STATE

Ohio prepares to launch '988' suicide prevention lifeline, but funding questions remain

Titus Wu
Akron Beacon Journal
The National Suicide Prevention Lifeline is getting a shorter, three-digit number, 988, in July. But is Ohio ready?

After the 2021 mass shooting at a Colorado supermarket, Tony Coder was on a call with a northeast Ohioan unable to get help from the National Suicide Prevention Lifeline. He told Coder he was thinking about shooting up a grocery store and that by killing himself first, he would save many lives.

Coder, executive director of the Ohio Suicide Prevention Foundation, recalled talking him down and referring him to a mental health professional.

"People end up calling us because they don't get the answer to the help that they need," Coder said. "Some of those crisis calls are pretty literally life or death." 

On July 16, the federal government is requiring states launch a more robust and easy to remember 988 hotline with the aim of providing more capacity – costing $136 million for Ohio over five and a half years. Questions remain how that total cost will be covered.

The current 24/7 suicide prevention hotline, (800) 273-8255, is meant for people contemplating suicide to get immediate help. But nationally and in Ohio, low funding and staffing has meant some have long wait times and are unable to reach someone.

Already, Ohio's answering service for those in crisis is stretched thin as suicides increase. Twenty-two of 88 counties have no in-state coverage, and for the rest, Ohio's lifeline centers are unable to handle all of the calls.

What the 988 suicide hotline will do

At least 72,560 calls in Ohio were made to the National Suicide Prevention Lifeline in 2020, according to the lifeline. That's a 57% increase from 2016 and likely to grow under stresses caused by the COVID-19 pandemic.

Yet only 60% to 70% of Ohio calls were able to be answered by a lifeline center in the state, per state and lifeline data. When that doesn't happen, callers might abandon calls or are connected to out-of-state people in a national backup network.

The number of suicides has steadily increased since 2014 from 1,488 to 1,809 deaths in 2019, according to the Ohio Department of Mental Health and Addiction Services, which is in charge of the 988 rollout.

The number of Ohio suicides have steadily increased over the years. The rollout of a new 988 suicide prevention hotline aims to counteract that.

Before 988, the state's 12 lifeline centers' limited capacity should be no surprise. They're part of a patchwork system, often relying on their own limited funding, staff and volunteers. Plus, 22 of 88 counties had no in-state coverage at all. 

The number of lifeline staff per center can vary from 20 to only one, Coder said. A state survey showed most centers received lifeline-designated funds of $10,000 or less to run lifeline budgets often more than $100,000. The rest usually has to be made up with other, mostly local sources of funding. 

Kent-based Coleman Professional Services answers lifeline calls in Canton with a staff equal to eight full-time employees, said Michelle Smith, who oversees the operation. There are usually two workers per shift answering 5,000 crisis calls a month from all types of hotlines, including 250 from the lifeline.

While they've managed to answer at least 90% of calls, it was harder to keep up during the pandemic when the percentage of more serious calls, such as those involving suicide, increased.     

"Calls were longer; they were more intense," Smith said. "We had more staff test positive for COVID. My managers and I were working midnight shifts, filling in." 

The new 988 system will do more than making the hotline number easier to remember, much like 911. Ohio will expand coverage to all corners of the state, adding six providers. There will also be a statewide backup network. Staffing will increase to meet the goal of a 90% in-state answer rate.  

Another feature aims to let Ohioans, especially youth, text or chat 988. Only two centers recently added that capability, and technological upgrades are needed.

The improvements are expected to boost demand for the hotline – as well as costs. The 988 line could get at least 179,000 calls and texts in just the first year, the department estimated.    

How will the 988 suicide hotline be paid for?

For the first time, there will be a state-level funding source for the lifeline, though state lawmakers will need to figure that out. Some have called it an unfunded federal mandate.

While the feds have given and could give more 988-designated money, it so far won't be enough to cover the estimated $136 million needed to last until 2027.

Coleman Services said a lot of 988's technological upgrades will require shifting backup staff who can assist with high call volumes to focus on data entry and collection. It'll have to boost its staffing, adding one more person per shift.  

States have struggled with how to fund 988; only four have passed legislation doing so, according to the National Alliance on Mental Illness.

Ohio has taken a unique position: put any funding decisions off until later. Instead, it will fully fund the launch plus the first year of the 988 program with at least $20 million of COVID-19 relief money and other federal sources, just in time for discussions on the state's next budget.    

"In this first year, we're going to learn a lot about the utilization and the cost of running the system," Ohio Department of Mental Health and Addiction Services Director Lori Criss said in an interview. "So we wanted to make sure to really measure twice, cut once and be responsible with the public taxpayer dollars."

Not having long-term funding yet worries some advocates. It could put a running 988 system in jeopardy if lawmakers can't come up with a solution. 

Rep. Gail Pavliga, R-Atwater, said any long-term funding decisions are still in the early stages. Pavliga is carrying a bill that would simply establish a repository to receive any money for 988. 

Ideas have been proposed, such as a 50-cent monthly fee on phone bills, similar to how 911 is funded. The state could also allocate money from other revenues. The responsibility for financing 988 will not be primarily on local governments, said Criss.

Other challenges remain, such as the workforce shortage in behavioral health, an ongoing issue plaguing all sectors of health care amid the pandemic.  

But at the very least, the department is confident the 988 hotline will be up and running by July 16. 

"It will take years, if not decades, to get this fully formed," said Criss. 

Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.