North American Numbering Council Report and Recommendation on the Feasibility of Establishing a 3-Digit Dialing Code For a National Suicide Prevention and Mental Health Crisis Hotline System May 10, 2019 Table of Contents Section 1: Executive Summary ................................................................................................................................ 3 Section 2: Introduction and Background ................................................................................................................ 4 Section 3: Assumptions ........................................................................................................................................... 5 Section 4: Analysis of Alternatives .......................................................................................................................... 6 4.1: Common Attributes of N11 Codes ............................................................................................................... 6 4.2: The 211 Code ................................................................................................................................................ 7 4.3: The 311 Code ................................................................................................................................................ 9 4.4: The 411 Code .............................................................................................................................................. 10 4.5: The 511 Code .............................................................................................................................................. 12 4.6: The 611 Code .............................................................................................................................................. 13 4.7: The 711 Code .............................................................................................................................................. 15 4.8: The 811 Code .............................................................................................................................................. 16 4.9: The 911 Code .............................................................................................................................................. 17 4.10: N11 Code Usage ....................................................................................................................................... 20 4.11: N11 Code Analysis .................................................................................................................................... 21 4.12: A New Non-N11 3-Digit Dialing Code ....................................................................................................... 25 4.13: A New Non-N11 3-Digit Dialing Code Using Number Sign (#) or Star (*) ................................................ 26 4.14: Enhance Awareness of Existing Toll-Free Number(s) .............................................................................. 28 Section 5: Implementation Logistics ..................................................................................................................... 29 5.1: Public Education Tasks ............................................................................................................................... 29 5.2: Service Provider Tasks ................................................................................................................................ 30 5.3: Additional Implementation Timeframe Considerations ............................................................................ 33 Section 6: Implementation Costs .......................................................................................................................... 33 6.1: Service Provider Costs ................................................................................................................................ 33 6.2: States and Localities Costs ......................................................................................................................... 35 6.3: Federal Government Costs ......................................................................................................................... 35 6.4: Other Stakeholder Costs ............................................................................................................................ 36 Section 7: Recommendations ............................................................................................................................... 36 7.1: N11 Code Expansion ................................................................................................................................... 37 7.2: N11 Code Repurposing ............................................................................................................................... 39 7.3: New Non-N11 3-Digit Code ........................................................................................................................ 41 7.4: Other Considerations ................................................................................................................................. 44 7.5: Overall Recommendation .......................................................................................................................... 44 Section 8: Cost/Benefit Analysis ........................................................................................................................... 44 Appendix A: NAOWG March 7, 2019 Data Request to Service Provider Associations ......................................... 46 Appendix B: March 13, 2019 NANPA Response per Second Referral Letter ........................................................ 47 Appendix C: March 19, 2019 Veterans Crisis Line (VCL) Response to NAOWG N11 Inquiry ............................... 48 Appendix D: April 2, 2019 Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) Response to NAOWG N11 Inquiry ............................................................... 57 Appendix E: March 2019 AIRS Survey of Blended Information and Referral/Crisis Members ............................ 60 Page 2 of 70 Section 1: Executive Summary The FCC tasked the North American Numbering Council (NANC) with developing a report and recommendation on the feasibility of establishing a 3-digit dialing code for a national suicide prevention and mental health crisis hotline system, whether such a 3-digit code should be established, and what 3-digit code should be established if such a code is established. The eight N11 codes are the scarcest resource in the North American Numbering Plan (NANP) and all eight N11 codes are in use today, whether officially designated for such use or not. The undesignated 411 and 611 codes are extensively used, and the designated codes (i.e., 211, 311, 511, 711, 811, and 911) are used and relied on by many stakeholders in many or all jurisdictions throughout the country. Only two of the eight N11 dialing codes share some common purpose with crisis and suicide hotlines: 211 and 911. The 211 code is already in use for crisis calling in some United States (U.S.) markets, relevant training and certification processes already exist for organizations that supply 211 services, today’s 211 Interactive Voice Response (IVR) system capabilities can expand to route veteran and service member calls to the Veteran’s Crisis Line (VCL) on a priority basis, and expanded use of 211 for suicide prevention calling has been cited as beneficial to promotional messaging for 211 overall.1 Further, 211 services are already offered to 94% of the population today, so service providers are well-versed in routing calls to 211.2 Documented crisis and suicide call volume projections from the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA)3 and the Secretary of Veterans Affairs (VA)4 exceed levels for which 911 can reasonably be expected to accommodate an expanded use for both emergency calls and a national suicide prevention and mental health crisis hotline system. The use of IVRs on 911 calls would not be practicable, and the institutionalization of 911 for emergency calling eliminates its consideration for repurposing. No other N11 dialing code reasonably meets key criteria (e.g., call volumes, disruption to existing services, costs to transition existing uses to other alternatives) determined by the NANC to necessitate consideration for repurposing or expanded use with a national suicide prevention and mental health crisis hotline system. For these reasons and those cited in this report, the NANC recommends: • If a 3-digit code is to be established, the 211 code should be expanded to include crisis and suicide prevention calling services for veterans, service members, and civilian members of the U.S. population. The NANC recommends concurrent use of the existing toll free numbers (e.g., 800-273-TALK, 800- SUICIDE) that have been institutionalized through traditional promotion and wide-scale use, at least until such time that their call volumes significantly diminish. • If the 211 code is not expanded, then alternatively, the “988” non-N11 code should be deployed for a national suicide prevention and mental health crisis hotline system, as long as it is understood that 988 likely cannot be deployed ubiquitously across all networks, and mandatory 10-digit dialing may need to be implemented in area codes where