Calls and texts have been pouring in to the nation’s suicide prevention hotline since the government last summer simplified the number to 988.
But while calls and texts have been coming in at record rates from those seeking help with drug addiction or suicidal thoughts, the cost for maintaining the National Suicide Prevention Lifeline is also piling up.
And while the Biden administration has been picking up the tab so far, the law makes state and local governments responsible for the future expansion of more than 200 call centers that route contacts to mental health counselors.
Taxpayers and consumers are already beginning to pay for those growing costs as legislatures add fees to phone bills or add funding for the call centers to their state budgets.
Five states — California, Colorado, Nevada, Virginia and Washington — have created phone taxes to fund the call centers by adding between 12 and 50 cents to the monthly bill for a phone line.
Another six are considering similar fees: Minnesota, New Jersey, Oregon, Rhode Island, Texas and Vermont.
Congress designated the new 988 dialing code during a pandemic relief spending spree in 2020, authorizing state governments to levy new telecommunications fees to cover the costs.
Former President Trump signed the National Suicide Hotline Designation Act into law that October and the Biden administration has since deposited nearly $1 billion of startup money into 988 operations.
“Significant investments in capacity at the federal, state and local levels have helped ensure that the 988 Lifeline has been able to respond to many more people in crisis,” 988 Director Monica Johnson told The Washington Times. “Data following the transition to 988 in July 2022 continues to show an increase in overall calls, texts and chats from the year prior, all while answer rates are significantly improving.”
While the Biden administration’s investments have covered most of the launch and initial surge in calls, the law makes state and local governments responsible for the future expansion of more than 200 call centers nationwide that route contacts to mental health counselors.
Virginia was the first state to pass a phone tax funding 988 operations under then-Gov. Ralph Northam, a Democrat who signed it into law in March 2021 ahead of the transition. That new service fee adds 12 cents a month to the cellphone bill of Virginians with a subscription wireless plan and makes those with prepaid wireless services pay 8 cents per retail transaction.
Policy analysts on the right, though, remain skeptical about adding a “suicide tax” to residents’ monthly phone bills.
“This is an unfunded mandate, pure and simple, and the federal government needs to rethink their funding mechanism,” said Raven Harrison, a Texas-based Republican political strategist. “We also need to be looking at utilizing churches and other charitable organizations to help shoulder the load, because rarely does the government do anything better or more effectively than the private sector.”
According to the nonprofit National Alliance on Mental Illness, at least 20 other states have passed or are debating other 988-related legislation that does not involve a phone tax.
Some of the bills, like the one approved Monday in the Democrat-dominated Maryland General Assembly, would route money directly from state budgets to 988 call centers or mobile crisis services. Others would create task forces to study potential funding alternatives.
“The way Congress set this up is reasonable,” said Ed Haislmaier, senior research fellow in health policy at the conservative Heritage Foundation. “The federal government can’t do something and tell states to pay for it, but it can facilitate a program in a way that removes obstacles to states doing things.”
The situation recalls the Obama administration’s 2009 push to expand Medicaid benefits through the Affordable Care Act, said James Carville, a Democratic Party political strategist. He pointed out that many Republican-led states have refused to pay for that expansion, especially in the Deep South.
“Frankly, I think cruelty is part of the appeal when you don’t want to pay for something that benefits people who aren’t like you,” Mr. Carville said. “The idea is that you don’t need a suicide hotline or [psychiatric] drugs and counseling if you get depressed — you can just suck it up and soldier on.”
According to the federal Substance Abuse and Mental Health Services Administration, the new 988 hotline answered 404,194 calls, chats and texts in February. That’s an increase of 161,678 contacts from the same month last year, before the change.
Call volume in February increased year-over-year by 48%. The number of online chats rose by 247% and the number of text messages shot up a staggering 1,599% over the same period.
The crisis centers absorbing this spike ”are fundamentally operated at the local level” and need state funding mechanisms to expand services as demand keeps growing, said Dani Bennett, a spokesperson for the Substance Abuse and Mental Health Services Administration, which is part of the Department of Health and Human Services.
“States are taking a range of approaches, including assignment of coalitions and commissions, leveraging state Medicaid funding, and passing legislation that allocates specific funding to 988 response,” Ms. Bennett said.
Through SAMHSA, HHS funds Vibrant Emotional Health — the 988 line’s nonprofit administrator — to support telephone networking, data collection, quality assurance, operator training and call routing.
Federal money also funds a small network of national crisis call centers and text and chat services that back up the local centers during overflow.
The Democrat-led Congress and White House included $501.6 million for the 988 Suicide and Crisis Lifeline in the fiscal year 2023 omnibus spending package. That followed an earlier $432 million investment from the Biden administration.
Ms. Bennett said the federal grant monies do not cover mobile crisis response, community behavioral health clinics or dedicated crisis care-related funds — all areas where states must find ways to pick up the tab.
“The federal investments have been used to scale up crisis center capacity, national back-up center capacity and to provide special services, including a sub-network for Spanish language speakers, to ensure all Americans have access to help during mental health crises,” Ms. Bennett said. “Prior to this investment, the lifeline, which has existed since 2005, had been long unfunded and under-resourced.”
The U.S. Department of Veterans Affairs, HHS and FCC developed the suicide lifeline — which also links to the Veterans Crisis Line — in a joint effort. The original number continues to function alongside the 988 code.
The number of people contacting the old hotline spiked during pandemic lockdowns and stayed elevated during remote work arrangements, mental health counselors say. Call centers reported the uptick came from suicidal adults with work-from-home jobs who felt unable to get out of bed or were abusing opioids to numb their loneliness.
State and local call centers received 3.6 million calls, chats, and texts on the hotline in 2021, the FCC reported last year. The FCC expects that number to double in the first full year of the new 988 number.
According to the Centers for Disease Control and Prevention, suicide was the second leading cause of death for young people aged 10-14 and 25-34 in 2020. From April 2020 to 2021, the CDC found more than 100,000 people died from drug overdoses, up significantly from pre-pandemic levels.
To fund the 988 expansion, blue states have led the way in adding fees to monthly telephone bills, the method that already funds 911 call centers in many parts of the country.
In 2021, Washington passed a law imposing a monthly 40-cent tax per phone line to fund 988 operations.
That fee will bring in an estimated $11 million each year. A separate bill pending in the state Legislature would develop informational materials, launch a social media campaign, fund mobile rapid response crisis teams and report hotline usage data.
In neighboring Oregon, lawmakers are considering a monthly tax of 50 cents per phone line. And Minnesota Democrats have introduced bills in the House and Senate that would impose a monthly phone fee between 12 and 25 cents.
Other states have sought ways to fund the 988 expansion without a phone tax.
In the measure that the Maryland General Assembly passed Monday, lawmakers in the deep-blue state will set aside $12 million in 2025 for 988 operations.
A proposed Ohio spending bill would provide roughly $21 million of tax dollars in the fiscal year 2024 and about $26 million in fiscal 2025 “to support statewide operations and related activities” of 988.
In Wyoming, lawmakers rejected a proposed $46 million allocation to the 988 Lifeline, opting instead in February to create a 988 trust fund and reserve account — both of which remain empty — that can receive private donations and future state budget allocations until 2028.
• Sean Salai can be reached at ssalai@washingtontimes.com.