Policy Statement in Implementation of 988 Suicide and Crisis Lifeline
Background
Our country’s youth are facing mental health crises of staggering proportions. This increase in pediatric mental illness was noted even before the COVID-19 pandemic, as there was a 34.6% increase in the prevalence of mental illness from 2012 to 2018. In 2017, 20% of U.S. children and adolescents (15 million), ages 9 to 17, had diagnosable psychiatric disorders and suicide became and still is the second leading cause of death in youth ages 10-24. In response, the Children’s Hospital Association, the American Academy of Child and Adolescent, and the American Academy of Pediatrics joined forces in October 2019 to declare a national emergency in pediatric mental health.
Historically, there has not been a unified hotline or comprehensive system for communities to manage mental health crises such as suicidal ideation or substance intoxication in a timely fashion. Most communities call 911 (police, fire, or emergency medical response program), which is often not staffed with professionals who are trained or equipped to handle mental health crises. In July 2022, the 10-digit National Suicide Prevention Lifeline transitioned to a three-digit 988 Suicide and Crisis Lifeline. Dialing or texting 9-8-8 connects an individual to state and local call centers supported by the U.S. Department of Health and Human Services through the Substance Abuse and Mental Health Services Administration (SAMHSA) and staffed by professional crisis counselors who can help de-escalate crisis presentations and provide the right resources for further stabilization and prevention services within the community.
While the Lifeline significantly expands access to immediate crisis support, most communities lack a full crisis continuum of care that follows a system of care philosophy to include early outreach to people at risk, mobile crisis teams, crisis stabilization options, and post-crisis community-based supports in an equitable and just fashion.
To transform the 988 Lifeline into a system that includes the full crisis continuum of care, the American Academy of Child and Adolescent Psychiatry recommends:
- Federal and state funding to support communities in building a full crisis continuum of care.
- A system that provides services in an equitable manner inclusive of all races, gender, ethnicities, religions, and countries of origin.
- A 988 system that is integrated or coordinated with all other systems involving youth and families, such as the school system, juvenile justice system, and the welfare system.
- A system that abides by federal and state mental health and addiction parity laws.
- A system that follows standards of care with outcome data supporting best practices.
- Sufficient planning and investment to develop the needed workforce capacity for this crisis response system, including child psychiatrists.