A 99-cent monthly charge on every phone line would fund improved response to behavioral emergencies and potential suicides under a proposal Gov. Tom Wolf’s administration hopes to introduce as the nation implements a new 988 crisis lifeline.
The lifeline and related services — plus the proposed charge to pay for them — are billed by the Department of Human Services [DHS] as opportunities to reduce suicides and enhance the handling of behavioral emergencies.
The 988 line — which is now supplementing and later replacing the existing 1-800-273-8255 line — “makes it possible to access emergency help when you are often in one of your most desperate, darkest places,” said Kristen Houser, deputy secretary of the DHS Office of Mental Health and Substance Abuse Service.
Houser said a shorter phone number isn’t enough because spotty behavioral emergency response can leave people at risk of suicide or vulnerable to hospitalization or incarceration. That’s why the state needs funding for mobile responders and overnight drop-in centers.
So far, the administration hasn’t found a legislative sponsor for its proposed phone charge, which is drawing skepticism from fiscal conservatives.
One Republican lawmaker — whose party has majorities in the state House and Senate — called the 988 lifeline “a huge step forward,” but doubted whether the new charge was necessary.
“We have 911 centers already in place,” said Sen. Patrick Stefano, R-Fayette, who is involved in suicide prevention legislation as chair of the Veterans Affairs commission. “Why are we trying to duplicate what’s already there?”
No free upgrade
Dial 988 in Pittsburgh now, and you’ll likely be connected to resolve Crisis Services, a Point Breeze North-based division of UPMC that can provide phone counseling, send out a mobile team or provide an overnight bed.
In coming months, the number should work on all U.S. phones. Federal legislation passed in 2020 requires by July 16, the number 988 will connect callers to the national suicide prevention and mental health crisis hotline system. The idea is that three digits are a lot simpler than the previous nationwide lifeline or local lines, like resolve’s behavioral crisis number 1-888-796-8226 [1-888-7-YOU-CAN].
The new lifeline number also reflects a belief by mental health advocates that the 911 model — in which police, firefighters or medics are typically dispatched to address emergencies — isn’t ideal for behavioral health situations.
Houser said that upwards of 80% of behavioral emergency calls can be handled with phone counseling alone. When dispatch is required, she said, “I need a behavioral health professional to respond,” rather than a public safety employee.
Will such a professional be available? That depends on where you are and when you call.
The department counts 45 counties (out of 67 in the state) that have crisis response services. But some counties have one-person teams or only operate during limited hours, according to a DHS spokesman.
Closing that gap, and improving behavioral emergency response everywhere, won’t be cheap.
In December, the federal Department of Health and Human Services announced $105 million in federal funds to help states beef up staff at their behavioral crisis call centers. Pennsylvania was awarded nearly $3.2 million. “It’s a one-time payment and these are services that we need to sustain,” Houser said.
To pay for enhanced behavioral emergency services, Congress gave states the option of assessing fees on phones.
Houser said DHS looked at current volumes of behavioral emergency calls and projected an increase as the 988 number is advertised. The department worked with actuaries to estimate the cost, over five years, of building out a stronger system, especially in counties without mobile behavioral health responders or overnight centers.
Houser declined to release the full five-year cost estimate, but said the state proposes to cover it with a new fee of 99 cents per phone line per month. “Some bills have three phones on it. There would be three 99 cents” on such a bill.
An existing $1.65-per-month charge on phone lines to support 911 service is expected to raise nearly $319 million in the coming fiscal year. If the proposed 988 fee is collected on the same number of phones, it could raise around $191 million.
Stefano called that “a major tax increase, especially on businesses [and others with] multiple lines.”
He added: “I’m getting pushback from the telecomms that they don’t want to be the tax collectors for Pennsylvania.”
PublicSource reached out to four telecommunications trade organizations, none of which provided substantive comment.
“I would unquestionably support it and advocate for it,” said Rep. Michael Schlossberg, D-Lehigh, who co-chairs the bipartisan mental health caucus and who struggled with suicidal thoughts in his youth.
He added that it would be of little use for him, as a Democrat, to sponsor the required bill. “It is difficult for a member of the minority party to pass very significant legislation, especially one that involves a live-wire issue like raising a fee.”
Watching the wallets
Stefano said he won’t entertain a 99-cent fee unless he is convinced that the state has done a thorough study to find the most efficient course of action.
He said the state should consider putting 988 desks into 911 centers. “You have the 988 call taker right there who can mobilize the response systems that are necessary, backed up by police or EMS,” Stefano said.
Rep. Frank Farry, R-Bucks, who chairs the House Human Services Committee, said that any bill creating a new fee could open the door to requests from county administrators to raise the 911 phone fee, said Farry. “It may not seem like a lot,” he said, “but in these economic times, everything matters when it comes to anybody’s wallet.”
Pennsylvania’s $1.65 fee is on the high end, according to state-by-state data published by NENA: The 9-1-1 Association.
So far, according to the National Alliance on Mental Illness [NAMI], four states have enacted monthly fees on phone lines to fund 988-related services. They are: Colorado (30 cents), Nevada (35 cents), Washington (40 cents as of next year) and Virginia (8 to 12 cents, plus a small increase in the 911 fee).
In the end, 988 should save money, said Christine Michaels, CEO of NAMI Keystone Pennsylvania.
Legislators should consider the likelihood that a better behavioral emergency response system will reduce the volume of 911 calls and resulting “high-cost services” like hospitalization and jail, she said.
Michaels added that the legislation may have a better chance of finding a sponsor after the November election in which the entire state House, half the Senate and the governor’s office are on the ballot.
She noted that parents of school-age children should be especially engaged, given heightened pandemic-era concern with youth mental health. “I don’t think this is something people will have trouble paying for.”
Rich Lord is Public Sources economic development reporter. He can be reached at firstname.lastname@example.org or on Twitter @richelord.
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