Alabama lawmakers are considering a bill to add a monthly surcharge of 98 cents to cellphone and landline bills to raise about $70 million a year to expand care for people suffering from mental health crises, including those at risk of suicide.

The commissioner of the Alabama Department of Mental Health said the bill would save lives. It has bipartisan support but faces some opposition from the cellphone industry and uncertainty with the clock winding down on the legislative session.

The bill would be the latest in a series of steps Alabama has taken over the last few years to close what officials say was a glaring lack of help for people in severe distress from mental illness.

Last year, Alabama established the 988 Suicide & Crisis Lifeline to connect callers with specialists to help people cope with thoughts of suicide, depression, anxiety, addiction, and other problems and to guide them to additional services. The three-digit number replaced a 10-digit suicide hotline and is intended to people with mental health emergencies the same way that 911 does for emergencies in general.

Congress launched the initiative for the 988 Lifeline when it passed the National Suicide Hotline Designation Act of 2020. That bill authorized states to add surcharges to phone bills to fund the 988 call centers and services for callers. The idea is similar to the $1.86 monthly fee phone subscribers pay to support 911 services.

“There was recognition that calling 988 doesn’t do you any good if you don’t have the services, particularly crisis services, available to people,” Alabama Department of Mental Health Commissioner Kimberly Boswell said.

The 988 Lifeline is an entry point for what the ADMH calls Alabama’s crisis system of care, a system that is new, growing and far from complete.

In the last two years, the ADMH has opened mental health crisis centers in Huntsville, Mobile, Montgomery, and Birmingham. Centers in Dothan and Tuscaloosa will open later this year. A study commission created in 2021 determined that Alabama needed a total of 11 crisis centers. Boswell said the additional five would most likely be in communities with 50,000 or more people but the sites have not been chosen. For rural areas and places not close to one of the centers, the ADMH is working to develop mobile crisis teams.

“The whole purpose of the surcharge is to be able to expand crisis services statewide,” Boswell said. “So right now, our crisis centers that are established cover 19 of the 67 counties. We have mobile crisis teams in rural communities that cover about seven more counties.”

The ADMH has three call centers to answer 988 calls. Boswell said the goal is to eventually have a call center at every crisis center.

Boswell said Gov. Kay Ivey’s administration and the Legislature, in an effort spearheaded by House Speaker Nathaniel Ledbetter, has increased funding for mental health over the last few years. But Boswell said that comes after a decade of underfunding.

“We have a crisis in mental health,” Boswell said. “We have a crisis when it comes to suicide. And we really believe that we’ve demonstrated over the last three years by standing up these crisis services that this is the way to address access to mental health care in the state of Alabama.”

The bill, HB389, or the 988 Crisis System of Care Act, is sponsored by Rep. Rex Reynolds, R-Huntsville, chair of the House General Fund committee, and has 17 co-sponsors. The committee held a public hearing on the bill last Wednesday. Several lobbyists from the telephone and communications industry said the proposed fee was higher than in any other state and suggested paying for the 988 call centers and crisis services out of the state’s General Fund rather than creating a new surcharge.

Reynolds said services are important enough to justify the fee. He said a dedicated funding source would avoid the uncertainty of relying on the General Fund, which rises and falls with the economy.

“We don’t know what the future budgets will look like,” Reynolds said. “And I think this stabilizes funding from now on.”

Reynolds said efforts are ongoing to change the bill to address concerns by those from the industry and others. An earlier version would have allowed a commission created by the bill to increase the fee to as much as $3 a month. That provision has been removed from the latest version of the bill, Reynolds said. He said that’s one of about 18 changes in the bill so far. The bill is on the agenda for the General Fund committee’s meeting on Wednesday. Reynolds said he is not yet sure the committee will vote on the bill and advance it for a vote by the full House.

“It’s too early to tell,” Reynolds said. “We’re having conversations within the Legislature. With leadership. They’re having conversations with all the stakeholders. All that’s got to come together to address the bill. It’s just so critical. But it’s got to be right. It’s a big bill and impacts a lot of Alabamians.”

Only 10 meeting days remain in the 30-day legislative session. Reynolds said if the bill does not pass this year, he will continue to work on it and introduce it again next year.

Rep. Andy Whitt, a Republican from Harvest in Madison County, told the committee about a phone call from his son early Wednesday morning.

“I could tell he was distraught,” Whitt said. “And he told me that one of his friends had committed suicide last night in Huntsville, Alabama. In the suicide note, without going into great detail, the young man, the 22-year-old, felt that he couldn’t speak to anyone, he couldn’t find anyone to talk to. He felt alone. He’d moved to Huntsville and didn’t have any family and he felt like he couldn’t go on and he took his own life.”

Whitt ask the other committee members to remember the young man’s family.

“It seems like we’re hearing these stories every day,” Reynolds said.

Boswell said demand for services at the crisis centers and calls to 988 have reinforced the importance of the funding. The crisis centers in Huntsville, Mobile, and Montgomery have been operating more than a year. In 2022, more than 400 patients evaluated at the three centers were suicidal. Others had depression, substance use disorder, anxiety, psychosis, and mania. More than 1,500 of those evaluated at the centers would have otherwise gone to hospital emergency departments and more than 400 would have gone to jail, according to the ADMH.

The 988 Suicide & Crisis line received more than 34,000 calls, chats, and texts, from July 2022 to March 2023, including more than 23,000 calls, the ADMH said. Boswell said 15 calls came during a suicide attempt. The commissioner said she expects the numbers to rise as more people learn about the 988 line. She said the response to the crisis centers and the 988 service is the best evidence for the importance of the bill and the life-saving potential for the crisis system of care. She acknowledges the difficulty in passing legislation that will require cellphone users to pay a new surcharge.

“I know it is a big ask in the context of the current political environment,” Boswell said. “But when I saw those numbers, there’s no way I couldn’t advocate to try and get this bill passed. Because what that demonstrated to me is lives are being saved through crisis services. We know that 15 people who called 988 over the last year were in an active suicide attempt. And we were able to get them help and prevent that suicide from happening. And so those numbers really, that was the tipping point for me to say, OK, the model is right. We have shifted to a new a business model. But more importantly, the model demonstrates that we’re saving lives.”

You can watch a video of the public hearing on the Alabama Channel, a production of the League of Women Voters of Alabama.

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