Bill Overview
Title: 9–8–8 Implementation Act of 2022
Description: This bill modifies provisions to increase access to behavioral health services, with a focus on crisis services and the 9-8-8 telecommunication system. (The 9-8-8 system provides callers with mental health or suicide crisis support and resources through the existing National Suicide Prevention Lifeline and is scheduled to take effect by July 16, 2022.) The bill reauthorizes through FY2027 and revises the National Suicide Prevention Lifeline program and requires a national suicide prevention media campaign. In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA) must establish standards for a behavioral health crisis continuum of care that health care providers and communities may use in responding to individuals experiencing a behavioral health crisis. The continuum must include emergency treatment, stabilization, and related services. The bill expands Medicaid and other insurance coverage for such services. The bill further expands Medicaid coverage for behavioral health services. This includes permanently allowing coverage of certain community-based mobile crisis services and exempting some short-term stabilization services from coverage restrictions that apply to institutions for mental diseases. Additionally, the bill establishes (1) an office within SAMHSA to coordinate behavioral health activities; and (2) various grants, including a pilot program for mobile crisis care teams that respond to behavioral health crises rather than law enforcement and a capital improvement program for certain behavioral health facilities. The bill also reauthorizes through FY2027 and expands certain workforce programs for behavioral health providers. It also addresses training for emergency services dispatchers and coordination of the 9-1-1 system with the 9-8-8 system.
Sponsors: Rep. Cárdenas, Tony [D-CA-29]
Target Audience
Population: Individuals in need of or potentially in need of mental health or crisis support services globally
Estimated Size: 66000000
- The bill impacts individuals experiencing mental health or suicide crises as it aims to improve access to behavioral health services.
- Mental health crises are a global phenomenon, and the need for support systems and services is ubiquitous across nations.
- The establishment of a continuum of care and mobile crisis services extends beyond those actively facing crises to people who might face them in the future.
- Mental health issues have worldwide prevalence, affecting various groups regardless of age, gender, or socio-economic status.
Reasoning
- The policy is aimed at individuals in mental health crises, therefore the target group includes those in need of emergency behavioral health services.
- While the immediate impact is on those currently experiencing crises, the policy's broader effect includes preventive care and a more sustained support system.
- Given the budget constraints, focus must be on the most impactful and cost-effective measures to reach those in dire need.
- Interviewees are selected to represent both direct beneficiaries of the program (those in mental health crises or with a high risk) and those with indirect benefits (family members, health professionals).
- The policy's enhancement of Medicaid coverage and mobile crisis units suggests wider outreach beyond just those calling the 9-8-8 line directly.
Simulated Interviews
high school student (Los Angeles, CA)
Age: 18 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 15/20
Statement of Opinion:
- I think having a number like 9-8-8 makes it easier to reach out.
- Accessibility to mental health resources can be improved with this policy.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 9 | 6 |
emergency room nurse (Nashville, TN)
Age: 40 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 14/20
Statement of Opinion:
- The policy could ease pressure on emergency departments by using crisis teams.
- Coordination with 9-1-1 is crucial for effective response.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
retired teacher (Phoenix, AZ)
Age: 65 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- Medicaid expansion for mental health is a vital change for us.
- The new system might provide a quicker response when in crisis.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
software developer (Chicago, IL)
Age: 32 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- Having 9-8-8 seems beneficial but needs proper awareness campaigns.
- I'm glad the policy includes media campaigns as well.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
social worker (New York, NY)
Age: 55 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 13/20
Statement of Opinion:
- The policy could be a game-changer in providing quicker and more specialized care.
- Funding and proper staffing are crucial for its success.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 7 |
artist (Austin, TX)
Age: 28 | Gender: other
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- More accessible care can prevent situations from escalating.
- The Medicaid expansion is a lifeline for continuous support.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
police officer (Houston, TX)
Age: 50 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- Diverting mental health crises to specialized teams will help a lot.
- The coordination with law enforcement could improve community trust.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
graduate student (Boston, MA)
Age: 23 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 11/20
Statement of Opinion:
- The policy could provide more affordable access to care.
- Mobile crisis care teams sound promising for urgent needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
unemployed (Miami, FL)
Age: 37 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 20.0 years
Commonness: 9/20
Statement of Opinion:
- The media campaign could help reduce stigma and encourage seeking help.
- Affordable mental health services are much needed.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 7 | 4 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
primary care physician (Seattle, WA)
Age: 45 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 11/20
Statement of Opinion:
- The policy might finally give us tools to offer better care in crises.
- Focused training for responding to mental health emergencies is crucial.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
Cost Estimates
Year 1: $1000000000 (Low: $850000000, High: $1150000000)
Year 2: $1020000000 (Low: $870000000, High: $1170000000)
Year 3: $1040000000 (Low: $890000000, High: $1190000000)
Year 5: $1080000000 (Low: $920000000, High: $1230000000)
Year 10: $1150000000 (Low: $980000000, High: $1300000000)
Year 100: $1400000000 (Low: $1200000000, High: $1600000000)
Key Considerations
- Inter-agency collaboration is crucial for effective implementation and cost management.
- Behavioral health workforce limitations may affect the rollout speed of some programs.
- Medicaid expansion can have significant impacts on state budgets and require careful planning.