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As 988 crisis line sees more use, states debate how to pay for it


As 988 crisis line sees more use, states debate how to pay for it

Mar 31, 2023 | 12:02 am ET
By stateline
As 988 crisis line sees more use, states debate how to pay for it
Virginia is part of a nationwide transition to 988, a simple three-digit hotline for mental health emergencies. But experts worry the system won't be able to handle an expected deluge of new crisis calls. (NBC12)

By Noelle Straub / Stateline, an initiative of the Pew Charitable Trusts

Editor’s note: If you or someone you know needs support now, call or text 988 or chat 988lifeline.org.

Almost everyone agrees that putting money behind the national suicide and crisis hotline is a good thing.

But not everyone thinks a new phone tax is the best way to pay for it.

Since the crisis line’s easy-to-remember 988 number launched last July, its use has increased significantly. The lifeline had 404,194 calls, chats and texts in February alone, an increase of 161,678 contacts over February 2022.

Calls answered increased by 48%, chats answered by 247% and texts by 1,599%. (Some calls went unanswered, either because a caller hung up or there was a technical service interruption.)

An infusion of federal money to the national nonprofit that administers 988 and to local call centers that historically have received little or no federal aid has largely covered the expense of launching the new number and the recent increase in volume. But in the future, state and local governments still will be responsible for funding the local centers where calls are first routed, leaving many budget writers grappling with how to cover the costs as demand increases.

When Congress passed a law in 2020 requiring the Federal Communications Commission to designate 988 as a national suicide prevention and mental health crisis hotline, it also allowed states to enact new telecommunications fees to fund 988 operations. Yet only five states have done so: California, Colorado, Nevada, Virginia and Washington.

Virginia’s mental health hotline launches amid fears it won’t meet expectations

Six other states have pending legislation that would impose a fee: Minnesota, New Jersey, Oregon, Rhode Island, Texas and Vermont, according to the education and advocacy nonprofit National Alliance on Mental Illness.

About 20 other states this year have either passed or are considering other 988-related legislation, ranging from providing money for the 988 program or for mobile crisis services to creating a task force or launching a study of potential funding sources, the alliance said.

Officials knew that the 988 number would significantly increase contact volumes, meaning states would need to come up with more funding for call centers; that’s why Congress allowed states to impose a telecom fee. And the federal Substance Abuse and Mental Health Services Administration, which oversees the crisis line, wants the transition to 988 to spur the growth of a robust system that links callers to community-based providers who can deliver a full range of crisis care services, such as mobile crisis teams or stabilization centers.

States had about a year and a half from passage of the federal law to the launch of 988, noted Stephanie Pasternak, director of state affairs for the National Alliance on Mental Illness.

Pasternak said 988 implementation has happened fast, “and that’s been a challenge, I think, for states in terms of really figuring out exactly how much funding they need and where they need to pull that funding from.”

The group wants states to enact comprehensive laws as they transition to a more robust 988 hotline, which means answering a few key questions, she said.

“Number one, what does 988 look like in their state?” Pasternak said. “How is it going to be sustained financially, and who’s in charge?”

Sustainable funding could come from a phone fee, included in people’s monthly phone bills, or through recurring spending, she said. For example, Ohio lawmakers have proposed a recurring line item in the state budget to pay for 988. The Ohio spending bill would provide nearly $21 million in fiscal 2024 and nearly $26 million in fiscal 2025 “to support statewide operations and related activities” of the lifeline.

But many states already charge a monthly phone fee to pay for 911; now, some are debating whether to do the same for 988.

“Anytime you want to have a discussion about adding a new statewide fee, that’s just always a politically challenging conversation to have,” Pasternak said.

How it works

People experiencing a suicidal, substance use or mental health crisis can call, chat or text the line 24 hours a day. The former 10-digit number 800-273-8255, which launched in 2005, still functions as well.

Calls are routed to the local lifeline network crisis center, based on the caller’s area code; if a local center can’t take the call, it is routed to a national backup crisis center.

There’s a network of more than 200 state and local independently operated call centers. The national backup centers are run by the nonprofit Vibrant Emotional Health, which administers the lifeline on behalf of the federal government.

It’s largely up to state governments to fund the local call centers. In-state counselors are more likely to be familiar with local resources and may be better able to provide referrals or assistance.

In 2021, Washington state passed a law imposing a tax on phone service to fund the 988 line.

Consumers there now pay 40 cents monthly per line. The fee brings in about $11 million each year, according to Crosscut.

But 988 efforts in Washington state continue. The state House this month unanimously approved a bill that would require the state to develop informational materials and a social media campaign related to the 988 crisis hotline, boost training for responders, fund mobile rapid response crisis teams and report data on hotline use. It awaits action in the state Senate.

Federal and state efforts also focus on some groups particularly at risk. Military veterans now can reach the Veterans Crisis Line by dialing 988 and pressing 1.

In November, Washington state launched the country’s first crisis response line dedicated to serving American Indian and Alaska Native people. Anyone calling 988 from a Washington state area code can press 4 to be connected to the Native and Strong Lifeline; calls are answered by Native crisis counselors.

During the pandemic, American Indians experienced suicide and overdose attempt rates at least two times higher than that of non-American Indians, according to the state.

Debate over phone fees

Oregon legislators are considering a bill that would establish a monthly tax of 50 cents per phone line. A House committee approved the bill this month.

At a February hearing, Dwight Holton, CEO of the regional nonprofit Lines for Life, testified that the volume his organization handled rose after the 988 number launched, from 14,956 contacts in the July 2021-January 2022 period to 21,094 in the July 2022-January 2023 period.

Several advocacy groups lent their support to the bill, saying it would provide stable funding for a needed resource; those groups include the Urban League of Portland, Our Children Oregon, the Oregon chapter of the National Alliance on Mental Illness and Everytown for Gun Safety.

But the Oregon chapters of the Association of Public Safety Communications Officials and the National Emergency Number Association opposed the legislation. While they support 988 efforts, officials from the two groups said, adding a new tax on phone lines unrelated to 911 would “confuse” the straightforward approach to funding 911.

“What we do not support is any entity encroaching on the tax that we have worked long and hard for repeatedly,” officials said in written testimony. “We feel that any further taxes or increasing our tax to fund other things is an open invitation for many others to want their piece of that pie and it would risk our ability to successfully continue down the road.”

Jake Lestock of the wireless communications trade group CTIA encouraged legislators to use other state and federal money to support the 988 program. He noted most states have gone that route rather than enacting a new tax, which he said would especially affect working families and Oregonians with financial challenges. But if lawmakers do choose a tax, he added, it “should be kept as low as possible and justified by data.”

“These types of taxes are highly regressive. Wireless phones are the gateway to the internet for many Oregonians.”

In Minnesota, Democrats have introduced bills in the House and Senate that would impose a phone fee of between 12 cents and 25 cents per month, with the exact amount to be recommended by the commissioner of health.

During a February hearing of the House Human Services Policy Committee, bill sponsor state Rep. Jessica Hanson said that since 988 launched, Minnesota’s four call centers have increased their call load by 44%, web chats by 173% and texts by 250%.

“It’s critical that calls to 988 from Minnesotans be answered in our own state so that connections to local resources and mobile crisis response can be made as needed,” the Democrat said.

But Republican state Rep. Dave Baker suggested that rather than create a new fee, the funding should be taken out of current phone taxes or fees already being charged to consumers. He said he’d like to offer an amendment to that effect as the bill progresses.

Hanson responded that the fee would create a stable structure to fund the program that couldn’t be changed — and that it purposely would draw residents’ attention.

“When folks look at their cellphone bills, they see a 911 fee,” Hanson said. “We want people to see a 988 fee so that if they themselves ever face this, maybe they’ll be like, ‘What is this 988 fee?’ and hopefully will look it up. So, there is a piece of this that is to help spread the word.”

Wyoming lawmakers considered a different funding model: a long-term trust fund. A new law signed in February creates a 988 trust fund and related reserve account — but it doesn’t have any money in it.

The original bill would have directed $46 million of state money into the fund, but Republicans skeptical of providing state dollars took out the provision. As passed, the law directs the Department of Health to request funding for the program in its next standard budget request. In the meantime, the fund can accept donations. The law also has a sunset date of 2028.

Republican Gov. Mark Gordon criticized the move to strip the state money.

“We are the worst state in the nation for suicide. We have two counties in our state that have the worst records for suicide. And not to recognize that as a not only an important issue, but a pro-life issue, and [that] we need to get ahead of it, was a big disappointment to me,” Gordon said at a news conference, according to the Casper Star-Tribune.