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California Moves Toward Banning Candy Additives


By Annie Sciacca

Halloween candy could be in for a California makeover.

Asserting that the Food and Drug Administration has not moved quickly enough on dangerous food additives, state lawmakers last month passed the California Food Safety Act, which bans four ingredients found in popular snacks and packaged foods — including candy corn and other Halloween treats.

Consumer health advocates hope the ban, signed into law by Democratic Gov. Gavin Newsom on Oct. 7 and set to take effect in 2027, will lead confectioners and food producers to modify their recipes for products sold both in California and elsewhere around the country.

The law prohibits the manufacture and distribution of brominated vegetable oil, potassium bromate, propylparaben, and red dye No. 3, which are used in processed foods including variations of instant potatoes and store-brand sodas, as well as candies. The additives have been linked to increased risks of cancer and nervous system problems, according to the Environmental Working Group, which sponsored the legislation, and are already banned in many other countries.

Melanie Benesh, vice president of government affairs for the Environmental Working Group, celebrated the new law as “a very big deal” and the first of its type in the country.

Food manufacturers and their lobbyists opposed the legislation, rejecting the idea that the four additives are unhealthy and arguing that such assessments should be made by the FDA.

“We should rely on the scientific rigor of the FDA in terms of evaluating the safety of food ingredients and additives,” said Christopher Gindlesperger, a spokesperson for the National Confectioners Association.

But food safety advocates say the FDA has moved far too slowly in regulating food chemicals.

“It’s unacceptable that the U.S. is so far behind the rest of the world when it comes to food safety,” said state Assembly member Jesse Gabriel (D-Woodland Hills), who introduced the bill along with Assembly member Buffy Wicks (D-Oakland), in a statement.


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A letter sent to lawmakers from the sponsors of AB 418 this year noted that many new additives put in food products are not reviewed by the FDA before reaching the market. A provision in federal law called “generally recognized as safe” allows the industry to designate the chemicals as safe enough to include in food, even without notifying the agency.

FDA spokesperson Enrico Dinges, referencing the Federal Food, Drug, and Cosmetic Act, noted in an email that “food and color additives must be approved for their intended conditions of use, and safety information must be available to establish a reasonable certainty of no harm before they are used in products on the market.”

He added that the agency regularly reviews new data on food chemicals, and it is working on a proposed rule to ban the use of brominated vegetable oil — one of the ingredients included in the new California law — as a food ingredient. Dinges said it was “not uncommon for a substance to be approved in one jurisdiction but not in another.” He noted some color additives are authorized for use in Europe and elsewhere but not allowed in the U.S.

California’s initiative made headlines this year as a “Skittles ban” that would wipe popular candies off California shelves. But Gabriel and other proponents of the bill said the intention is simply to require modifications in the ingredients, as has already happened in Europe.

One additive included in an original version of the bill — titanium dioxide, which is in Skittles and other candy — was removed from those products before the bill reached its final version. It has been labeled a carcinogen by the International Agency for Research on Cancer.

“I admire the California legislature for doing this,” said Joan Ifland, a researcher who studies food addiction and a fellow at the American College of Nutrition. She hopes state lawmakers go further in addressing food safety issues and the chemicals in processed food. “It should give courage to other legislators.”

Perhaps the most prominent ingredient on California’s banned list is red dye No. 3. It is allowed only in candied and cocktail cherries in the European Union but is widely used in the U.S.

A search of Food Scores, an online database maintained by the Environmental Working Group, generated more than 3,000 products that contain the chemical. The list includes items like frosted pretzels and scores of brand-name candies such as Peeps and Pez. It also includes items like fruit cocktail cups, protein drinks, and yogurts.

Peeps is already phasing out the ingredient — products will no longer contain red dye No. 3 after the 2024 Easter season, according to Keith Domalewski, director of marketing for its parent company, Just Born Quality Confections.

“Just Born has always evolved with new developments and consumer preferences,” Domalewski said in an emailed statement. “We have worked hard to develop new formulations to bring fans the colorful PEEPS they know and love.”

Pez representatives did not respond to a request for comment. The two major manufacturers of candy corn also did not comment.

The FDA banned some uses of the color additive in 1990, confirming it had been linked to increased risks of cancer, and prohibited its use in cosmetics and as a pigment in various foods. It said at the time it was taking steps to restrict the chemical — but never did.

Another of the newly banned ingredients, potassium bromate, has also been linked to cancer and is on California’s Proposition 65 list of ingredients that may pose increased cancer risks. It also has not been banned.

Food manufacturers and distribution groups did not indicate whether they would challenge California’s new law.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 



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From 911 operator to acclaimed Photographer


Giselle Hernandez a local from San Gabriel, once a 911 operator, launches her career as photographer.  She now takes aim with LA Times Magazine, Sweetie and Batman.  

Giselle followed her passion for photography and film when she was in High School. While she worked as a 911 operator she attended the Art Center College of Design and studied Photography and Imaging. Her work is an artistic creation where color, lighting, design all come together as a masterpiece. Her clients have been:Paramount, Netflix, Born and Raised and Violet Gray..and many more. You may have seen her cover of Entertainment Magazine with Zoe Kravitz and the new Batman, Rover Pattinson. 

We are proud of you as an Angelino and Hispanic professional. 

See her work – click

Mothers of Color can’t see if providers have a History of Mistreatment. WHY NOT?


BY SARA KWON October 5, 2023

When Selam Solomon Caldwell and her husband learned she was pregnant last year, the stakes for finding the right OB-GYN felt high. Caldwell, a Black woman, had heard stories from family and friends of maternity care providers who ignored their requests or pressured them into cesarean sections without clear medical justification.

As a relative newcomer to Los Angeles, the recruiter, now 31, knew few Black people who could recommend doctors who had treated them with respect. She combed review sites, including Google reviews and Healthgrades, but couldn’t find how nearby physicians and hospitals might treat a Black woman like her.

“It’s hard to tell if it’s a fellow Black person who’s giving the review,” Caldwell said.

Consumer ratings sites rarely identify patient experiences by race or ethnicity and hospitals are under no obligation to reveal the racial and ethnic breakdowns of their patient satisfaction scores. Yet that information could be instrumental in holding maternity care providers and hospitals accountable for treating patients inequitably and could empower expectant mothers like Caldwell in finding quality obstetric care.

“You can’t change what you don’t see,” said Kimberly Seals Allers, founder of Irth, an app allowing Black and brown women to find and leave reviews of maternity care providers. She’s one of a few entrepreneurs developing new tools for collecting feedback from mothers of color.


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A steady drip of new research over the past several years has spotlighted racial discrimination by maternity care providers and the role it may play in one of the country’s most vexing health disparities: Black women experience the worst birthing outcomes, a gap not explained by income or education, according to a KFF analysis. In 2021, they were nearly three times as likely to die of pregnancy-related causes as white women.

Mothers of color, especially Black women, report that they do in fact experience discrimination. They are more likely than white women to say that their care providers ignored them, scolded them, or pressured them into treatments they didn’t want. The extent to which discrimination is reported varies widely by survey, but one recently published report by the Centers for Disease Control and Prevention found roughly 30% of Black, Hispanic, and multiracial women reported mistreatment during maternity care, compared with 20% of women overall.

It’s unclear how many hospitals track survey responses by race, and, even if they do, they rarely reveal that information. And the federal government requires generic reporting on how patients say they were treated, making it difficult to pin down and address incidents of bias in maternity care.

A woman in a red dress stands while holding her baby, smiling at him as he smiles at the camera
Women of color like Selam Solomon Caldwell can’t see whether hospitals or physicians discriminate. A few entrepreneurs are developing new tools for collecting feedback from mothers of color.(LAUREN JUSTICE FOR KFF HEALTH NEWS)

Funding and Regulations Lag

Currently, the results of the industry’s standard patient experience survey, known as the Hospital Consumer Assessment of Healthcare Providers and Systems, are made publicly available by the federal government to help patients compare hospitals. They incentivize hospitals to improve care and are included in the rankings of many hospital ratings sites, such as U.S. News & World Report’s Best Hospitals. But it doesn’t ask about maternity care or discrimination and has low response rates, particularly among people of color.

These flaws can also make the survey inadequate for improving birth equity. “We know it’s insufficient,” said Amanda P. Williams, an OB-GYN and clinical innovation adviser to the nonprofit California Maternal Quality Care Collaborative. Hospitals, she said, could fill in the gaps by collecting feedback from maternity care surveys and breaking the results out by race and other demographic information; they could also talk to patients through forums such as town halls or focus groups.

Joy Lewis, senior vice president for health equity strategies at the American Hospital Association, said many hospitals do this work, both generally and in obstetrics.

However, Williams believes it isn’t happening enough in maternity care.

She said there are some pockets where people are doing these activities but that they are not yet widespread. At a national conference of 200 hospital executives this year, Williams said, only a few raised their hands when asked if they break out their maternity outcomes data. “If your overall C-section rate is fine, you might think everything’s hunky-dory,” she said. “But if you see that your Black people are having 50% higher C-section rates than your white and Asian patients, there’s very important work to be done.”

Then there are barriers to participation. Studies have found many in the Black community distrust the health care system.

Fearing retaliation and being seen as an “angry Black woman,” Ta-She-Ra Manning, a maternal health program coordinator in Fresno, California, said she didn’t provide any critical feedback when her OB-GYN dismissed her concerns about unusual symptoms during her 2021 pregnancy.

Meanwhile, new funding to measure disparities has been slow in coming. President Biden’s 2023 budget proposed $7.4 million to develop a supplemental survey aimed at reducing maternal health disparities, among other steps. But Congress did not fund the item. Instead, an agency in the Department of Health and Human Services is developing it with its own funding and estimates the work will take less than five years, according to a statement from Caren Ginsberg, who directs the agency’s surveys.

Still, the public likely won’t see changes anytime soon. After a survey’s measures are created, it can take several years for the results to be publicly reported or tied to payment, said Carol Sakala, senior director for maternal health at the National Partnership for Women & Families, an advocacy organization.

“This molasses level of movement contrasts acutely with all the things hitting the news about people not getting the right care and attention and respect,” Sakala said.

Amid growing interest in health equity, traditional ratings sites are grappling with how much to share with the public. For its birthing hospital ratings, U.S. News & World Report recently started assessing whether hospitals tracked racial disparities in maternity outcomes measures, but it withholds actual results. Healthgrades is taking time to think through how to collect and display sensitive information publicly, said spokesperson Sarah Javors in a statement.

Black Innovators Fight for Better Data

Some Black women are trying to fill the void by creating new feedback mechanisms that could be more trusted by the community. Allers said she created Irth after a traumatic birth experience as a Black mother at a highly rated hospital left her feeling failed by mainstream ratings. On the app, verified users answer questions, from whether they felt respected by their doctor to if they experienced certain types of mistreatment such as dismissal of pain. Irth currently has 10,000 reviews of hospitals, OB-GYNs, and pediatricians nationally, according to Allers.

“Our data is for the community,” said Allers. “They know their feedback has value to another mom or family.”

Irth also offers analysis of the reviews to hospitals and leads campaigns to collect more reviews for them. But Allers said many hospitals have expressed little interest.

Karen Scott, an OB-GYN who created PREM-OB, a scientifically validated survey that measures racism in Black birthing experiences, said she has met hospital leaders who don’t think their providers could mistreat patients or who worry that documenting responses could carry legal risk.

The American Hospital Association’s Lewis declined to comment specifically on Irth and PREM-OB but acknowledged the Black community’s long-standing mistrust of health care providers. She said hospitals want to hear more from patients in historically marginalized groups.

Early signs of progress are emerging in parts of the country.

California hospitals will likely report disparities in birth outcomes and patient satisfaction measures. Hospitals are expected to start posting data broken out by race and other demographics on their websites in 2026, though the state hasn’t finalized the measures that will be required, said Andrew DiLuccia, a spokesperson for the state’s health data agency. At least two states, Washington and New Jersey, have disclosed rates of C-sections among low-risk patients by race for individual hospitals.

Scott founded Birthing Cultural Rigor to increase uptake of her survey. The firm has partnered with birth equity groups to recruit respondents in select counties in Georgia, Michigan, Ohio, and Tennessee. Scott said results will be used to train local health professionals on how to reduce racism in maternity care.

Separately, Irth will collect and analyze reviews for three hospitals or health systems in California, said Allers. One of them, MemorialCare Miller Children’s and Women’s Hospital Long Beach, will work with Irth to better understand the impact of birth equity efforts such as implicit bias training.

“We’ll get to see if what we’re doing is actually working,” said Sharilyn Kelly, executive director of the hospital’s perinatal services.

Caldwell, the recruiter, eventually found a doctor she trusted and went on to have a smooth pregnancy and delivery. Her son is now 8 months old. But with so little information available on how she might be treated, she said, she felt anxious until she met her doctor, when “a lot of that stress and anxiety melted away.”

Digital strategy & audience engagement editor Chaseedaw Giles contributed to this report.

[Editor’s note: California Healthline is an editorially independent service of the California Health Care Foundation, which has contributed funding to PREM-OB and the birth equity nonprofit Narrative Nation, which developed Irth.]

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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More than $50 Billion in settlement funds delivered to state and local governments


More than $50 billion in settlement funds is being delivered to thousands of state and local governments from companies accused of flooding their communities with opioid painkillers that have left millions addicted or dead.

That’s an enormous amount of money — double NASA’s budget and five times the revenue of an NBA season.

But how that massive windfall is being deployed and how future dollars will be spent seem to be shrouded in mystery. Reporting requirements are scant, and documents filed so far are often so vague as to be useless.

Most of the settlements stipulate that states must spend at least 85% of the money they will receive over the next 15 years on addiction treatment and prevention. But defining those concepts depends on stakeholders’ views — and state politics. To some, it might mean opening more treatment sites. To others, buying police cruisers.

Those affected by the opioid epidemic and those working to fight it have an array of ideas: To Marianne Sinisi, who lost her 26-year-old son, Shawn, to overdose in western Pennsylvania, the settlement funds are “blood money” that she hopes can spare other parents similar grief. To Steve Alsum, who works with people who use drugs in Grand Rapids, Michigan, it’s a chance to finally reach all those in need. And to David Garbark, who is in recovery from opioid addiction, it’s a way to give others in his eastern North Carolina community a second chance, too.

Spending the money effectively and equitably is a tall order, given the persistence and complexity of addiction, which affects individuals and communities, and is the topic of heated debates in scientific research, social services, politics, criminal justice, and even at kitchen tables.

What’s more, many states are not being transparent about where the funds are going and who will benefit. An investigation by KHN and Christine Minhee, founder of OpioidSettlementTracker.com, concluded only 12 states have committed to detailed public reporting of all their spending.

The analysis involved scouring hundreds of legal documents, laws, and public statements to determine how each state is divvying up its settlement money among state agencies, city and county governments, and councils that oversee dedicated trusts. The next step was to determine the level and detail of public reporting required. The finding: Few states promise to report in ways that are accessible to the average person, and many are silent on the issue of transparency altogether.

More than $3 billion has gone out to state and local governments so far. KHN will be following how that cash — and the billions set to arrive in coming years — is used.

Per most of the settlements, governments are required to report only on the 15% of the money that can be used for things unrelated to the epidemic, like offsetting budget shortfalls or fixing old roads. As of March 28, only three states and counties had filed such reports. Although they listed dollar amounts, none said precisely how the money was spent.

State and local governments can enact more rigorous reporting protocols — for example, requiring a publicly available list of every place that receives money and for what purpose — but few have so far.


Left in the Dark

More than 250,000 Americans have died of overdoses from prescription opioids, which were aggressively promoted as painkillers and distributed by a host of health care companies, including Johnson & Johnson, AmerisourceBergen, McKesson, and Walmart. The settlements are meant to compensate and remediate the effects of that corporate behavior.

But many people whose lives have been upended are again feeling traumatized.

Sinisi said she and other parents who’ve lost kids to addiction have been left in the dark or, worse, treated like nuisances by officials in charge of the money.

“They want to look at you as this angry parent who lost a child,” she said, “rather than a concerned citizen who wants to see a difference made for other mothers, fathers, and their children.”

In Michigan, even the state’s Opioid Advisory Commission, which is tasked with evaluating the use of settlement money, has struggled to track the cash.

For six months after the state legislature allotted $39 million of settlement funds to the health department last summer, little information was made public about how that money would be spent. No news releases. No way for organizations to apply for funds.

“We can’t really identify the impact of those dollars if we don’t know how they’re being used,” said Dr. Cara Poland, the commission’s chair and an addiction-medicine doctor.

With scant oversight nationwide, many people fear dollars may flow to efforts that research has proven mostly useless but jibe with the local political bent, like arresting people who use drugs, expanding jails, and favoring abstinence-only recovery over medications. They may go to the loudest bidder, with companies promising to find the next groundbreaking treatment and rehab facilities — some with shoddy track records — eyeing the cash.

Not to mention concerns that money will flow to activities that have little to nothing to do with opioid treatment: building new stadiums or public schools. Back in the ’90s, these day-to-day budget priorities consumed most of what states won from cigarette companies in the national tobacco settlement, leaving little for anti-smoking programs.

The opioid settlement funds will be different, say state attorneys general who fought for them. In addition to requiring at least 85% of the money be used on opioid-related expenses, most agreements include a list of suggested interventions like increasing addiction treatment for the uninsured and expanding recovery housing.

“We wanted to give states flexibility on what approaches they wanted to adopt,” while ensuring money didn’t go to “provide corporate tax relief” as the tobacco dollars did, said North Carolina Attorney General Josh Stein, who led negotiations for the national settlements.

But enforcement of the 85% standard is, oddly, left to the companies that paid out the money. They are unlikely to be vigilant, legal experts say. The money is committed already and, for many of these multibillion-dollar companies, the settlements are chump change. For example, Johnson & Johnson is set to pay $5 billion over nine years, but the company reported sales of nearly $95 billion in the past year alone.

An Emerging Picture

As the checks start to trickle in, a handful of states are committed to transparency while others seem to be falling short. Missouri has promised to report all its spending in online reports so that anyone can see who receives money, how much, and for what programs. New Hampshire already has posted reports online, and Colorado has created a public dashboard to track how funds are used.

Other states, like Nevada, have taken a middle-of-the-road approach, requiring that recipients report to the legislature or another oversight body, but not ensuring the reports will go public. Some states require audits but don’t promise to list specific expenses. And others allow the public to request records but won’t provide them automatically.

Then there are states hit hard by the opioid epidemic like Michigan and Ohio, where problems with transparency are already emerging. Each state is expecting to receive at least $1 billion.

When Poland, of Michigan’s Opioid Advisory Commission, realized she was getting little information on how the state’s funds were being spent, her commission decided to use its first annual report — published this month — to demand better. “Timely and transparent reporting” to the public is “an ethical responsibility,” it said, calling on lawmakers to enact greater oversight for settlement cash recipients and create a public dashboard to track spending.

KHN interviewed nearly a dozen people and filed a public records request to uncover how the state health department is spending the initial settlement funds allocation of $39 million.

A budget document obtained by KHN shows that as of Jan. 9, the Michigan Department of Health and Human Services had contracted $3.9 million in settlement funds to 35 grantees. Most are local health departments or syringe service programs that the state health department has previously funded.

An additional $27 million is set aside for particular interventions, such as growing the addiction treatment workforce, expanding recovery housing, and mitigating the harms of opioid use with medications like naloxone.

And, after KHN’s inquiries, the department released a statement that listed similar priorities.

Those initiatives make sense to Jonathan Stoltman, director of the Michigan-based Opioid Policy Institute, which researches stigma and digital privacy in addiction treatment. But he would have liked to have known about them in advance and to have had a clear process laid out for groups to apply for the funds. Otherwise, organizations that are well positioned to use the money to help those most in need may miss a once-in-a-lifetime chance to scale up their work and save lives.

Last summer, when Stoltman inquired about applying for the funds, the health department told him to submit a “high level proposal” to “share around,” according to emails reviewed by KHN.

“Anything that is backdoor scares me,” said Stoltman. “I got lucky that I found who to talk to, even if it didn’t go anywhere.”

Steve Alsum, executive director of the Grand Rapids Red Project, which was awarded about $266,000 to improve the health of people who use drugs, said he expected the state to have an application process with scoring criteria to explain why certain groups were chosen. But, he said, “it hasn’t been clear who is making the decision and how it’s made.”

Jared Welehodsky, who leads the department’s efforts related to the settlement, said it is in the process of releasing several competitive grant applications for the bulk of the money. That didn’t happen sooner because most payments didn’t arrive until the end of 2022 and “we didn’t want to comment on how the money was going out when we didn’t have money to go out,” he said.

Talk of Keeping the Public Out

In Newark, Ohio, Linda Mossholder, 75, has been inquiring about the settlement dollars at City Council meetings since last summer. As a volunteer with Newark Homeless Outreach, which serves weekly free lunches, she encounters many people who use drugs and wants to see the money help them.

The proud owner of a T-shirt that reads, “Your first mistake is thinking I’m just an old lady,” Mossholder has followed up with emails, voicemails, and public records requests. But she hasn’t gotten a clear answer about how the city plans to use the nearly $50,000 it’s already received.

In January, Mossholder said, the city’s director of public service finally told her the plan was to allocate settlement cash to first responders for naloxone. But when KHN filed public records requests to confirm, City Auditor Ryan Bubb wrote, “No funds have been allocated or spent.”

Meanwhile, in northeastern Ohio, a regional board that will control millions of settlement dollars spent a February meeting discussing whether the public should be allowed to access meeting recordings at all.

“I wouldn’t open it up to the public, honestly,” said Judy Moran, a board member who represents Eastlake, according to a recording of the meeting obtained by KHN. Other board members asked if their gatherings were subject to the state’s open-meeting laws.

Moran later told KHN, “Of course the public has a right to know how these funds are disbursed,” but she said she worried recordings would allow people to take words “out of context.”

In Ohio at least, that may not be a choice for much longer.

A lawsuit brought by Harm Reduction Ohio to open the meetings of a separate board — the OneOhio Recovery Foundation, which oversees the lion’s share of the state’s expected $1 billion — is working its way through the courts. A local judge this month rejected the foundation’s request to dismiss the lawsuit, writing that “the public deserves transparency.”

But OneOhio spokesperson Connie Luck said the foundation is a “private, nonprofit organization, and not a government agency.” It has so far allowed public attendance at meetings, but has said it is not required to do so.

The final ruling in this lawsuit, which is the first of its kind on opioid settlement funds, will set a precedent for the public’s right to information nationally.

In some parts of the country, the prospect of dollars to treat a long-underfunded epidemic brings hope, said Tricia Christensen, who works at a nonprofit tracking settlement funds across Appalachia. When people know what’s happening, it not only deters misuse but can reveal surprising successes, she said.

That knowledge is empowering.

“These funds are the cavalry coming in. You’re finally getting relief after suffering alone for so long,” said Crystal Glass, of southwestern Virginia, who is in recovery from opioid and meth use and now works as a peer recovery specialist.

She hopes officials will involve people affected by addiction in their decisions.

As she put it: Transparency “is letting everyone — I mean everyone — know they can be part of this.”

KHN’s Colleen DeGuzman and Megan Kalata contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Muchos estados todavía no financian la exitosa línea 988 para crisis de salud mental

Desde que la Red Nacional de Prevención del Suicidio lanzó hace un año un número de teléfono de crisis de tres dígitos, el 988, la cantidad de llamadas, chats y mensajes de texto a esa línea directa aumentaron el 33%. 

Pero a pesar de este resultado exitoso, el futuro financiero del programa es incierto.

En los dos últimos años, el gobierno federal aportó unos $1,000 millones procedentes de las leyes American Rescue Plan y Bipartisan Safer Communities para poner en marcha la línea, concebida como una alternativa al 911 para aquellas personas que estén sufriendo una crisis de salud mental. Cuando se agote esa ayuda, los estados tendrán que cubrir el costo de los centros de llamadas.

“No sabemos cuánto dinero destinará el Congreso en el futuro”, dijo Danielle Bennett, portavoz de la Administración de Salud Mental y Abuso de Sustancias (SAMHSA), la agencia federal que está a cargo de la línea 988. “Pero la esperanza es que se mantenga un fuerte apoyo bipartidista para financiar el 988 adecuadamente y que los estados también establezcan sus propios mecanismos de financiación”.

Sólo ocho estados promulgaron leyes para sostener el 988 mediante tarifas telefónicas, según la Alianza Nacional de Enfermedades Mentales, que está haciendo seguimiento de los estados que financian el sistema. Otros presupuestaron financiación a corto plazo. Pero muchos estados, principalmente rurales, donde escasean los servicios de salud mental y las tasas de suicidio suelen ser más altas que en los estados más urbanos, no hay planes a largo plazo para proporcionar apoyo.

Según un análisis de KFF de datos de la línea de Prevención del Suicidio y Crisis, desde el verano pasado el 988 recibió casi 5 millones de contactos, incluyendo llamadas, textos y mensajes de chat. Y los programas locales lograron responder a un alto porcentaje de las llamadas, en lugar de desviarlas a otros estados.

Para mantener a ese personal estatal que atiende los teléfonos, es fundamental asegurar la financiación a largo plazo de estos programas, afirman defensores de la salud mental y operadores estatales del 988.

En la versión anterior, “esencialmente, no se les pagaba a los centros de llamadas”, afirma Chuck Ingoglia, presidente y director ejecutivo del National Council for Mental Wellbeing, que aboga para que se invierta en el 988. “Cada vez más se reconoce que estamos facilitando el contacto con la gente y, por lo tanto, necesitamos más infraestructura”.

En Ohio, donde datos de la primavera de 2023 muestran que los operadores locales respondieron al 88% de llamadas, los legisladores admitieron recientemente que se necesita una financiación estable. En julio, el gobernador republicano Mike DeWine aprobó $46.5 millones para el 988 en el presupuesto del estado. Pero esa ayuda sólo alcanzará para dos años del programa.

“No es la financiación segura y sostenida que esperábamos”, dijo Brian Stroh, CEO y director médico de Netcare Access, un centro de llamadas que atiende a cuatro condados rurales en la frontera del este de Ohio.

SAMHSA, que distribuye los fondos para el 988, lo compara con el número de teléfono de emergencia 911, con la diferencia de que el 988 es estrictamente para crisis de salud mental. La ley National Suicide Hotline Designation Act de 2020, que estableció la creación del 988, permite a los estados cobrar recargos telefónicos para mantener el 988 indefinidamente. Esta estructura de financiación es similar a la del 911.

Stroh dijo que está “bastante satisfecho” con los resultados del primer año de 988 para Netcare Access. Pero agregó que con un sistema de financiación a corto plazo, es difícil asegurar la estabilidad laboral para los operadores de llamadas y competir con los salarios de otras industrias.

Kristin McCloud, directora ejecutiva de Pathways of Central Ohio, un centro de llamadas que también atiende a los condados rurales al este del estado, dijo que recibieron $573,056 en el primer año del 988. Esos fondos eran exactamente lo que necesitaban para formar al personal que atiende las llamadas de crisis y adquirir computadoras para que puedan trabajar a distancia.

Durante ese período, los operadores respondieron 2,316 llamadas, casi el doble de las atendidas el año anterior.

“Siento que por primera vez nos dieron el apoyo adecuado”, dijo McCloud, que lleva más de 35 años trabajando en servicios sociales.

Según la SAMHSA, antes de las subvenciones del 988, la mayoría de los centros de atención recibían fondos federales mínimos para responder a las llamadas de crisis, normalmente un estipendio de entre $2,500 y $5,000 por año.

Al igual que Stroh, McCloud piensa que la reciente asignación de Ohio es un paso importante, pero le gustaría que el estado establezca un plan de financiación permanente. Un proyecto de ley pendiente en la legislatura agregaría un recargo a las facturas telefónicas para ayudar a financiar el 988, como han hecho algunos otros estados.

Todos menos uno de los condados del este a los que Pathways of Central Ohio y Netcare Access prestan servicios han sido designados por la Oficina de Atención Primaria del Departamento de Salud del estado como zonas de escasez de profesionales de salud mental.

En North Dakota, donde casi todos los condados son rurales y llevan esa designación, un único centro de llamadas gestiona el programa 988 del estado.

Se trata del centro FirstLink, que ha visto un aumento considerable en el número de llamadas de crisis de salud mental desde la transición al 988. Comparando los primeros seis meses de 2023 con los primeros meses de 2022, las llamadas aumentaron un 55%, según Jeremy Brown, director de comunicaciones.

Esta demanda “nos ha ayudado a iniciar conversaciones con la legislatura estatal sobre financiación y apoyo”, dijo.

En mayo, el gobernador republicano Doug Burgum aprobó una asignación única de $1.86 millones para el 988 en el presupuesto de dos años de North Dakota.

Brown dijo que esta financiación ayudará a FirstLink a capacitar a sus empleados y a mantener las líneas telefónicas al día. También permitirá que los centros envíen unidades móviles de crisis cuando sea necesario.

FirstLink prefiere tratar de resolver las crisis por teléfono antes de enviar una de estas unidades, dijo Dallas Tufty, uno de los operadores de FirstLink.

“La única vez que llamamos para pedir un rescate o algo así es cuando la vida de la persona está en peligro inmediato e inminente”, dijo.

Tufty trabaja 40 horas a la semana en FirstLink, y al menos seis de ellas están dedicadas a responder llamadas y mensajes al 988. Operadores como Tufty también responden a la línea 211 de FirstLink, otro programa que proporciona información sobre asistencia de salud y servicios sociales. No es una línea de emergencia, pero a veces las personas en crisis llaman allí en lugar de hacerlo al 988.

Sin importar la línea a la que llaman, dijo Tufty, lo más difícil es no saber qué ocurre una vez que termina la llamada.

“En algunos casos no sabes si van a volver a llamar cuando lo necesiten,” dijo. “Aunque tengas un plan, no hay mucho que podamos hacer por teléfono para que la gente cumpla con ese plan”.

Aunque North Dakota y Ohio financian el 988 a través de presupuestos estatales, no todos los estados lo hacen. En Montana, el gobernador republicano Greg Gianforte recientemente destinó $300 millones a los sistemas de salud conductual y  discapacidades del desarrollo. Estos sistemas pueden financiar, entre otras cosas, “oportunidades para que los residentes de Montana reciban atención integrada de salud física y conductual”, según el proyecto de ley. Pero el estado todavía no ha abordado la financiación del 988 en particular.

En 2021, los legisladores de Montana se negaron a promover un proyecto de ley para establecer una tarifa telefónica y cuenta de ingresos para financiar el 988, antes de su lanzamiento.

En este punto, “si se puede financiar con el actual presupuesto, sin nueva legislación, nos parece bien”, dijo Matt Kuntz, director ejecutivo de la sede de Montana de la Alianza Nacional de Enfermedades Mentales. “Sólo queremos asegurarnos de que se financie de forma sostenible, porque es un servicio importante”.