us find a bed or psychiatric resources for someone.”

That’s an issue that upcoming trainings and programs should address, says Massachusetts Secretary of Health and Human Services Marylou Sudders.

Sudders said 988 call centers in Massachusetts will be ready to deal with all kinds of calls on day one. If call takers hear from someone with an acute emergency that needs an immediate, in-person response, they’ll be able to seamlessly connect with emergency services, Sudders said.

“What we’re doing now, between now and July, is the training and the coordination between the systems to ensure that my phone call, if I were to call 988, and I presented in an urgent crisis that there’d be an immediate handoff,” she said.

A broader plan for Massachusetts

In addition to the national 988 rollout, the state is working to expand behavioral health services, beginning in January 2023.

The Baker administration’s Roadmap for Behavioral Health Reform includes the opening of community behavioral health centers around the state where people can get urgent care and the expansion of the state's ability to dispatch mobile crisis teams.

The plan also includes yet another phone line. This one, the state is calling a “helpline,” and it would be able to connect callers to mental health services. Once it’s launched in January, Sudders said, callers to 988 could be transferred to this new state number, if necessary.

“Those are trained clinicians, who would then say, you know, ‘We’re immediately calling out a mobile crisis team,’ or ‘Can we get you in for an appointment tomorrow for a clinical assessment?” Sudders said.

The state is currently reviewing bids from contractors to run the new helpline.

When it’s rolled out, that kind of service will help a lot, according to Annabel Lane of the National Alliance on Mental Illness of Massachusetts.

“But there’s going to be this weird gap of time between July and January, where we’re going to have a 988 number, and people are going to be told this is a mental health crisis number, but it’s not going to be fully equipped necessarily to handle all the kinds of things that people might be calling with,” Lane said.

“The version that’s dropping in July is not the 988 that’s envisioned at the national level,” Lane said. People could call 988 hoping to get a mobile crisis team in an emergency, she said, and still wind up getting a 911 response. “I think people are thinking of this as an alternative that’s going to be ready immediately, and that’s not going to be the case right away.”

Some of those who will be on the answering end of 988 calls are more sure about their readiness to respond right away.

Eileen Davis, the director of Call2Talk, said she’s confident her team has the training to assess the level of risk a caller is at, and respond appropriately.

“The call takers are trained,” Davis said. “They spend a lot of time in their preparation training before they answer calls to know how to assess the level of risk a caller can potentially be at, and they know what to do.”

How to fund and build a more “perfect” 988

Legislation that’s still pending at the state and federal levels will shape the system’s funding, rollout and ultimate technical setup. Massachusetts Congressman Seth Moulton, who wrote the 2020 federal legislation creating 988, expects there will be several bills in the coming years to hone and refine the federal system.

Beyond federal funding and $10 million in next year’s state budget to implement the new system, Cape and Islands Democrat Julian Cyr wants to add a fee to Massachusetts phone bills that will fund hotline, much like the existing fee that supports the 911 system. The funds would be directed to routing calls as well as recruiting, training and staffing the centers — and funding crisis outreach teams and behavioral health providers that would be responding to incoming calls.

Cyr, who co-chairs the Legislature’s committee on mental health, substance use and recovery, is pushing for state lawmakers to pass two bills, SB 2572 and SB 1274, that include a range of behavioral health initiatives, including the new fee. The federal legislation explicitly allows states to add the fee to phone bills to support 988 — a step at least four states have already taken.

“We’re going to be able to get 988 up and running, and $10 million is going to fund 988, probably through the end of the year,” said Cyr. “And then there’s a real question about, how do we fund this going forward? I would really argue that we should be using the [funding] tool the federal government has given us.”

It’s a measure that some the wireless communications industry is partially objecting to. In written testimony, industry trade association CTIA argues any fee-based funds collected for 988 should be more strictly limited to use for the routing of calls and operational logistics, not funding crisis teams or centers.

There are also technical concerns with 988 that would need to be resolved at the federal level: chiefly, making sure a caller will be connected with services in their state.

“The way the federal government has set up the [988] system, if you have a 508 or 617 or a 413 number, you’re going to reach someone in Massachusetts,” Cyr said.

But if someone calls 988 with an out-of-state area code, that call will be routed to that other state. This is particularly an issue for the large number of college students who come from other states to study in Massachusetts, he pointed out. “That is something that seems pretty darn problematic,” Cyr said.

It’s not an issue for the 911 system, which uses the location where someone is calling from to route their call to a local dispatcher, regardless of the caller’s area code.

Cyr and Sudders say they’re pressing the FCC to make the change so that callers connect with someone in-state in case they need some kind of urgent help.

Moulton, the Democrat from Massachusetts’ Sixth District, acknowledges there’s still work to be done.

“I can’t say that I’m 100 percent satisfied with the progress all the states are making towards meeting this deadline and truly being ready to go in July,” Moulton told GBH News. “But we can’t let the perfect be the enemy of the good.”

Moulton is now a co-sponsor of the 988 Implementation Act, which he said will help get 988 closer to “perfect.” The bill, which was introduced in March, would provide funding for mobile crisis teams and call centers, as well as put funding toward workforce development and trainings for such responders. It also supports the establishment of community behavioral health clinics, like the ones Massachusetts is setting up through its behavioral health reform “roadmap.”

“So it’s all about making sure that 988 is actually implemented well,” Moulton said.

“If we were trying to create a perfect system, we probably wouldn’t have this for 50 years,” Moulton said. “We’ll get much more quickly to a perfect system by having the imperfect system launch.”

Even though it won’t be perfect on day one, this national system is going to save lives right away, Moulton said, because people experiencing a crisis will know there’s someone ready to listen a phone call away.