The fledgling 988 Suicide & Crisis Lifeline – which has struggled to get sustainable funding from states – got a lifeline of its own last week when the Department of Health and Human Services announced awards of more than $130 million to 51 states and territories to support and expand the national network of 988 call centers.

The national three-digit hotline was established by federal legislation in 2020 and launched in July. It replaced the 10-digit phone number for the National Suicide Prevention Lifeline, which had been operating since 2005.

The 2020 legislation envisioned the 988 network being supported by small surcharges on the monthly bills of telephone users – the same way 911 is paid for. But to date, only five states – Virginia, Colorado, Nevada, Washington, and California ­– have chosen to implement this funding approach, according to the National Alliance on Mental Illness (NAMI).

Mental health advocates said the funding announced Friday was useful but insufficient to develop and sustain a strong crisis-call system.

“It will certainly help states, but it does not meet the full funding need to operate 988,” Hannah Wesolowski, NAMI’s chief advocacy officer, said in an email. “In reality, it’s going to take a combination of local, state, federal and other resources to operate this system.”

The awards announced on Friday accounted for most of the $150 million designated for 988 services under the Bipartisan Safer Communities Act, which was signed into law in June. That investment comes on top of $163 million in federal funds appropriated earlier this year.

A RAND study, published in June, suggested that state and local agencies were not prepared for the upcoming change. In a survey conducted for the study, more than half of 180 state, regional and local behavioral health program directors reported that “they were not involved with the development of a strategic plan related to the launch of 988.” Only 16%, noted RAND, “had developed a budget to support 988 operations.” 

The network saw an immediate spike in traffic after the July 16 launch. According to the Kaiser Family Foundation, the system logged 112,000 more calls, texts and chats in August, the first full month of the new system, than in August 2021 – a 45% increase.

The higher volume continued into October, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), when the 988 Lifeline answered 141,032 more calls, chats and texts than in the previous October.

For years, people have called 911, the universally known emergency number, when they or a family member are in psychological distress and need immediate help. One recent study of eight major cities found that mental health-related calls made up 21% to 38% of all calls to 911.

But there is growing agreement that police are generally not the appropriate responders, a view driven by countless examples of police arresting, harming or even killing people in crisis when responding to mental health calls. The Treatment Advocacy Center estimates that people with untreated mental illness are 16 times more likely to be killed during a police encounter than other civilians approached or stopped by law enforcement.

Indeed, a key rationale for creating 988 was to provide a way for people to seek crisis assistance without calling 911 or involving police. The 2020 bill establishing 988 as a nationwide mental health emergency line built the network on the existing National Suicide Prevention Lifeline.

The name was also changed to broaden awareness and usage of the system beyond those considering suicide, said Wesolowski.

“It’s really meant to help anyone who’s experiencing a mental health crisis,” she said.

The need for such services has grown. In 2020, almost 46,000 people in the US committed suicide, according to the Centers for Disease Control and Prevention – about one every 11 minutes. Among adults, an estimated 1.2 million made a suicide attempt while 12.2 seriously considered suicide, according to the agency.

Of the newly announced awards, the largest chunk, $64.8 million, is for Vibrant Emotional Health, the organization that serves as the administrator for the 988 network. The funds will be distributed by SAMHSA.

Another $47 million is to help states and territories “expand and enhance” their 988 services, and $21.1 million is for tribal communities. The agency said it will announce details of the tribal funding early next year.

“We see significant mental health need in tribal communities, and they’re often disconnected from a lot of mental health resources,” said Wesolowski. The 988 system is also seeking to increase chat and texting capabilities and is piloting “specialized services for LGBTQ+ youth,” who are at higher risk of suicide and suicidal ideation, she said.

David Tuller

David Tuller, DrPH, is a senior fellow in public health and journalism at UC Berkeley’s Center for Global Public Health, part of the School of Public Health. He received a masters degree in public health...