As of Saturday, anyone in the U.S. can call or text 988 to be connected to trained crisis counselors who can help those experiencing a mental health or substance abuse crisis.
For many Texans, including those living in Bexar County, however, the expanded hotline won’t connect callers to new mental health resources. While some states have beefed up 24/7 crisis services in advance of the 988 rollout, Texas isn’t one of them.
The new number does not replace the National Suicide Prevention Lifeline (1-800-273-8255), but offers an easier-to-remember complement to the service first launched in 2005 by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).
Now known as the 988 Suicide & Crisis Lifeline, the new number and name represents a rebranding to emphasize that its counselors are trained to handle any type of emotional distress and substance abuse, beyond suicidal thoughts. Families or friends worried about a loved one may also call. 988 calls are available in English and Spanish and can connect callers directly to the Veterans Crisis Line as well.
Callers in Bexar County seeking additional local support will mainly be referred to the Center for Health Care Services (CHCS), the local mental health authority of Bexar County.
Beyond 911 services and hospitals, however, crisis services in Bexar County are not available 24/7. San Antonio is piloting a new mental health team, which includes specially-trained police officers, paramedics and licensed clinicians, but it’s only deployed in one substation’s territory, and only from 7 a.m. to 11 p.m.
CHCS runs its own state-mandated 24-hour crisis and substance use helpline, which will remain active, said Allison Greer, vice president of governmental relations for CHCS. “Callers to the 988 number who require emergent or urgent care services will be warm transferred to our crisis helpline.”
Congress designated the new 988 dialing code in 2020 to operate through an existing network of more than 200 locally operated and funded crisis centers across the country.
But because Bexar County does not have a crisis center, calls from here are directed to centers in Austin, Dallas, Fort Worth, El Paso or Houston. When those lines are full, calls are routed out of state.
Less than half (40%) of Texas’ nearly 190,000 Lifeline calls in 2020 were answered within the state, according to its annual report. Calls in Texas have increased 87% since 2016.
Most contacts with the hotline don’t require additional immediate intervention, according to a SAMHSA FAQ on the rollout of the new number, with less than 2% requiring a connection to emergency services such as 911.
Caller information is kept confidential, the FAQ states, “except in cases where there is imminent risk of harm to self or someone else, or where otherwise required by law.”
Beyond suicide prevention, “988 is really intended to be a more comprehensive [service],” said Doug Beach, board president of the San Antonio chapter of the National Alliance on Mental Illness. “The earlier people reach out for help and we can direct them to resources, the better the outcomes.”
Raising awareness about the new number is one way to encourage people to reach out for help before they get into crisis. Beyond that, he said, the ultimate goal is for 988 to be backed by local 24/7 crisis services and mobile crisis teams so callers can get the care they need.
There is some federal funding to expand 988 but it’s up to each state to come up with a 988 implementation plan, Beach said — and Texas is “behind the curve.”
As part of its general appropriations budget last year, the state allocated funds to help it analyze its current Lifeline infrastructure and study preparedness for 988, but according to the national NAMI organization, it hasn’t yet approved any money for actual implementation.
Until then, Beach said, “this is going to be a soft launch of 988” in Texas.
It took years for the Lifeline to become what it is today — a comprehensive network of call centers, Beach said, and it will likely take several more to provide more robust, local services. “It’s not a simple proposition.”
NAMI recommends states adopt model legislation developed by the National Association of State Mental Health Program Directors that includes a funding mechanism for 988 crisis services: a monthly fee on all phone lines.
A few states, including Virginia and Washington State, have adopted such fees which were made possible nationwide through the 2020 act of congress that established the 988 initiative.
The Texas legislature has yet to consider such legislation.
Gov. Greg Abbott called for the state to “do a better job with mental health” in the wake of the Uvalde shooting, but months earlier he slashed nearly $210 million from the 2022 budget of the state’s Health and Human Services Commission, which administers health, mental health and substance abuse programs.
The simplicity of the 988 number to streamline mental health services is welcome, but a sustainable funding source to establish more crisis call centers and mobile response services will be needed to keep up with demand, Lyssette Galvan, public policy director for NAMI Texas.
In the year after 988’s launch, the Lifeline is projected to receive more than 487,000 calls — more than two times the calls in 2020 — from within Texas alone, Galvan said. “We don’t have that capacity right now.”
If you or someone you know needs mental health support, local and national resources include:
- 988 Suicide & Crisis Lifeline: call or text 988 / call 800-273-8255 or text 741741
- NAMI’s non-crisis local “warm line” 210-734-3349 or email@example.com
- Center for Healthcare Services crisis hotline 1-800-316-9241 or 210-223-SAFE (7233)