A year after behavioral health system’s launch, NV and the nation struggle with implementation
Nevada was one of only five states initially dedicating funding for the 988 lifeline and associated services, but the rollout has been fraught with delays. (Photo: U.S. Substance Abuse and Mental Health Services Administration)
Note: The National Suicide Prevention Lifeline is 988. Nevadans can reach services by calling, texting, or chatting online. To find mental and behavioral health services in Nevada, visit:behavioralhealthvn.org
Last year, the national suicide lifeline shortened its number to three digits: 988, and along with that change launched a nationwide effort to create a comprehensive 24-hour, 7 days a week crisis behavioral health care system based on having someone to call, someone to come and somewhere to go for the first time in U.S. history.
The hotline was the first step in creating that system. Since July 2022, more than 5 million calls have been made to 988 across the network of over 200 local and state crisis centers in the United States, 2 million more than before the change according to the Substance Abuse and Mental Health Services Administration (SAMHSA) 988 One Year Anniversary Issue Brief.
In Nevada, “calls into the 988 line as well as the texts and chats have increased by 40% in the last year and that is a beautiful thing,” said Rachelle Pellissier, executive director of Crisis Support Services of Nevada, the nonprofit that has overseen the state’s suicide hotline for over 50 years. “That means it’s that much easier for someone in a behavioral health crisis to get someone on the phone in a couple of minutes and get help.”
“We don’t have all of the staff or things we need,” Paellissier is quick to add.
Nevada’s rollout encountered not just staff shortages but other barriers, including delays in funding, and a struggle to provide multilingual access and cultural competency training, especially for the Asian American Pacific Islander communities
The state also needed to begin building mobile crisis teams and crisis stabilization centers from the ground up, and has struggled to overcome challenges posed by a lack of coordinated behavioral health services in place beforehand. Nevada has for years ranked at or near the bottom of all states in access to care and higher prevalence of mental illness, according to the nonprofit Mental Health America’s annual rankings.
Despite being one of only five states that passed legislation to fund the 988 National Suicide Prevention programming, as of June, Nevada had one of the nation’s lowest percentages of calls answered within state borders, according to a Kaiser Family Foundation report that compared answer rates nationally.
“With 988, the federal government said to the states that you need to make sure you meet all of these key performance indicators and that you pay for it. That’s kind of new to all those states and not just Nevada.” Pellissier said. “All of the states, including Nevada, have really struggled to figure out how to fund this.”
Not just the phone line
State legislation enacted in 2019 directs telecommunications companies to collect a 35-cent fee surcharge on phone bills but was delayed when a loophole found that the bill only applied to landlines, a vanishing commodity, and would have generated only $1.5 million in funding per year instead of the anticipated $15 million, according to the Nevada Department of Behavioral Health and Human Services (DHHS).
This year Gov. Joe Lombardo signed legislation amending the 2019 law, despite objections from Republican state Sens. Heidi Seevers Gansert and Pete Goicoechea voted, who were against moving the bill out of Senate Finance.
The state started receiving funds this month, according to the DHHS.
Pushback from Gansert included whether the funds raised by the surcharge can be used for the other parts of the crisis behavioral health care system outside of the call center, including multiple behavioral health crisis direct services and facilities like Designated Mobile Crisis Teams (DMCTs) and Crisis Stabilization Centers (CSC).
The legislation Lombardo signed, Senate Bill 237, clarifies that the surcharge can be used to establish and operate crisis stabilization centers that will be a part of the wider 988 infrastructure in the state.
Before the state can begin building the DMCTs and the CSC, it must take bids, and before it does that, it has to issue a request for proposals (RFP). There have been several delays in the release of the RFP, which is not expected to be released until late this year.
“In this RFP the State will select a vendor to provide a robust 988 call center solution with an overarching CRS system. With this RFP the State plans to have a phased approach to ensure fidelity to best practices per national guidelines. The first phase will include a call center and the second phase will add dispatch capabilities of DMCTs. The third phase will be the establishment and operation of CSCs,” according to a statement provided via email by Caleb Vasquez-Stadin, the public information officer for DHHS.
In the interim, Crisis Support Services continues to bear the brunt of the increase in call volume, as has been the case since the 988 number was enacted in July of last year with minimum staffing.
In addition to funding and staffing delays, 988’s first year in Nevada has been troubled by a roughly 50-second period it takes for callers to navigate the system before being routed to someone staffing the crisis call center. Callers seeking help are first asked by automation if they are a veteran, if they need specific language assistance, and other questions before they are routed to the crisis call center that is associated with their phone number, Pellissier said.
The Kaiser report analyzed in-state answer rates in December and found 65% of calls from Nevada area codes were answered in the state, a significant drop from the rate of 77% in July 2022 when the 988 number launched. More recently, Nevada’s in-state answer rates are still some of the nation’s lowest, at 71% in January and 75% in February, well shy of an initial 95% goal.
Those rate averages haven’t moved much, according to Pellissier.
Trying to get beyond police as the first responder
The 988 national implementation model hopes to create a separate mobile crisis response team to divert most crisis calls away from law enforcement. These teams often consist of two mental health specialists, like a clinician and a peer support advocate, who show up first to cases that can’t be de-escalated by the 988 call center.
The final part of the 988 implementation plan is building crisis stabilization centers for those who need a dedicated environment that isn’t a hospital emergency room or a jail to get help and then more accessible resources in the community to support after-crisis care.
More than 30% of people living with serious mental illness have their first interactions with the mental health care system through law enforcement agencies and are also 16 times more likely to be killed by law enforcement.
But as it stands, the delays in funding and establishing services and facilities have also pushed back the creation of those diversion systems, meaning Crisis Support Services of Nevada continues to rely on law enforcement for crises that they can’t de-escalate.
That time constraint coupled with the high prevalence of mental illness and limited access to care, a culturally and linguistically diverse population, and the vast rural and frontier swaths of the state converges with Nevada’s long history of being one of the nation’s worst states in addressing mental health care.
“While the State continues its implementation strategy, there are parallel work groups with community partners to ensure all Nevadans are being served. The State of Nevada has also been working with other states with similar geographic and demographic landscapes to learn more about how to serve a diverse population,” according to the statement provided by DHHS
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