Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 26, Issue 2, 2023. Pages: 85-95
Published Online: 1 June 2023

Copyright © 2023 ICMPE.

Implementation of the 988 Suicide & Crisis Lifeline: Estimating State-Level Increases in Call Demand Costs and Financing

Jonathan Purtle,¹* J. Chance Ortego,² Sachini Bandara,³ Alena Goldstein,⁴ Jordan Pantalone, ⁴ Matthew L. Goldman⁵

¹Department of Public Health Policy & Management, New York University School of Global Public Health, New York, NY, USA
²Department of Child and Adolescent Psychiatry, Hassenfeld Children’s Hospital at New York University Langone, New York, NY, USA
³Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
⁴Vibrant Emotional Health, New York, NY, USA
⁵San Francisco Department of Public Health, San Francisco, CA, USA

Background: Per federal law, “988” became the new three-digit dialing code for the National Suicide & Crisis Lifeline on July 16, 2022 (previously reached by dialing “1-800-283-TALK”).

Aims of the Study: This study aimed to produce state-level estimates of: (i) annual increases in 988 Lifeline call volume following 988 implementation, (ii) the cost of these increases, and (iii) the extent to which state and federal funding earmarked for increases in 988 Lifeline call volume are sufficient to meet call demand.

Method: A 50 state pre-post policy implementation design was used. State-level Lifeline call volume data were obtained. For each state, we calculated the absolute difference in number of Lifeline calls in the four-month periods between August-November 2021 (pre-988 implementation) and August-November 2022 (post-988 implementation), and also expressed this difference as percent change and rate per 100,000 population. The difference call volume was multiplied by a published estimate of the cost of a single 988 Lifeline call ($82), and then by multiplied by three to produce annual, 12-month state-level cost increase estimates. These figures were then divided by each state’s population size to generate cost estimates per state resident. State-level information on the amount of state (FY 2023) and federal SAMHSA (FY 2022) funding earmarked for 988 Lifeline centers in response to 988 implementation were obtained from legal databases and government websites and expressed as dollars per state resident. State-level differences between per state resident estimates of increased cost and funding were calculated to assess the extent to which state and federal funding earmarked for increases in 988 Lifeline call volume were sufficient to meet call demand.

Results: 988 Lifeline call volume increased in all states post-988 implementation (within-state mean percent change =+32.8%, SD =+20.5%). The total estimated cost needed annually to accommodate increases in 988 Lifeline call volume nationally was approximately $46 million. The within-state mean estimate of additional cost per state resident was +$0.16 (SD =+$0.11). The additional annual cost per state resident exceeded $0.40 in three states, was between $0.40- $0.30 in three states, and between $0.30- $0.20 in seven states. Twenty-two states earmarked FY 2023 appropriations for 988 Lifeline centers in response to 988 (within-state mean per state resident = $1.51, SD = $1.52) and 49 states received SAMHSA 988 capacity building grants (within-state mean per state resident = $0.36, SD = $0.39). State funding increases exceeded the estimated cost increases in about half of states.

Conclusions: The Lifeline’s transition to 988 increased 988 Lifeline call volume in all states, but the magnitude of the increase and associated cost was heterogenous across states. State funding earmarked for increases in 988 Lifeline center costs is sufficient in about half of states. Sustained federal funding, and/or increases in state funding, earmarked for 988 Lifeline centers is likely important to ensuring that 988 Lifeline centers have the capacity to meet call demand in the post-988 implementation environment.