988 Suicide Prevention Lifeline sees 45% increase in contacts, but funding concerns remain

Since the 988 Suicide & Crisis Lifeline launched on July 16, call centers have seen a 45% increase in contacts -- primarily in people texting or sending messages seeking help -- compared to last year, according to new data from the federal government's Substance Abuse and Mental Health Services Administration (SAMHSA).

"What we've seen is a big increase in text and chat, and some increase in phone calls," said Tim Jansen, chief executive officer for Community Crisis Services, Inc., in Hyattsville, Maryland. "Fortunately, [CCSI was] prepared. Answer rates have been really good nationally. The national waiting time has been reduced … It's still not where it needs to be, but it's significantly better."

988 is the new three-digit number for the service previously known as the National Suicide Prevention Lifeline, which had been operating with a ten-digit number since 2005. Prior to the launch of the new number -- touted as making the service more accessible -- advocates worried whether the system was appropriately funded and staffed to handle the anticipated spike in contacts from people in need.

The Lifeline has historically been underfunded and understaffed, the government has acknowledged. Ahead of the 988 launch and an anticipated increase in calls, $432 million in federal funding was invested in shoring up the system, enabling call centers across the nation to hire additional staff. But Jansen told ABC News that whether additional state funding is appropriated for the partner call centers in local areas across the country makes a difference.

"SAMHSA put some money in on the front end," Jansen said. "I think the SAMHSA funds have gotten everybody sort of off the mark and got everybody into the race. But it's got to be continued in order for things to move forward. Some states are going to do that easier than others."

Answer rate data from SAMHSA for the month of August, the first full month of implementation for 988, shows an 84% answer rate for calls, 97% for chats and 98% for texts. The answer rates for chats and texts represent a major increase compared to numbers released by SAMHSA in an appropriations report late last year, which showed a 30% answer rate for chats and 56% rate for texts through December 2020.

Jansen told ABC News that funding from the state of Maryland, in addition to the federal investments, made sure his facility was prepared. Many states, however, have offered no form of financial support for the system, though they were empowered by Congress in 2020 to enact cell phone taxes to fund the call centers, similar to how 911 call centers are funded.

Health and Human Services Secretary Xavier Becerra has been traveling across the country as part of HHS' National Tour to Strengthen Mental Health.

Earlier this month, he touted the Biden administration's investment in 988, saying in a statement: "Our nation's transition to 988 moves us closer to better serving the crisis care needs of people across America."

"988 is more than a number, it's a message: we're there for you," he added. "The transition to 988 is just the beginning. We will continue working towards comprehensive, responsive crisis care services nationwide to save lives."

Advocates for those in crisis, however, worry about the long-term of funding for the system given the uncertainty of future federal investment -- with shifting politics and shifting priorities -- and, so far, a lack of widespread monetary backing from states.

"We're going to need continued investment," said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness. "One of my fears is that people are gonna think, 'OK, [the launch], came and went, our work is done.' There's so much more work to do. I keep saying we're closer to the starting line than the finish. But I think this is something that has a lot of momentum, but also is going to help millions of people and we can't lose sight of that."

Jansen, with the crisis center in Maryland, said that while "so far, [it's] been beautiful," a designated fund via a cell phone tax would also "make a huge difference."

That scenario would allow his facility to "focus a little less on the fundraising and a whole lot more on service delivery," he said.

Four states have passed cell phone taxes that would fund the 988 call centers year over year.

"There's only so much money, and folks prioritize what they see as important," Jansen said. "Hopefully everybody sees saving lives from suicide is important. I think they do. But you know, it always comes down to 'where does money get spent?'"

Since the launch of the new number, advocates cite another worry: Misinformation spreading online about 988 using personal information to track callers or send police without cause to the homes of those contacting the service -- which those involved say is an exaggeration.

"My biggest concern is that people will lose trust in the system just as it's getting off the ground and has the potential to help millions of people," said Wesolowski with the National Alliance on Mental Illness. "I am really fearful that somebody who could use that support and help is going to hesitate to call. We want every life saved. We want every person who's in emotional distress helped."

Call centers do have "imminent risk" standards by which they are required to send assistance to people who have contacted 988, though most calls do not reach that level, according to SAMHSA.

"It is important to note that fewer than 2% of calls to the 988 Lifeline require an emergency response, and most of those are done with the consent and cooperation of the caller," Dr. John Palmieri, acting director of SAMHSA's 988 and Behavioral Health Crisis Coordination Office, said in a statement. "We want anyone who calls, texts, or chats 988 to know that they are not required to provide any personal information to talk to a trained counselor."

Jansen noted that "every imminent risk policy underscores least invasive intervention as is possible. So you do the things that are the least invasive."

"Ninety-nine times out of 100, people are ready, willing and able to participate [with emergency personnel]," he said. "They don't call, they don't start a text or chat unless some part of them wants to live. So you have a little bit of an advantage."

Wesolowski noted that the concerns online of excessive intervention from 988 disproportionately impact marginalized communities, particularly communities of color.

"A lot of communities that are marginalized by our public systems and have seen kind of the worst results from this type of response when it's been available are skeptical, and it is completely reasonable that they are, given their past experience," Wesolowski said. "The exact people who can be best helped by 988 and and the system being built around it may not trust it enough to call, and I think that's incredibly concerning. That means more people aren't going to get the help they need and potentially many more lives lost."

Jansen also noted that making sure the 988 system works for everyone is important going forward.

"We've really got to look at suicide as sort of a more comprehensive or global issue. We've really got to be able to market in a way that we're getting into communities of color," he said. "And we've got to be getting in touch with them and making sure everybody can use 988 in a way that's culturally appropriate and appropriate to their community and all that sort of stuff. So there's some work to be done there in terms of outreach."

Jansen said the most important part of what his Maryland call center does is meet people "where they are" and start there to help them.

"988 is your three-digit dialing to mental health and crisis care systems," he said. "You are going to reach somebody who can help you right now that's going to be kind and educated enough to connect you appropriately, and most importantly, listen to you in terms of what your situation is."

If you are experiencing suicidal, substance use or other mental health crises, please call or text the 988 Suicide & Crisis Lifeline. You will reach a trained crisis counselor for free, 24 hours a day, seven days a week. You can also go to 988lifeline.org.