Mental health care is out of reach for too many. Here’s how N.J. can change that | Opinion – NJ.com

Report on New Jersey’s 988 Crisis Continuum of Care and its Alignment with Sustainable Development Goals

Introduction: Addressing Mental Health in the Context of SDG 3

In the United States, a significant public health challenge persists, with one in five individuals experiencing mental illness annually. This gap in healthcare access directly contravenes the objectives of Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all at all ages. New Jersey is addressing this challenge through the implementation of the 988 Crisis Continuum of Care, a novel model designed to provide accessible and immediate mental health support, thereby advancing SDG Target 3.4 to promote mental health and well-being.

The 988 Crisis Continuum of Care: A Framework for Sustainable Health Systems

The 988 initiative is structured to provide a comprehensive, community-based response to mental health, substance use, and suicidal crises. This approach not only supports SDG 3 but also contributes to SDG 10 (Reduced Inequalities) and SDG 11 (Sustainable Cities and Communities) by creating more equitable and resilient local health infrastructures.

Core Components of the Program

1. 24/7 Crisis Support: A multi-platform service (phone, text, chat) staffed by trained specialists provides immediate listening, support, and referral services. This ensures universal access, a key tenet of SDG 10.
2. Mobile Outreach Services: In-person crisis response teams are deployed into the community, reducing the burden on traditional emergency services and minimizing potentially traumatic hospital visits, which aligns with creating safer and more sustainable communities under SDG 11.
3. Crisis Stabilization and Diversion Hubs: The model includes two types of support facilities:
   • Crisis Stabilization Centers: Offering up to 24 hours of clinical and support intervention.
   • Crisis Diversion Homes: Providing continued services for up to 30 days.

Challenges to Program Sustainability and the Role of SDG 16

The long-term success of the 988 Crisis Continuum of Care is threatened by systemic challenges, primarily related to funding. This issue highlights the importance of SDG 16 (Peace, Justice, and Strong Institutions), which calls for effective, accountable, and inclusive institutions.

Funding Instability and Institutional Weakness

• Ongoing instability in federal funding streams poses a significant threat to the continuity of the 988 program.
• The launch of critical components, such as the Crisis Receiving Stabilization Centers, has been delayed due to these financial challenges.

A Legislative Solution for Sustainable Funding

To ensure the program’s long-term viability and strengthen its institutional foundation, a legislative solution has been proposed. The 988 telecom fee bill (S4502/A5978) would establish a stable funding source through a nominal monthly fee of 40 cents. Passage of this bill would provide the financial security necessary to fully implement and sustain the state’s five Crisis Receiving and Stabilization Centers, thereby reinforcing the state’s commitment to SDG 3 and SDG 16.

Conclusion: A Call for Partnership to Achieve the Goals (SDG 17)

The 988 Crisis Continuum of Care represents a significant step toward achieving multiple Sustainable Development Goals by providing an equitable, community-focused model for mental healthcare. However, its success is contingent on establishing strong, sustainable institutions through stable funding. Achieving this requires a multi-stakeholder partnership, as envisioned in SDG 17 (Partnerships for the Goals). Public engagement with elected representatives is a critical mechanism for influencing policy and securing the financial framework needed to ensure that essential mental health services are available to all.

Analysis of the Article in Relation to Sustainable Development Goals (SDGs)

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: This is the primary SDG addressed. The article focuses entirely on mental health, the prevalence of mental illness (“One in five people… experiences mental illness”), the challenges in accessing care, and the implementation of a new crisis response system to support individuals experiencing mental health, substance use, or suicidal crises.
• SDG 10: Reduced Inequalities: The article highlights that mental health “care remains out of reach for millions of people,” indicating a significant inequality in access. The 988 Crisis Continuum of Care is presented as a solution to make support services more accessible to everyone, thereby reducing this inequality.
• SDG 16: Peace, Justice and Strong Institutions: The article discusses the creation of a “novel model of crisis response” as a more effective institutional alternative to traditional emergency services. It also points to the need for strong institutional support through stable funding, advocating for a specific legislative bill (“S4502/A5978”) to ensure the long-term viability and effectiveness of this public service.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • The article directly relates to this target by describing the 988 Continuum’s goal to “reduce the risk of crisis escalation, hospitalization, or death” for people in a “suicidal crisis.” The entire initiative is designed to promote mental health and well-being by providing immediate support.
2. Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.
   • The 988 service is explicitly designed to support people “experiencing a mental health, substance use or suicidal crisis,” directly aligning with the goal of strengthening treatment for substance abuse.
3. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services… for all.
   • The article describes the current mental health system as “overwhelming, expensive and difficult to access.” The 988 Continuum, with its free-to-access phone, text, and chat services, is a step towards universal access to essential mental health crisis care. The debate over stable public funding aims to ensure the service remains available without imposing direct costs on individuals in crisis.
4. Target 16.6: Develop effective, accountable and transparent institutions at all levels.
   • The implementation of the “988 Crisis Continuum of Care” represents the development of a new, more effective institution for mental health crisis management. The call for legislative action to secure a stable funding stream (“proposed 988 telecom fee bill”) is an effort to make this institution accountable and sustainable for the long term.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Prevalence of Mental Illness: The statistic “One in five people in the United States experiences mental illness every year” serves as a baseline indicator of the scale of the public health challenge that needs to be addressed.
• Availability and Coverage of Crisis Services: The article implies that progress can be measured by the successful implementation and operation of the three core components of the 988 Continuum:
  1. The 24/7 phone, text, and chat service.
  2. The outreach mobile service for in-person response.
  3. The establishment and operation of Crisis Stabilization Centers and Crisis Diversion Homes.

  The delay in launching the Crisis Receiving Stabilization Centers due to funding is a negative indicator of progress.

• Reduction in Harmful Outcomes: The article suggests that the effectiveness of the program can be measured by its success in reducing “crisis escalation, hospitalization, or death.” This implies that tracking data on suicide rates, emergency room visits for mental health crises, and hospitalizations would be relevant indicators.
• Sustainable Financial Mechanism: The passage and implementation of the “proposed 988 telecom fee bill (S4502/A5978)” would be a concrete indicator of the establishment of a stable and long-term funding source, ensuring the continuity of the program.

4. Table of SDGs, Targets, and Indicators

Source: nj.com