Last week, Sue Ann Atkerson, LPC, MBA, CEO of Behavioral Health Link, testified before the United States House of Representatives Committee on Energy and Commerce’s Communications and Technology Subcommittee. The hearing, called “Strengthening Communications Networks to Help Americans in Crisis,” included six witnesses who spoke on eight separate bills. Atkerson testified on suicide prevention and 988—the 3-digit dialing code the FCC has formally begun to make the nationwide number for mental health and suicide crisis. The specific legislation she addressed is H.R. 4194, the “National Suicide Hotline Designation Act of 2019.” The bipartisan bill, said Atkerson, is “a historic step toward saving more American lives.” In her oral testimony, she highlighted three primary points: Suicide is a leading cause of death in the United States, faster access to the National Suicide Prevention Lifeline will save lives, and funding and specialized services are vital for the success of 988.
Suicide is the 10th leading cause of death for Americans overall and the 2nd leading cause of death for those ages 10-34. Atkerson shared with the subcommittee that nearly 50,000 Americans died in 2018, over 1,000 more than the previous year. Some populations, such as veterans, African American youth, Non-Hispanic American Indian or Alaska Natives, and LGBTQ youth are particularly vulnerable to suicide. In fact, LGBTQ youth are “four times more likely than their heterosexual peers to contemplate suicide.” Furthermore, noted Atkerson, the suicide attempt rate for transgender youth has skyrocketed. Chairman Michael F. Doyle Jr. is the U.S. Representative for Pennsylvania’s 18th congressional district, and Ranking Member Robert Edward Latta is the U.S. Representative for Ohio’s 5th congressional district. Atkerson pointed out that Pennsylvania is ranked 4th in the United States for suicide death, and Ohio is ranked 5th, highlighting that this public health issue affects all of us. No matter where we are.
There’s often a misconception that mental health crises aren’t as dire or as life-threatening as those that are physical. Atkerson pointed out that timely intervention in a mental health crisis is equally critical. In fact, the window between people deciding to act and attempting suicide is short, somewhere between 5 to 10 minutes. She shared with the subcommittee that 988 is precisely what Misha Kessler needed when he was a sophomore at George Washington University. He was experiencing suicidal thoughts. Misha isolated himself, believed he’d become a burden to friends and family, and was experiencing insomnia. His pain reached a fever pitch, and to escape it, he crawled out of his dorm room window and told himself to jump. Without other options, said Atkerson, “Misha ended up in inpatient psychiatric hospitalization.” For many people, inpatient hospitalization results in psychological burdens because it removes people from their day-to-day lives, their support system, and familiar environments. It also has a financial toll because extended hospital stays disrupt employment and come with a hefty price tag, further creating challenges. In a world where the easy-to-remember 988 number exists for mental and suicide crises, Atkerson said, Misha’s experience could have been vastly different. “His 988 call would have redirected to the Lifeline, where local call centers deescalate 98% of calls, getting people the help they need immediately.”
“His 988 call would have redirected to the Lifeline, where local call centers deescalate 98% of calls, getting people the help they need immediately.”
We often hear of the golden period of intervention for heart attacks and strokes, which are 30 and 90 minutes, respectively. The same is true for mental health and suicide crises, and that means, said Atkerson, “time is of the essence.” In 1967, the FCC met with AT&T and established a nationwide, easy-to-remember, 3-digit number: 911. This ensured that medical emergency care was readily available and accessible to people in need regardless of location. Atkerson said that, similarly, 988 can offer people in mental health and suicide crisis the help they need in the time they need it. Currently, the default system for people in psychological crisis is medical, thrusting people into emergency rooms, which “are often ill-equipped to address psychiatric needs and can lead to delays in accessing appropriate care.” These services also come at a high cost to patients, both personally and financially, and also to taxpayers because it depends heavily on law enforcement and emergency medical services. Just like 911, an easy-to-remember, 3-digit code will send calls to appropriate resources. In the case of 988, that means, people in mental health and suicide crisis will have “direct, immediate access to trained mental health professionals whose rapid intervention often results in life-saving actions.”
In 2019, the Lifeline answered over 2.2 million calls. Experts estimate that the number of calls will at least double in the first year, which would result in roughly 4.4 to 5 million callers, potentially much more. A critical component for 988 to be fully effective is funding. Atkerson highlights that to absorb the increase in call volume from 988, the Lifeline’s network of 170-plus accredited call centers must be “fully funded and well equipped to handle specialized needs of callers…” She says this is going to require a braided funding approach, including giving states the authority to levy fees such as service charge revenue through wireless carriers, which is included in H.R. 4194. Also, to best help people who are most vulnerable, Atkerson states that partnerships between the Lifeline and specialty suicide prevention resources must be strengthened. She recommended that the House of Representatives adopt the Senate companion bill, S. 2661, which directs SAMHSA to develop an implementation plan for specialized services for LGBTQ youth and other at-risk populations. This could include, she noted, “training crisis counselors and integrated voice response to route calls to specialized organizations.”
In closing, Atkerson shared with the subcommittee that there is consensus among the mental health community, including Lifeline member call centers, that Congress should pass H.R. 4194. “Providing faster access to a fully-funded Lifeline network with specialized services for our most at-risk populations will save American lives.”
Image (left to right): Connor Jobes, manager of federal policy at the American Foundation for Suicide Prevention, Colleen Creighton, executive director of the American Association of Suicidology, Dee Martin, head of the Policy Resolution Group with Bracewell LLP, Sue Ann Atkerson, chief executive officer of Behavioral Health Link, Sam Brinton, head of advocacy and government affairs at the Trevor Project, and John Lee, principal at the Policy Resolution Group with Bracewell LLP.