The new 988 crisis line, designed to replace the national 10-digit National Suicide Prevention hotline, is starting to gain traction in Maryland, one of the few states allocating direct funding to the effort, crisis responders said.

The crisis line was among the topics discussed at a roundtable event on youth mental health in Baltimore on Friday, attended by Gov. Wes Moore, U.S Department of Health and Human Services Secretary Xavier Becerra and other government officials, crisis response providers, mental health advocacy organizations and youth advocates.

The roundtable was hosted by the Behavioral Health System of Baltimore, the organization overseeing public behavioral health services in the city.

Mariana Izraelson, executive director of Grassroots Crisis Intervention Center, one of three local 988 crisis responders at the roundtable, said the text and chat feature has been particularly popular with youth. They are able to message anonymously, she said, which allows them to say “how they really, truly feel.”

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She praised the 988 concept for “meeting people where they are” by providing immediate care through a single nationwide access point available 24 hours per day. The crisis line, meant to replace national suicide and Here2Help hotlines — with calls to those numbers now routed to 988 — was rolled out by the federal government in July of last year. It’s operated by over 200 local crisis response providers.

Miriam Delphin-Rittmon, assistant secretary of the Substance Abuse and Mental Health Services Administration (SAMHSA), said last month that 172,000 more contacts were made to the crisis line nationwide compared to a year prior. Text and chat rates have also surged, with chats increasing by 263% and texts increasing by 1,445% over the same time period.

Grassroots Crisis Intervention Center is one of a limited number of 988 providers nationwide that is able to receive text and chat messages in addition to regular phone calls, and the only one of eight statewide crisis responders in Maryland with that capability. The organization has seen a “significant increase” in 988 use, with the largest jump in text and chat, Izraelson said.

Grassroots fields 3,000 text and chat messages per month, Izraelson said, some from outside Maryland. She said kids of all ages are reaching out, with an uptick in messaging occurring during school lunch time and after 8 p.m.

Becerra said some young people and particularly young men have expressed concerns that they will be “transferred over to law enforcement” if they call 988 for a mental health crisis, though he knows those fears are unfounded.

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Izraelson said her organization has very specific protocols to determine when they need to involve outside parties, with the goal is to minimize the involvement of law enforcement and deescalate and resolve situations on their own.

She said paramedic and mobile crisis teams are contacted only when an individual is suicidal and unable to make a plan for their own safety. She said less than 1% of calls result in law enforcement involvement; however, the rate is “a little higher” for text messages, as people are more likely to reach out with the intent to communicate “a final message.”

Becerra praised Maryland as one of a handful of states to allocate a dedicated funding stream to 988, instead of relying exclusively on federal funding, which may not be sustainable. Last year, the state legislature established a $10.5 million trust fund meant to fund 988 for its first two years of operation. A bill has been introduced this session to allocate an additional $12 million for 2025 to satisfy anticipated growth in demand and to build a more robust crisis infrastructure statewide.

The roundtable also highlighted effective yet underutilized practices for supporting youths struggling with mental health issues, such as providing access to peer support networks and involving youths in co-designing programs that target them.

Youth advocates Sage Hughes and Sam Jesner shared their experiences of navigating the mental health system and said that having access to peers going through similar challenges is particularly helpful. Both felt that opportunities for peer support should be expanded.

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“Having a group of people who understand your issues and can empathize with them is really impactful,” Hughes said. He said older generations can sometimes minimize the effect of trauma and encourage “pushing aside” mental health issues.

Stacey Jefferson, director of policy and stakeholder engagement at Behavioral Health System of Baltimore, emphasized that youths show more investment in programs they help shape, and involving them gives underserved groups, such as youths of color, “a seat at the table.

Federal and state investments in youth

In July of last year, the Biden Administration announced over $300 million in funding to address the youth mental health crisis that developed during the COVID-19 pandemic. Most of this funding has been allocated to the Department of Education, which will distribute $280 million in grants to state and local education agencies to increase the number of credentialed mental health providers in schools with “demonstrated need” and form partnerships with colleges and universities to train more school-based mental health providers and strengthen the workforce pipeline.

The Department of Health and Human Services will award $27 million to local pediatric providers — including in emergency departments and mental health providers in schools — to expand telehealth capabilities and consult virtually with pediatric mental health specialists to better diagnose and treat kids experiencing psychiatric issues.

In a joint letter sent to state governors in July 2022, Becerra and the U.S. Department of Education secretary called on them to take advantage of Medicaid’s updated “free care rule,” which allows schools to bill for an expanded set of mental health services provided on campus.

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The Centers for Medicare and Medicaid Services issued guidance last August to help schools understand how Medicaid can be leveraged to fund mental health services, which makes providing those services more sustainable for them.

Federal legislation passed last May requires CMS to update a decades-old technical assistance guide for schools to integrate modern approaches such as telehealth and provide best practices for navigating the confusing and foreign world of medical billing.

The legislation also provides $50 million in grants for states to implement or expand school-based Medicaid programs, and requires HHS to set up a technical assistance center to help states and schools learn how to bill for services.

Gov. Moore said his administration supports expanded access to mental health support in schools and highlighted its own $1.4 billion proposed investment in mental-health and substance use programs.

He stressed the importance of providing robust funding to community-based organizations that often must “clean up the debris that comes from broken systems that exist on a larger level,” Moore said.

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“Continued and accelerated support of these things that frankly have been neglected for a while is going to be a core priority for our administration,” he said.