Most of the 988 suicide prevention call centers established under the Biden administration are experiencing worker shortages due to insufficient funding, a new study finds.
Congress designated the dialing code in 2020, authorizing state governments to levy phone taxes to cover a projected uptick in demand due to a rise in anxiety, depression and suicide.
The Federal Communications Commission replaced the 10-digit National Suicide Prevention Lifeline with 988 in July 2022, prompting a surge in contacts.
Published Tuesday in JAMA Network Open, the study surveyed 77% of the nation’s over 200 call centers. It found that 71% were understaffed and 89% lacked the funds to hire. Another 80% struggled with recruitment and retention.
Lead author Samantha Matthews, an assistant policy researcher at the Rand Corp., said the findings “reflect broader workforce shortages across the behavioral health crisis system.”
“Crisis center work is demanding and emotionally intense, which makes supporting this workforce essential,” Ms. Matthews said. “Addressing these issues will likely require sustainable funding models, operational efficiencies, and innovative recruitment and retention strategies.”
Jonathan Purtle, a New York University public health professor who co-authored the study, called on policymakers to raise salaries for 988 workers. A previous study he co-wrote last June found that lower 988 use rates led to less funding in politically conservative Southern states than in Democrat-led states.
“It is high-stakes, challenging, and emotionally taxing work, and people could often make more money with better benefits in many less demanding jobs,” Mr. Purtle said.
The Biden administration covered the 988 launch by investing nearly $1 billion in the national nonprofit that funds operations.
But state and local governments remain responsible for financing future expansions of the call centers, which route contacts to mental health counselors.
As of this week, 12 states have enacted permanent 988 phone taxes ranging from 12 to 72 cents: California, Colorado, Delaware, Illinois, Maryland, Minnesota, New Mexico, Nevada, Oregon, Vermont, Virginia and Washington.
Five others have levied recurring state appropriations: Arizona, Florida, Georgia, Kansas and Utah.
Fee legislation is pending in eight more states, while 25 states have no plans to enact funding legislation, according to a tracker from the National Alliance on Mental Illness.
Timothy Jansen, CEO of a fully staffed 988 call center in Hyattsville, Maryland, said funding levels vary widely.
“Some states are very supportive, some not,” Mr. Jansen said. “We are lucky we pay a good wage, have good benefits, etc.”
Michael Austin, a former economic adviser to two Republican governors of Kansas, said the study reveals “a predictable flaw” in the program’s funding mechanism.
“Washington made a national promise while leaving states and local centers to cover the permanent labor costs,” said Mr. Austin, an economist with the National Center for Public Policy Research’s Project 21. “Seed money can launch a hotline, but it cannot permanently staff a 24/7 crisis system.”
’Need for robust investments’
The Substance Abuse and Mental Health Services Administration said the Trump administration has continued to “invest significant resources” in the 988 program.
The agency estimates that it has received 21.9 million calls, texts and chats since its launch, with volume growing each year.
“Long-term sustainability of the 988 Lifeline has always included the need for robust investments in crisis care systems from state, territorial and local leaders,” the agency said.
The National Association of Counties noted that 988 call centers have struggled to keep up with an uptick in mental health complaints since the pandemic.
“Counties and community-based providers that staff and operate local 988 call centers are responding to significantly higher demand while facing the same workforce challenges affecting behavioral health systems nationwide,” the association said.
But Adam Hoffer, a policy expert at the Tax Foundation, cautioned that “988 staffing shortages shouldn’t be attributed to a lack of tax revenue” from states charging cellphone users monthly fees.
“In our annual wireless report, we point out that in 2024, wireless subscribers paid $4 billion to state and local 911 and 988 fees,” Mr. Hoffer said.
The Bureau of Labor Statistics has projected that substance abuse, behavioral disorder and mental health counselor jobs will grow 17% from 2024 to 2034, with about 48,300 openings per year.
KFF, a public policy think tank, reported in 2024 that more than 500,000 Americans took their own lives between 2012 and 2022, with suicide rates rising in most states over that period.
Psychologist Vince Callahan, founder of the Florida Institute of Neural Discovery, said growing demand for 988 has created “a staffing nightmare” with no quick fix.
“You suddenly need thousands more trained crisis counselors, and that pipeline takes time,” Mr. Callahan said.
