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Implementation of the Federal 988 Suicide and Mental Health Crisis Hotline Policy: Determinants and Effects of State Policy Implementation Financing Strategies

Award Number: R01MH131649
ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 03/01/2023
PERIOD OF PERFORMANCE END DATE: 12/31/2027

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Implementation of the Federal 988 Suicide and Mental Health Crisis Hotline Policy: Determinants and Effects of State Policy Implementation Financing Strategies - PROJECT SUMMARY On July 16, 2022 “988” will become the national toll-free dialing code for the National Suicide Prevention Lifeline (Pub. Law 116-172). The Lifeline receives 3.5 million calls annually and has demonstrated effectiveness at decreasing suicidality, hopelessness, psychological distress, and suicide death. The transition from the current 10-digit Lifeline dialing code to 988—a three-digit code like 911—is projected to potentially triple call volume. The impact of 988, however, will likely be determined by state policy responses to financing its implementation. The federal law that creates 988 encourages states to pass user fee legislation (e.g., a flat fee monthly per every cellphone plan holder in the state, identical to how 911 is financed). The current state policy landscape is extremely varied. As of January 2022, four states had passed user fee legislation and many others were considering such legislation. The proposed policy implementation project focuses on the characteristics, determinants, and impacts of 988 user fee legislation and other policy strategies used by states to finance 988 implementation. The project’s Specific Aims are to: 1) Characterize states’ 988 implementation financing strategies and identify determinants of implementation strategy adoption; 2) Explore perceptions of the financing determinants of 988 policy implementation success and acceptability and feasibility of legislative financing strategies to improve implementation; and 3) Determine the effects of 988 user fee legislation on the policy implementation outcomes of fidelity (Lifeline in-state answer rates) and reach (Lifeline state call volume rates), the effectiveness outcomes of suicide death and emergency department use for mental health crises and self- harm, and assess effect heterogeneity across demographic groups. These aims will be achieved by a legal mapping study, national surveys of 250 suicide prevention stakeholders (e.g., Lifeline call center leaders), 60 semi-structured interviews, and a difference-in-differences analysis comparing trends in implementation and effectiveness outcomes pre (2015-2021) and post (2022-2025) 988 implementation between states that did and did not pass 988 user fee legislation. The project team has expertise in policy implementation science (Purtle, Raghavan), suicide (Lindsey), law (Pomeranz), and quantitative policy analysis (Stuart). Practice partners include Vibrant Emotional Health, which administers the Lifeline, and the American Foundation for Suicide Prevention. The project is innovative because it advances the understudied area of policy-focused implementation science. The project is significant and will have impact because it focuses on a major federal policy in the early stage of implementation and because it will generate knowledge to inform implementation financing decisions related to 988—which is likely to be a primary gateway to mental health crisis and suicide prevention services for the foreseeable future. The project is aligned with NIMH’s Strategic Plan, which prioritizes suicide prevention, and the NIMH pledge to reduce the suicide rate by 20% by 2025.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $404,189 )
2026	2026	NEW YORK UNIVERSITY	70 WASHINGTON SQ S FL 11	NEW YORK	NY	10012	NEW YORK	USA	Mental Health Research Grants	000	4	3/4/2026	NON-COMPETING CONTINUATION	$404,189
														Subtotal = $404,189

Issue Date FY: 2025 ( Subtotal = $343,548 )
2025	2025	NEW YORK UNIVERSITY	70 WASHINGTON SQ S	NEW YORK	NY	10012	NEW YORK	USA	Mental Health Research Grants	000	3	12/24/2024	NON-COMPETING CONTINUATION	$343,548
														Subtotal = $343,548

Issue Date FY: 2024 ( Subtotal = $403,319 )
2024	2024	NEW YORK UNIVERSITY	70 WASHINGTON SQ S	NEW YORK	NY	10012	NEW YORK	USA	Mental Health Research Grants	001	2	7/9/2024	NON-COMPETING CONTINUATION	$40,331
2024	2024	NEW YORK UNIVERSITY	70 WASHINGTON SQ S	NEW YORK	NY	10012	NEW YORK	USA	Mental Health Research Grants	000	2	1/30/2024	NON-COMPETING CONTINUATION	$362,988
														Subtotal = $403,319

Issue Date FY: 2023 ( Subtotal = $417,953 )
2023	2023	NEW YORK UNIVERSITY	70 WASHINGTON SQ S	NEW YORK	NY	10012	NEW YORK	USA	Mental Health Research Grants	000	1	2/20/2023	NEW	$417,953
														Subtotal = $417,953

Grand Total All Awards = $1,569,009

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Implementation of the Federal 988 Suicide and Mental Health Crisis Hotline Policy: Determinants and Effects of State Policy Implementation Financing Strategies

Award Number: R01MH131649

ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 03/01/2023

PERIOD OF PERFORMANCE END DATE: 12/31/2027

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