Alabama’s 988 crisis lifeline supporters call for more funding amidst growing mental health needs

Working at a call center for the state’s 988 suicide and crisis hotline can be rewarding.

Kelsi McDowell, volunteer coordinator at Birmingham’s 988 call center, has been with the center since 2015, when she started as a volunteer.

Currently, she helps out where she can and does a bit of everything around the call center. On the Monday before the 4^th of July, she was answering the rape response hotline.

But those taking the phone calls may need to hear about people’s traumatic experiences; watch disturbing videos, read case files or deal with the after-effects of violence on a day-to-day basis.

McDowell said that the hardest calls, although infrequent, are when people call with their mind set on taking their own lives.

“There are sometimes going to be callers that are just calling to say ‘goodbye,’ so that’s really tough,” McDowell said. “That’s really tough — when you don’t know what happens, or if they hang up and you can’t get them back on the phone.”

This exposure to traumatic experiences can affect them even if they’re not the ones directly experiencing the trauma. This sort of indirect trauma is called vicarious trauma, often faced by people who work or volunteer in jobs like helping people in a mental health crisis, can be an issue.

That’s why Emily Roebuck, director of the 988 call center in Birmingham, encourages her employees to practice self-care, such as separating their work-life from personal life, but she said that the job usually attracts empathetic people, who may find coping with the exposure difficult.

“As empathetic people, it’s just true that our feelings are going to come into play, but we always have to be able to kind of monitor ourselves and make sure that our emotions aren’t getting in the way of our own wellness, or in the way of us helping the caller,” Roebuck said.

So far, funding for 988 centers have come from a federal grant, totaling just over $2.4 million between 2022 and 2023. The money doesn’t allow the creation of a comprehensive response service.

A bill in the Alabama Legislature to fund services related to the 988 hotline stalled after disagreements on funding, leading to its defeat in the 2023 legislative session.

Josaylon Henry, clinical director at the WellStone crisis center in Huntsville, said that additional funding would have allowed her to hire more crisis counselors to answer more calls. She said that hiring more callers would ease the amount of work they do, which would allow for more time to debrief with a supervisor.

At WellStone, 988 counselors have the opportunity to debrief with supervisors after a particularly traumatic intervention.

“Their supervisor talks through steps and actions that were taken,” she said, “and the supervisor then provides feedback and coaching, if necessary.”

Henry said that some calls may take hours to find the interventions and steps necessary to save the individual’s life. That is why, she said, 988 call centers need more funding to increase capacity and provide current employees more resources.

Currently, WellStone has two full-time positions and one part-time position open. To be up to capacity, she said she would need to hire four to six full-time workers.

“It is disheartening that we did not get the funding for that, so that we can really work on expanding the need of having 988 counselors, so that was disheartening, but we’re hopeful for the future,” she said.

Lack of funding

The 988 line is vital in a state seeing mounting problems related to mental health. According to Mental Health America, Alabama ranked 45th in the country, including Washington D.C., for overall mental health. In terms of access to care, Alabama ranked 50th.

The 988 Lifeline is available in all counties, but many calls from Alabama are routed to the national number because the call center does not have enough people to answer all the calls in the state, said Alabama Department of Mental Health (ADMH) Commissioner Kimberly Boswell.

Individuals whose calls are answered in state, regardless of the county, are given the resources that are within their area.

“But oftentimes, when people are in a crisis, they can't really drive two hours to Mobile or two hours to Huntsville,” Boswell said. “So more often than not, if there's not an available crisis center, they're going to be sent to the local [emergency room].”

Only 19 of Alabama’s 67 counties have access to crisis centers. Others lack additional services, like crisis centers and mobile crisis teams.

A bill sponsored by Rep. Rex Reynolds, R-Huntsville, known as the 988 Crisis System of Care Act, would have funded these services in more counties. It would have required ADMH to develop, coordinate and administer Alabama’s mental health care initiative, which includes supporting the 988 lifeline.

The legislation would have set a fee of 98 cents per cell phone line beginning Oct. 1, 2024. The legislation would also have established a commission that would have been responsible for developing a hardship waiver process for individuals who cannot pay the 98-cent user fee.

Five states have enacted the legislation that funds these services via a telecommunication surcharge, and that Alabama’s would be the highest, at more than double the rate in Washington state (40 cents), the current highest fee.

Washington, however, also appropriated $23 million from its General Fund budget towards the lifeline implementation, according to the National Academy for State Health Policy. Of the 13 states that have appropriated funds from the state budget, three also implemented a telecom surcharge.

Supporters pitched the bill as a vital measure to address the mental health crises affecting the state. But the legislation did not pass before the end of this year’s legislative session.

Members of the telecom industry opposed the legislation, calling the fee per cell phone line a tax.

ADMH will get $500,000 from the General Fund for the 988 line next year. The agency is working on another federal fund application.

But Boswell said they will have to go back to the Legislature in the regular session next February for more funding.

“Does it make sense to make this request in 2025 out of the General Fund, or will there be more support potentially for the bill and a surcharge in the next session that we didn't see in this session?” Boswell said.

The commissioner said they’re going to be asking for a “pretty significant increase” to be able to provide these services in all 67 counties around the state.

“It really is a policy question about whether it comes from the General Fund, whether or not it comes from the surcharge, or some other option that may be on the table by the next session,” she said. 

‘$1 for a veteran that’s suicidal’

The Birmingham 988 call center continues to field messages from people seeking help, with Roebuck trying to ensure workers are in a good frame of mind.

“If we burn out, we can't do what we do anymore, and none of us want that,” she said.

Susan Baty-Pierce, vice president of advocacy for NAMI Birmingham, said the failure to pass the 988 funding bill this year broke her heart. The state cannot let another veteran or another child die, she said, simply because of funding.

As an advocate for the last 35 years, she said that she understands that Alabama lawmakers don’t like to raise taxes on its people, but she said that at some point, legislators “have to allow some things that can't be replaced or provided by anybody else.”

“If they don't have the money to put in the General Fund — fine, I don't question that,” she said. “But then it's got to be passed on to the customers that ask for phone service, due to lack of any other funding from any other source. It has to happen.”

But she said that this is not a sprint, but a marathon. She said that if they need another year to better fund the service, then she supports it.

“Is it going to be a tax? Is it going to be a fee? Is it going to be funded through the General Fund or the Treasurer's office? NAMI Birmingham supports whatever efforts that we can continue to work forward with,” she said.

Baty-Pierce said that she recognizes lawmakers in Alabama choose to budget conservatively, and that they want less oversight and less government.

“I hear that, but you can't do this — a $1 for a veteran that’s suicidal — God help us,” she said.