Use of the 988 Suicide and Crisis Lifeline established under the Biden administration has flatlined amid conservative pushback, according to a study published Monday in JAMA Network Open.
Researchers from New York University and Johns Hopkins University found in an analysis of national data that 988 call centers averaged 23.7 calls, text messages and online chats per 1,000 people in 2024.
They noted that this figure is less than half of the 53 adult emergency room visits per 1,000 people that involved a mental health diagnosis last year. Among the U.S. regions, 988 contacts were highest in the West, at 27.1 per 1,000 people, and lowest in the South, at 20.
“This is consistent with state variation in funding for and legislative attention toward 988, both of which may affect awareness and use,” the researchers wrote. “Lower rates of 988 use in the South, which is more politically conservative than other regions, is also consistent with prior research showing less favorable attitudes toward 988 among Republicans than Democrats.”
Many Republican state lawmakers have resisted funding the fast-growing hotline, objecting that the federal government dumped the program in their laps as inflation soared to record highs.
Additionally, President Trump’s proposed federal budget calls for the elimination of $1 billion from a major federal funder of 988 and the removal of a dedicated LGBTQ crisis line from the service.
“988 is funded by a mix of federal and state funds,” said Jonathan Purtle, a New York University public health professor and lead author of the study. “It’s largely state, and states vary widely in terms of their funding for 988.”
The Washington Times has reached out to the Trump administration for comment.
Congress designated the 988 dialing code in 2020, authorizing state governments to levy telecommunications fees to cover a projected uptick in demand stemming from the change.
Acting on this law, the Federal Communications Commission replaced the 10-digit National Suicide Prevention Lifeline with 988 in July 2022 to make 24/7 crisis care more available for cellphone and landline users with an easier-to-remember number. Contacts soon surged alongside a pandemic-era rise in anxiety, depression and suicide.
Timothy Jansen, the CEO of a federal 988 Suicide and Crisis Lifeline center in Hyattsville, Maryland, said the switch was “absolutely” worth the added expense.
“We aren’t seeing any decreases in need for services,” said Mr. Jansen, a licensed mental health counselor. “Only decreases on the funding side as the federal government continues to slash funding.”
While the Biden administration covered most of the initial launch by investing nearly $1 billion in the national nonprofit that funds 988 operations, the law makes state and local governments responsible for future expansions of the more than 200 call centers that route the contacts to mental health counselors.
So far, 11 states have added permanent phone taxes ranging from 12 to 72 cents to monthly phone bills to fund the call centers: California, Colorado, Delaware, 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 Alaska, Illinois, New Hampshire, New Jersey, New York and Rhode Island.
According to an online tracker from the National Alliance on Mental Illness, the remaining 28 states have no plans to enact funding legislation.
Sarah Davidon, an official with the Colorado Behavioral Health Ombudsman’s office, said Mr. Trump’s budget and low awareness of 988 in conservative areas have put the program “at risk.”
She pointed to studies showing that only about 13% of Americans are aware of the number despite the surge in people contacting it.
“It provides a simple, nationally recognized number linked to specific specialties such as LGBTQ and veterans,” said Ms. Davidon, a senior policy adviser at Georgetown School of Medicine. “Lower usage may be connected to workforce shortages, budget constraints, and ongoing systemic challenges, not improved mental health.”
The older 10-digit help number, which continues to function alongside 988, received 3.6 million contacts in 2021.
The study published Monday found that 988 received 16,333,707 contacts between its July 2022 launch and the end of last year, with 11% rerouted to the Veterans Crisis Line. That’s 48.9 contacts per 1,000 people, averaging more than 5.4 million contacts annually.
Over the 30 months, 11,453,863 or 70.1% of 988 contacts were calls and 2,942,852 or 18% were texts. The remaining 1,936,992 or 11.9% were online chats.
In Kansas, lawmakers have allocated $10 million in 988 funding that is set to expire at the end of next year.
Michael Austin, a former economic adviser to two Kansas governors, said the GOP-controlled state Legislature could end that funding as it corrects a $700 million to $800 million operating deficit in its next budget.
“There may be more public benefit in directing it to other services or returning it to taxpayers,” said Mr. Austin, an economist with the National Center for Public Policy Research’s Project 21, a network of Black conservatives. “If nobody knows of it and nobody is using it, what benefit is there to having the service out there?”
• Sean Salai can be reached at ssalai@washingtontimes.com.