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After stopping my anxiety medication too quickly, I needed expert assistance quickly. I have good health insurance, but finding an appropriate professional became a lengthy, frustrating process. The lack of current or reliable online information for mental health was a big problem, even for me — and I’ve worked in health care. In 2021, a research survey from the National Alliance on Mental Illness revealed growing dissatisfaction with online mental health information. The survey involved both individuals with mental health conditions and those seeking assistance for family members. Eighty percent of responders who used navigational tools to find treatment or services reported difficulties with data availability and accuracy.
“This is a once-in-a-generation opportunity to fundamentally transform part of the mental health system that for far too long has been underfunded and under supported,” said Hannah Wesolowski, NAMI CAO. “There’s a lot to happen between now and calling it a success.” Last week, bipartisan legislation was introduced to provide federal funding and guidance for states to rev up their 988 crisis response infrastructure. The Administration plans to request nearly $700 million for launching 988 in its upcoming federal budget.
The psychiatric staff at Children’s National saw a change with COVID — common issues are amplified with mild depression leading to major depression. Across the country, only about 10% of hospitals have pediatric psychiatric services and only about 7% provide inpatient care, resulting in children waiting in the ER for beds, sometimes for weeks on end. The section on ﬁnding help for a struggling child links to NAMI and a NAMI blog post on navigating the overwhelming volume of new mental health apps.
“Members of the military have to function at a very high level and that takes a toll,” said Sherman Gillums Jr., NAMI Chief Strategy Officer and retired Marine officer. “We are taught to mask anything that is wrong with us, to adapt and overcome. Military culture looks at asking for help as a liability, from recruitment to training to the rest of one’s career.” Mr. Gillums noted that more troops were sharing their experiences with sexual harassment, assault and mental health struggles on social media. “This could be an intergenerational shift,” he said, “starting with young people who see themselves as humans first beyond their uniform and weapon.”
As a parent talking about emotional or mental well-being isn't always easy. The key is to ensure children feel comfortable expressing their feelings and getting help when they need it. "It's important to know that showing that you're concerned about their behaviors will not make things worse; it'll help acknowledge what they've been thinking and feeling, making you both more connected. Your role isn't to diagnose your child; keep your message simple: You've noticed behaviors that you are concerned about. You want to support them," says Jennifer Rothman, Senior Manager of Youth and Young Adult Initiatives at NAMI.
The 988 Implementation Act builds on the 2020 legislation that designated 988 as the new three-digit number for the National Suicide Prevention Lifeline. That bill authorized states to add surcharges to the monthly telephone bills of consumers to help fund the line but provided no other funding to states to run it. So far, according to NAMI, only four states (CO, NV, VA, WA) have done so. “It’s going to take federal investment as well as state and local leadership to make a 988 crisis continuum available to everyone,” said Hannah Wesolowski, NAMI Chief Advocacy Officer. “While Congress gave states this mechanism for a new funding stream, it is discouraging to see so few states leverage the opportunity.”
Legislation in more than two dozen states has passed or is pending to fund 988 services or study funding, according to NAMI. "Currently, as a country, we're not ready for this rollout," said Hannah Wesolowski, NAMI Chief Advocacy Officer. "There's so much demand out there and so many elements to knit together to really prepare to fully provide a mental health response to a mental health crisis."
Legislators introduced the 988 Implementation Act, a bill to help fund the 988 rollout and implementation. Hannah Wesolowski, NAMI Chief Advocacy Officer, said about 80% of calls to the Lifeline can be de-escalated over the phone. Of the 20% that can't, she said, about 70% can be resolved with the help of mobile crisis response teams. The rest can go to crisis stabilization centers, after which a majority can be discharged back into the community without being hospitalized. "Mobile crisis teams, which provide an alternative to law enforcement, are so critical. Relying on law enforcement is just an ineffective way to respond to [mental health] crises. That's not the job law enforcement signed up for, nor should we be asking them to do that," Wesolowski said.
The 2021 Mental State of the World report shows a decline in mental health worldwide, with young adults reporting the poorest outcomes. The report included 34 countries with over 220,000 internet-enabled adults. Ken Duckworth, MD, NAMI Chief Medical Officer, called the survey "extremely well timed and creative, although it only looked at internet-enabled populations, so one cannot make too many overall pronouncements, because a lot of people don't have access to the internet." The data regarding young people are particularly powerful. "The idea that young people are having a decrease in their experience of mental health across the world is something I haven't seen before." Duckworth suggested the reason might "have to do with the impact of the COVID lockdown on normal development that young people go through, while older people don't struggle with these developmental challenges in the same way."
There are growing concerns that the 24-hour National Suicide Prevention hotline, already straining to meet demand, will not be able to deliver on the promises of the overhaul for the launch of 988, unless states supplement the federal money with significant funds for staffing. Within a few years of the introduction of 988, it is likely to attract tens of millions of people seeking help, estimates show. Those projections are driving mental health advocates as they prod state lawmakers to approve funding. “Our concern is very much about whether there will be someone to answer that call when someone is in crisis,” said Hannah Wesolowski, NAMI Chief Advocacy Officer.