At two-year mark, federal funding for 988 is running dry. Enter phone fees.
A bookmark for children with the 988 suicide and crisis lifeline emergency telephone number is displayed by Lance Neiberger, a volunteer with the Natrona County Suicide Prevention Task Force, while they speak about mental health and suicide awareness in Casper, Wyoming on August 14, 2022. PATRICK T. FALLON/AFP via Getty Images
Only 10 states have identified permanent funding for the Suicide & Crisis Lifeline in their communities. Experts say a surcharge can help policymakers keep pace with the growing mental health crisis.
Two years ago the country’s national suicide lifeline downsized from 10 digits to three, with federal policymakers touting the revamped 988 number as easier to remember for individuals in crisis.
Since its launch in 2022, more than 10 million Americans have utilized the 988 Suicide & Crisis Lifeline via calls, texts and chats. And although there have been a few hiccups along the way—struggles staffing the hotline, raising awareness, long wait times, calls being routed to the wrong state—things are mostly running smoothly these days.
“We’ve seen answer rates at call centers go up while call wait times have gone down, which really means that the system has gotten better at connecting people to help more quickly,” said Stephanie Pasternak, the director of state affairs at the National Alliance on Mental Illness, or NAMI.
There’s just one big kink left: Most states have yet to figure out permanent funding for 988. Established by Congress in 2020, the federal government directed nearly $1 billion through the American Rescue Plan to launch the hotline. But as that money runs out, it will be the states picking up the tab for the more than 200 call centers throughout the U.S.
Enter 988 surcharges. While Congress may not be covering the cost of 988 services for much longer, it did give states the authority to collect fees from telecommunication companies to help fund the hotline in their communities. The fee is similar to the surcharge companies pay for 911 services, which often appears on customer's monthly phone bills. It provides states a new funding source, negating the need to pull from other funding streams that could short-shift other government services, Pasternak said.
So far, 10 states have seized the opportunity to impose 988 surcharges, which can cover a range of expenses like call center equipment and operations, staff wages, and data collection and analysis tools. They can also help fund mobile crisis teams or crisis stabilization centers, which need to be available 24/7 to effectively respond to 988 calls.
“A small surcharge reduces [policymakers’] need to tap into state general funds to sustain those services,” said Angela Kimball, chief advocacy officer at Inseparable, a mental health advocacy organization.
In September, Minnesota’s 988 fee will go into effect. The fee will start at $0.12 per line per month and is capped at $0.25. NAMI estimates it will bring in $9.8 million in annual revenue.
Delaware and Oregon similarly passed laws last year establishing a lifeline surcharge, which both went into effect in January. Delaware’s $0.60 fee is equal to the state’s 911 surcharge.
Virginia was the first state to impose a 988 surcharge—$0.12 per line per month—which it has been collecting since July 2021. Washington state also implemented a 988 surcharge in 2021 that started at $0.24 per line per month and increased to $0.40 last year. It’s helped bring in $11 million in revenue, a state official told Crosscut.
“It’s great progress, the fact that 10 states this early into 988’s existence have said, ‘Yes, we’re willing to charge this fee to support this system,’” Pasternak said. “I think we’ll certainly see that grow over time … now that states have a much better sense of what it costs to operate [mental health] systems.”
The surcharge model could be more sustainable for states, she added, as it’s less vulnerable to the waxing and waning of the economy like other government revenues can be. And despite usual pushback to new fees, which stakeholders and residents often view as taxes, 71% of Americans said they are willing to pay a fee to fund 988, according to NAMI.
With 988 call rates rising, states must prepare their mental health resources to meet that need, Kimball said, and surcharges offer another way to do that.
“Every day, every minute, every hour, there are people experiencing mental health emergencies across the country,” she said, “and we need the capacity to respond in a way that's going to get people back on the road to recovery.”
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