Federal Communications Commission FCC 20-100 Before the Federal
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Federal Communications Commission FCC 20-100 Before the Federal Communications Commission Washington, D.C. 20554 In the Matter of ) ) Implementation of the National Suicide Hotline ) WC Docket No. 18-336 Improvement Act of 2018 ) ) REPORT AND ORDER Adopted: July 16, 2020 Released: July 17, 2020 By the Commission: Chairman Pai and Commissioners O’Rielly, Carr, Rosenworcel, and Starks issuing separate statements. TABLE OF CONTENTS I. INTRODUCTION...................................................................................................................................1 II. BACKGROUND.....................................................................................................................................5 III. DISCUSSION........................................................................................................................................27 A. Designation of 988 as the 3-Digit Dialing Code for the National Suicide Prevention Lifeline............................................................................................................................................28 1. Designating a Wholly Unique 3-Digit Dialing Code vs. an Existing N11 Code .....................30 2. Designating 988 vs. Other Non-N11 Codes.............................................................................35 B. Implementation of 988....................................................................................................................37 1. Providers Subject to 988 Implementation Requirements .........................................................37 2. Routing 988 Calls.....................................................................................................................41 3. Dialing in Certain Geographic Areas .......................................................................................46 4. Implementation Timeframe for Ubiquitous Deployment of 988 .............................................54 5. Cost Recovery ..........................................................................................................................69 C. Assessing the Benefits and Costs of Designating and Implementing 988......................................73 1. Benefits.....................................................................................................................................74 2. Costs .........................................................................................................................................77 D. Other Issues.....................................................................................................................................81 IV. PROCEDURAL MATTERS.................................................................................................................86 V. ORDERING CLAUSES........................................................................................................................91 APPENDIX A – FINAL RULES APPENDIX B – FINAL REGULATORY FLEXIBILITY ANALYSIS I. INTRODUCTION 1. Now, more than ever, Americans need rapid access to suicide prevention and mental health crisis intervention services. According to the Centers for Disease Control and Prevention (CDC), the suicide rate in this country increased by 35% from 1999 to 2018,1 and suicide is now the tenth leading cause of death in the United States.2 Suicide claimed the lives of more than 48,000 Americans in 2018, 1 Holly Hedegaard et al., Increase in Suicide Mortality in the United States, 1999-2018, National Center for Health Statistics (NCHS) Data Brief No. 362, at 1 (Apr. 2020), https://www.cdc.gov/nchs/data/databriefs/db362-h.pdf. 2 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, “Preventing Suicide” Fact Sheet, at 1 (2020), https://www.cdc.gov/violenceprevention/pdf/Suicide-factsheet_508.pdf. Federal Communications Commission FCC 20-100 resulting in about one death every 11 minutes.3 And each year, many more Americans think about or attempt suicide. In 2018, 10.7 million adults in the United States seriously thought about suicide, 3.3 million made a plan for suicide, and 1.4 million attempted suicide.4 2. Suicide also disproportionately impacts various at-risk populations. For example, more than 20 Veterans die by suicide every day5 and between 2008 and 2017, the number of Veteran suicides exceeded 6,000 each year.6 LGBTQ young adults (ages 18-25) contemplate suicide at a rate more than four times higher than heterosexual young adults;7 and more than 1.8 million LGBTQ youth between the ages of 13 and 24 seriously consider suicide each year.8 Suicide is also the second most common cause of death among teenagers and young adults,9 and the rate of suicide for youth aged 10-24 increased by 56% from 2007 to 2017.10 By 2015, suicide rates among teenage girls hit a 40-year high;11 and between 1999 and 2014, the rate of suicide committed by girls ages 10 to 14 tripled.12 A 2019 study also found that self- reported suicide attempts among black teens increased by 73% between 1991 and 2017.13 And a 2020 study showed that college students who are deaf or hard of hearing are twice as likely to consider or attempt suicide than students without hearing loss.14 Suicide rates are also higher among Native Americans as well as rural Americans. According to the CDC, American Indians/Alaska Natives have the highest rates of suicide of any racial or ethnic group in the United States, and the rates of suicide 3 Id. 4 Substance Abuse and Mental Health Administration, Key Substance Use and Mental Health Indicators in the Unites States: Results from the 2018 National Survey on Drug Use and Health at 3 (2019), https://www.samhsa.gov/data/sites/default/files/cbhsq- reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf. 5 See Letter from Senator Tammy Baldwin and Senator Dan Sullivan, U.S. Senate Commerce Committee, to Hon. Ajit Pai, Chairman, FCC, WC Docket No. 18-336, at 2 (dated July 18, 2019) (Sen. Baldwin and Sen. Sullivan July 18, 2019 Letter). 6 U.S. Dept. of Veterans Affairs, Veterans Health Administration, Office of Mental Health and Suicide Prevention, National Veteran Suicide Prevention Annual Report, at 3 (2019), https://www.mentalhealth.va.gov/docs/data- sheets/2019/2019_National_Veteran_Suicide_Prevention_Annual_Report_508.pdf. 7 Amy Green et al., Suicidality Disparities by Sexual Identity Persist from Adolescence into Young Adulthood, The Trevor Project (Feb. 6, 2020), https://www.thetrevorproject.org/2020/02/06/suicidality-disparities-by-sexual- identity-persist-from-adolescence-into-young-adulthood/. 8 Amy Green et al., National Estimate of LGBTQ Youth Seriously Considering Suicide, The Trevor Project (June 27, 2019), https://www.thetrevorproject.org/trvr_press/national-estimate-of-lgbtq-youth-seriously-considering-suicide/. 9 Sally C. Curtin, M.A. and Melonie Heron, Ph.D., Death Rates Due to Suicide and Homicide Among Persons Aged 10-24: United States, 2000-2017, NCHS Data Brief No. 352, at 5 (Oct. 2019), https://www.cdc.gov/nchs/data/databriefs/db352-h.pdf. 10 Id. at 1. 11 Centers for Disease Control and Prevention, Quick Stats: Suicide Rates for Teens Aged 15-19 Years, by Sex— United States, 1975-2015, Morbidity and Mortality Weekly Report (Aug. 4, 2017), https://www.cdc.gov/mmwr/volumes/66/wr/mm6630a6.htm. 12 Sally C. Curtin, M.A., et al., Increase in Suicide in the United States, 1999-2014, NCHS Data Brief No. 241, at 1 (Apr. 2016), https://www.cdc.gov/nchs/products/databriefs/db241.htm. 13 See Lisa Rapaport, Suicide attempts rising among black teens, Reuters (Oct. 16, 2019), https://www.reuters.com/article/us-health-teens-suicide-idUSKBN1WV2CO (citing Michael A. Lindsey, Ph.D. et al., Trends of Suicidal Behaviors Among High School Students in the United States: 1991-2017, Pediatrics (Nov. 2019), https://pediatrics.aappublications.org/content/pediatrics/early/2019/10/10/peds.2019-1187.full.pdf). 14 Meghan L. Fox, Psy.D, Tyler G. James, MS, CHES, and Steven L. Barnett, MD, Suicidal Behaviors and Help- Seeking Attitudes Among Deaf and Hard-of-Hearing College Students, American Association of Suicidology Journal, Volume 50, Issue 2, pp. 387-396 (Apr. 2020). 2 Federal Communications Commission FCC 20-100 among this population have been increasing since 2003.15 And in 2017, the suicide rate for the most rural counties in the country was nearly double the rate for the most urban counties.16 3. Moreover, the societal, health, and economic impact of the ongoing COVID-19 pandemic is likely exacerbating suicide and mental health concerns in the United States.17 For example, the American Association of Suicidology reports that in a recent survey of over 350 mobile crisis teams, crisis residential programs, and crisis call centers across the country, “[a]lmost half (49%) of all respondents reported an increase in call volume since the onset of COVID-19, with some stating they are receiving double the usual volume.”18 4. To help Americans in crisis access suicide prevention and mental health support services, the federal government has established the National Suicide Prevention Lifeline, which can be reached by dialing 1-800-273-8255 / 1-800-273 (TALK).19 Both Congress and the Commission have recognized the need to ease access to this potentially life-saving resource by designating a shorter, “easy-to-remember, 3- dialing code” for the Lifeline.20 In August 2019, pursuant to Congress’ direction in the National Suicide Hotline Improvement Act of 2018,21 FCC staff reported on the technical