What Therapists Should Know about the Rollout of 988
Curt and Katie discuss the new suicide hotline, 988, that is set to roll out July 16, 2022. We talk about the legislation for 988 as well as what the primary concerns are for the launch. We explore the resources and infrastructure that is promised (but not ready) as well as ideas that might improve the success of this new initiative.
Click here to scroll to the podcast transcript.
Click here to scroll to the podcast transcript.
In this podcast episode we talk about what is already going wrong with the 988 roll out.
We have been paying attention to the 988 roll out and are concerned by the lack of preparation and funding for its implementation. We talk about why we’re freaked out about the upcoming roll out.
What is 988?
- Legislation (from 2020) makes the national suicide hotline easier to access, using the phone number 988 – set to launch on July 16, 2022
- Crisis, Suicide, or Lifeline phone number
- Replaces the previous numbers: 800-273-8255 (phone) or text to 741741
- Connecting local resources to local callers
- An entry point into the local crisis response system
- Opportunities for call, text, or messaging support during times of crisis
What are the primary concerns with the launch of 988?
“Mental health is not a priority according to any of the actions taken in response to [the 988 rollout] … Many states don’t have the funding to implement this at all set up.” – Curt Widhalm, LMFT
- Lack of infrastructure (calls are being sent out of state or not being answered at all)
- Lack of local resources to handle crisis response
- Lack of funding to develop these resources (potentially NO funding for staff, text, chat)
- Huge gaps in the crisis response system that will be exposed by increased access to this system
- Challenges with training hotline workers, who are likely going to be volunteers
- Inadequate training for inclusive services and linguistically responsive services.
“We’re looking at a good swath of folks who are most likely to be calling these [suicide hotline] numbers and they’re going to reach somebody that has no training to work with them.” – Katie Vernoy, LMFT
Ideas to improve 988 and the United States Mental Healthcare program
- Funding streams through Medicaid, combining forces with 911
- Using the implementation to identifying gaps
- RAND suggestions to coordinate with local organizations for strategic planning and identifying stable funding sources, needs assessments related to personnel
- Advocacy at the state level to make sure state legislatures are making this work
- Curt’s idea: have hotlines staffed with prelicensed or provisionally licensed folks (earning double hours toward licensure)
- Advocacy at the federal level to increase funding across the whole country
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Resources for Modern Therapists mentioned in this Podcast Episode:
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RAND Report: How to Transform the US Mental Health System
Relevant Episodes of MTSG Podcast:
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
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Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Curt Widhalm 0:00
This episode of The Modern Therapist’s Survival Guide is brought to you by Thrizer.
Katie Vernoy 0:03
Thrizer is a modern billing platform for private pay therapists. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer you can potentially save them hundreds every month with no extra work on your end. The best part is you don’t have to give up your rates. They charge a standard 3% processing fee.
Curt Widhalm 0:24
Listen at the end of the episode for more information on a special offer from Thrizer.
You’re listening to The Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:42
Welcome back modern therapists. This is The Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast for therapists where we talked about the underfunded and poorly thought out rollout so many mental health related things. And continuing our emphasis in that direction. We’re here to talk about the 988 rollout starting July 2022. And how this is a really well thought idea with some hurdles that have to be overcome here. So…
Katie Vernoy 1:18
You’re so kind. I would say the implementation sounds pretty crappy. But we’ll get to that.
Curt Widhalm 1:26
Katie, why don’t you start us off and tell our listeners about how 988 came to be.
Katie Vernoy 1:33
So if we’re looking at 988, in 2020, and I’m reading from the SAMSA, the Substance Abuse and Mental Health Services Administration from their website about 988. In 2020, Congress designated the new 988 dialing code to operate through the existing National Suicide Prevention Lifeline’s network of over 200 locally operated and funded crisis centers across the country. And on July 16 2022, this is coming up very, very soon, the US will transition to using the 988 dialing code and it is a once in a life opportunity to strengthen expand existing lifeline. This is one of their message things, I’ll put the link to all the SAMSA stuff in our show notes. But what I’m really seeing in a lot of this stuff that I’m looking at is the idea is we take a lot of kind of loosely connected services and try to create what we talked about with the Rand folks, which is this kind of robust Crisis Response System. And the idea is that 988 is going to be the entry point for that or one entry point for that. But right now, it seems like this is just the first step. So it’s shifting everyone to actually 10 digit calling. So people who weren’t with area codes now have area codes. So 9888 being dialed, it’s not the beginning of a phone number, it is now only going to be allotted for this lifeline. It provides for potentially chatting on their website, I guess, but also texting to 988, this is not available yet. It’s not clear. We’ll we’ll go into it whether it’s going to be actually truly available on July 16. But the idea is that folks who are in a crisis, feeling suicidal, or have a family member or friend or loved one of some sort that is suicidal, that they can call 988 rather than what is the number it’s like super long.
Curt Widhalm 3:29
1-800-273-8255 Or alternatively a Crisis Text Line by texting 741741.
Katie Vernoy 3:39
So there’s a lot of numbers to remember until July 16, when theoretically, people can dial 988 and that will just help with kind of starting the thing but they it seems like they’re starting to increase requirements for training or at least theoretically guidelines on how to run these different call centers and potentially are hoping that this will then move toward a a continuum of crisis response that we talked about with Dr. Ryan McBain and Dr. Nicole Eberhart on our first Fixing Mental Health Care in America thing which I will also put in the show notes. So I think that I think I got most of what it is and what supposed to be but it is something that they’ve had two years and multiple millions of dollars that have theoretically gone towards this. But so far, I think they just have it so that people can dial 988 but it may be that they call that number and that’s only what they get is that little bit of call, phone call.
Curt Widhalm 4:45
To add to this. This is to also help to bring together a lot more of local resources to local callers because the national lifeline that exists currently, is one where overflow from one state to the next might not necessarily have the resources. And, for example, here in from January 1st to March 31st 2022, many states are sending over 50% of the emergency suicide phone calls to call centers outside of the state where the person is calling. And when we’re talking about getting people in touch with Continuum of Care issues, things drastically differ from one state to the next. That if there’s somebody who’s familiar with metropolitan resources that are available in one area, it’s not necessarily easy for them to quickly and accurately provide resources for people in a more rural state. Now, a lot of this is designed to end up having people who are calling be sent to more local resources. Now, some states are better at this than others, for example, California answered 85% of the phone calls that they received between January 1st and March 31st 2022 at in state call centers.
Katie Vernoy 6:12
So but that’s only 85%. So even California that theoretically has a pretty robust social services system and mental health system. I know we have problems, but like, we’re actually I feel like a little bit of ahead of the game. We sent 15% outside of our state.
Curt Widhalm 6:29
Oh, no, no, we sent 246 out of 68,000 calls out of state, which is less than 1%, meaning that 14% weren’t even answered.
Katie Vernoy 6:42
Oh, no, oh, no. Oh, dear. Okay, so I don’t think I could remember that phone number. I can remember 988, these calls are going to increase.
Curt Widhalm 6:55
Right. Now for another example, Alaska, answered about 53% of their phone calls in that same period in their own state, and roughly about 33% of their phone calls went completely unanswered.
Katie Vernoy 7:10
Oh, no. Oh, my gosh. Okay.
Curt Widhalm 7:12
So the idea and you mentioned the our friends over at the RAND Corporation and we’re going to heavily cite from an unpublished paper that both Ryan and Nicole contributed to throughout this episode. But the idea is that 988 is going to help put more local people in touch with a more local system. And the idea behind this is that Congress when they passed this in 2020, was going to roll out funding support, and encourage states to create their own funding to make the 988 system more robust, and the current national hotline system. If you’ve paid attention to government at all, in your lifetime, you can imagine that many of these states have not actually provided some of their funding. And we’re looking at several states that have zero funding actually involved. We’re looking at this report, it’s It’s actually called a working paper, we’ll include the link to this in the show notes as well. But fewer than half of people who are calling in are getting treatment. And this just seems to be like a lot of agencies that are supposed to be now taking the phone calls, because part of building out this system is that the overflow from the already in place lifeline centers that exist for the National Suicide Prevention Hotline, would now go to local agencies. But many of these agencies never got a chance to be at the table in designing how this is built out. And so are left with very little federal or even state guidance or funding to actually be able to staff these things, have the resources like psychiatric emergency teams to be able to go out and respond to people. And this is where we’re hearing more and more about it since, July 16, comes out. And presumably the public’s hearing more and more about it too, but without the actual infrastructure in place to handle the inadequacies that already existed, but with a better campaign of reaching the public, we’re gonna run into some problems.
Katie Vernoy 9:31
I’m just even kind of reflecting back on my time as an LPS designet. So I was able to do some of these assessments and working in intensive kind of crisis response kind of care. And those systems were already really lacking. At one point the agencies got the responsibility to do these assessments versus the county wide teams and they had like two people for the whole county of Los Angeles which is like a small state almost it’s so big. And so it’s something where being able to do kind of the ongoing treatment versus this very specialized crisis response and triage, basically, I think is something where this, these are whole new programs for some of these community mental health organizations. And if there’s not guidance, if there’s not training, if there’s not funding, it’s a big mess, and it becomes something that nobody wants to do. You know, especially with these kind of on the ground crisis response, folks, it’s going into people’s homes, it’s driving out in the middle of the night. I mean, like, these are very specific jobs that a lot of therapists are not signing up for. I know, I knew folks who would have loved this job. So I hope that they actually get their act together and create something, but it sounds like there’s not enough folks to answer the phones. And then if they do answer the phones, it potentially is law enforcement that ends up going out, right. And we have a whole other slew of episodes were we talk about that. But if we’re if we don’t actually have that system in place, just having a number is just going to show the gaps more, right? Like it’s just going to show like how many people were failing because more people will call, more calls will go unanswered, and more people will, will not get the resources, or at least, it’ll be recorded how many people are not getting the resources that they actually need in these times of crisis.
Curt Widhalm 11:24
The RAND study surveyed 180 state regional and county health officials and found that only half think that their jurisdictions have the short term crisis stabilization services, which callers could be directed to. And only 28% had urgent care units that could be dispatched to people in urgent need. And only 22% had call centers that could schedule mental health appointments on behalf of the people who wanted them. Now, just to talk about the scale of this a little bit SAMSA in 2020, said that they had 3.6 million calls, chats and texts to the existing hotline. And after the 988 transition, they expect that volume to go to 6 million to 12 million within the first 12 months.
Katie Vernoy 12:16
Oh my gosh, and we already have calls not being answered. Stepping back just a second to what the Lifeline has supposed to have been as well as what these call centers could be like, it can be an entry point into mental health services. I know there are times when I have directed clients, if I’m away, or I’m on, I’m not doing calls at two in the morning, I’m not available to them, that suicide prevention hotlines can be helpful, it can be an intervention in and of itself. And so to me, getting a call answered, having some de-escalation, some conversation that helps someone to get out of that suicidal place. That can be helpful. So talk to me about the training for these folks that are going to be answering the phones because what you’re saying, and I’m agreeing from my own experience, that they’re not gonna be able to be connected to stuff very easily, because there’s a lot of people that a lot of agencies, I’m sure have waitlists. There’s a lot of resources that are just not there. So at the intervention level at like, let me call and get the support I need so I can get through the night and go back and see my therapist tomorrow morning. What is that training for the call center folks?
Curt Widhalm 13:32
So that’s also going to depend greatly on jurisdiction. For example, Alaska is requiring 50 hours of classroom time and 30 hours of shadow time. And Alaska mental health agency representatives are saying that we don’t have enough time to end up getting people trained. And this is from an article that was written on June 18th. And assuming that most people are going to be observing the July 4 holiday, this would be full time training for a couple of weeks before people are able to kind of step in and start to end up being able to be readily available to take phone calls.
Katie Vernoy 14:18
So they’re not going to have enough folks on the phones. But that I mean, that’s a problem that theoretically can get solved over time. If they hire people, train them and it’s a reasonable job that people can take on.
Curt Widhalm 14:33
Oh, you’re bringing up the j-o-b word. Now 75% of agencies across the country are planning on at least partially if not fully staffing these hotlines with volunteers.
Katie Vernoy 14:49
You have got to be kidding me. Oh my gosh, we have a job that is critically important to keep folks alive, to keep folks moving forward to the next day. And we’re going to staff those phones with volunteers that could just walk out, that may not be held accountable in the same way to training or whatever, who potentially won’t want to do the hours required because it is a volunteer position. Why is this part of the plan?
Curt Widhalm 15:23
Because mental health is not a priority according to any of the actions taken in response to this. That we’re looking at states that haven’t even funded this yet. Some states, like Illinois have talked about moving funding from 911 over to 988, which rob Peter to pay Paul, when it’s not even crossing over the resources that already exist for 911 to work collaboratively with 988. Many states don’t have the funding to implement this at all set up. And those are the states that are going to have some of the biggest issues with this when it comes to actually not only having people to answer the phone, but also then to put them into all of the continuum of care spaces that you mentioned earlier in the episode. I think part of the problem of this is that this is being marketed as a robust addition to our mental health system, when really what it is, is, it’s a great thing to say, if you’re in a suicidal crisis, we are trying to do something with it. But our system’s already overwhelmed. This is not really building out the rest of our continuum of care system. You, you look angry.
Katie Vernoy 16:46
I am so angry. I’m so angry. This is like, okay, there’s a little tiny hole in the boat and the water’s coming in. And they’re like, No, that hole is not big enough, let’s sink this boat. I just I picture the already impacted mental health system where there isn’t enough space for folks who already need mental health services. And then you add on top of that volunteers who may be well trained, there may be beautiful experiences, but the fact that they are not getting paid for a critical job at a critical time really pisses me off. But let’s just say you’ve got you’ve got an overwhelmed volunteer, most likely college students trying to get their resumes together or whatever, right? Like you’ve got folks who are super overwhelmed with nowhere to send anybody and potentially not the emotional intelligence and resources to be able to navigate these conversations. And so you’re getting it, it is not even a band aid. It’s like a stinky band aid with with poison on it.
Curt Widhalm 17:53
So let’s talk about some of the things that aren’t also in place. We’re not only are we not funding in many jurisdictions, the call center aspect of it. But many places are not building out the other two components of it, which is text availability, and website chat availability, that I don’t know might affect adolescents a lot more who don’t want to be heard by their parents through the door, and particularly LGBTQ+ adolescents, who may find this as the most convenient way of being able to reach out to somebody and I don’t know one of their most overwhelmed and weakest points in their lives.
Katie Vernoy 18:40
What I was looking at, there’s also phone, they’ll have lots of different language capacity, but text and chat are only English right now.
Curt Widhalm 18:52
And there’s more.
Katie Vernoy 18:54
Okay, continue. Just feel like I just feel like I need to take a shower.
Curt Widhalm 18:59
So according to the RAND working paper, less than one quarter of the respondents reported that their staff has training to interact with indigenous communities, less than 38% are not trained to work with physical or intellectual disabilities. But less than half of the survey reports that their staff was trained to engage with the unique needs of LGBTQIA+ populations, less than half with individuals experiencing homelessness. And more than one half of the survey respondents reported that they did not have specific training to work with children or adolescents.
Katie Vernoy 19:39
So we’re looking at a good swath of folks who are most likely to be calling these numbers and they’re gonna reach somebody that has no training to work with them.
Curt Widhalm 19:52
That is correct.
Katie Vernoy 19:55
It’s like you’re trying to piss me off. Like I, I wish I could put my head in the sand on this. This is something where this is really a…
Curt Widhalm 20:04
You want to be a member of Congress funding this?
Katie Vernoy 20:07
I do I do for just a moment, I just want to hide out and pretend like this isn’t the the shitshow that it is.
Curt Widhalm 20:15
This needs a lot more support. The overwhelmed system that’s here is not adequately lined up to deal with this. The plugging the gaps of the system, you brought up the holes in the ship sort of argument is, this is not plugging the gaps. This is making it more known of like, Hey, we’ve got we’ve got a ship for you come over to our ships, but it’s not doing any of the extra things that would actually make this system of mental health care actually work. And so what’s gonna end up happening is that a lot of this is going to end up getting referred, like you said to agencies that are either overwhelmed, it’s going to be, you know, shifted over to law enforcement or first responder or back to emergency rooms, kind of status quo sort of things as we’re looking at it without any long term plans. Because some of the funding interjections like one that Wyoming’s received, now Wyoming reports that they have the capacity to handle the about 500 phone calls per month ahead of what’s expected to be a surge, they’re getting $2.1 million in funding as a one time non recurring.
Katie Vernoy 21:39
Yeah, without that being a recurring funding or some sort of ongoing funding stream, it doesn’t make sense. It just you set something up, and then it falls apart.
Curt Widhalm 21:49
Now, the hope was that many states would implement funding for these programs, much like the 911 system is funded. Should you actually care to ever peruse your phone bill, there’s a surcharge for 911 services. That’s how 911 gets funded. Only four states currently have that in place.
Katie Vernoy 22:08
To try to decrease the level of I don’t know, hopelessness and malaise that I’m experiencing in this moment. It sounds like there may be some paths forward, if states have the political will to do it. There’s the 988 surcharge. That’s a possibility. It seems like some sort of integration and support between the 911 folks and the 988 folks to figure out how to build this infrastructure and successfully implement it across all of the ways. It seems like funding streams are really important. And some of this stuff potentially would be funded by Medicaid or insurance services for mental health. But there’s so many places where they don’t or there’s conflicts or stuff like that. So I think it’s, it’s something where this is something that if you throw money at it, it could get better. And the vision of it being an easy access point to a robust Crisis Response System, an entry point for mental health, like that vision seems really powerful. And so I feel like this is a possibility. And if we do show the gaps, if there’s, if this does say like, Hey, look at all these places, that we are not able to actually address the mental health needs of our community, does that potentially give us some momentum? I mean, I hate to be pessimistic. So I’m trying to find some optimism here. But like, sometimes when you show the gaps, people recognize they need to fix them or fill them up.
Curt Widhalm 23:55
You and I have been in enough Congress people’s offices, both in Sacramento and in DC. Come on, let’s be honest about this. We’ve been pointing out the gaps in our system for decade plus in just our personal experience, and that’s carrying on the work of people who’ve been doing this stuff for a decade plus before. Showing the gaps of the system. Maybe I’m just being overly pessimistic about this right now, but has not worked. Everybody you know, every staffer, every Congress person will shake your hand and look you in the eye and say, yes, that surely is something that we need to look into. But this has all of the makings of being a piss poor rollout that people are just like, here’s another government waste of money that doesn’t work, because not only are they saying that there’s this great new system out there, but nobody’s answering the calls and I’m just as bad as I was before and now with less tax dollars. Now, the RAND people have a few recommendations in their report and I’ve got one more that addresses part of this, but coordinating with local institutions to develop a strategic plan that enhances mental health emergency response and includes stable sources of revenue. Many of the places that the RAND people reached out to said that they were not consulted at all in this rollout, or were consulted at a very minimal level. And it seems asinine that a system that’s being just like shoved out to the states, and then just like, hey, I guess you get some public funding deal with this seems to have been maybe a caricature of what actually happened, but seems to be the big piece of this is stable funding.
Katie Vernoy 25:38
And cause I think a lot of this when you’re already saying that volunteers are going to be manning the call centers, I can already see a slew of unfunded mandates that come along with this. So it’s something that’s going to really tax the agencies that are already struggling to meet the mental health needs with paid services.
Curt Widhalm 25:57
Yes. Their second recommendation is conduct needs assessment for mental health infrastructure and personnel and examined whether recently passed federal legislation can support investments in it. This does not seem to be consistent with the creation of 988 at the federal level, but with the states running it. And so I mean, RAND people are very smart people. I’m not here to disagree with them. But I think that this has to be something that for those of you who are as pissed off, as we are about this, it’s really making sure that your state level representatives are tackling this because at the federal level, the intention of the bill from the beginning seemed to be have the states fund this, here’s some money to get it going. And the third recommendation from the RAND people is ensure that the local mental health emergency hotlines, follow best practices collect information on performance and are part of the lifeline network. And, yeah, that’s pretty good thing. But my thought is in talking with, whether it’s your representatives yourselves, or any of the professional organizations is, if we’re really looking at getting these things staffed, there is a space for the next several years until the funding is in place, that pre-licensed therapists could earn a certain number of double hours towards licensure by manning these hotlines. And that would be something working with your licensing boards is a possibility. But if we’re concerned about not professional people, not professionally trained people, or people with 80 hours of training to work with a wide variety of populations, this is possibly an area to solve a actual problem with some short term motivations for getting more people into the workforce quicker to actually serve on the other end of community mental health clinics and any of the continuum of care here.
Katie Vernoy 28:03
That idea has merit. And I really want to refer you to your own statement that pre-licensees need to get paid. And we’ll put the link to that episode in the show notes. But I think that because it’s been it’s mental health, I think that they’re going to continue to either under pay or not pay folks. And I think it just creates this ongoing problem. So my hope is that we can actually do something at the federal level. I know you said to talk to state legislators, but I think federal funding, I think needs to happen. And I think sometimes yeah, I don’t know, I don’t know, I guess you’re right. I don’t see it, I don’t see it happening soon. But I feel like if the states are left to their own devices, there are some states that just don’t have the political will, or the infrastructure to get the funding they need for this. And I think that I think the federal government needs to, to put in place potentially additional Medicaid funding or some sort of way that this can fall into other funding streams that that are already in place.
Curt Widhalm 29:13
We will include links in our show notes to a lot of the articles that we’re referencing here, as well as links on how to find out who your congress people are. And make sure that you connect with us on our social media, and join our Patreon or Buy Me a Coffee to help continue supporting us in the work that we’re doing to highlight this, these kinds of issues and being able to help continue the advocacy efforts for a better mental health system. And until next time, I’m Curt Widhalm with Katie Vernoy.
Katie Vernoy 29:49
Thanks again to our sponsor Thrizer.
Curt Widhalm 29:52
Thrizer is a new billing platform for therapists that was built on the belief that therapy should be accessible and clinicians should earn what they are are worth. Every time you bill a client through Thrizer an insurance claim is automatically generated and sent directly to the clients insurance. From there Thrizer provides concierge support to ensure clients get their reimbursement quickly and directly into their bank account. By eliminating reimbursement by cheque, confusion around benefits and obscurity with reimbursement status they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick and easy to get set up and it works great with EHR systems.
Katie Vernoy 30:33
Their team is super helpful and responsive and the founder is actually a longtime therapy client who grew frustrated with his reimbursement times. Thrizer lets you become more accessible while remaining in complete control of your practice. Better experience for your clients during therapy means higher retention. Money won’t be the reason they quit on therapy. Sign up using bit.ly/moderntherapists and use the code moderntherapists if you want to test Thrizer completely risk free, you will get one month of no payment processing fees meaning you earn 100% of your cash rate during that time.
Curt Widhalm 31:08
Once again, sign up at bit.ly/moderntherapists and use the code moderntherapists if you want to test Thrizer completely risk free.
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