As we wrote about earlier this summer, the national mental health crisis line, 988, recently celebrated its second anniversary and has received nearly 11 million contacts since June 2022. In recognition of National Suicide Prevention Month, we wanted to take some time to delve deeper into the state-level 988 data to see what it can tell us about how 988 is working in different states across the country. Here’s a summary of what we found.
Call volumes have risen in every state in the two years since 988’s launch, ranging from a 25% increase in Idaho to a 185% increase in Oklahoma – with an average call volume increase of 95% nationally. Vibrant Emotional Health, the 988 crisis line servicer, posts monthly Key Performance Indicators (KPIs) for each state and U.S. territory. We wrote about the primary KPI, the “In-State Answer Rate,” in our last blog. However, since then, we’ve reviewed the KPI documents for every available month in order to track each state’s In-State Answer rate – the percentage of calls answered in the state, rather than being routed to a regional or national call center. See Figure 1 below to see how your state has fared since 2022.
We also wanted to find out if states were collecting and posting their own 988 data and, if so, whether that data provides more granularity than national statistics. We reviewed websites for all 50 states, as well as DC and the U.S. territories, and found that ten have a 988 data dashboard with another six posting some other kind of state-level 988 performance review, such as this legislative report from New York.
Most of these state-based data dashboards include information on call volume and the individual’s reason for contacting the helpline. Other states have additional details, such as the type of support offered by 988 and 911 diversion. We found six states (CO, GA, LA, SD, WI, and WY) that provide an array of demographic data for contacts to 988, and a seventh state (NC) that provides only age as a demographic of support line users.
Given the unique needs of children and youth and the ongoing youth mental health crisis, we’d ideally like to be able to look across states to see whether this age group is using the helpline more or less often than other ages, but such analyses are difficult as states do not use the same age brackets and ages are unknown for a substantial portion of the user population (typically around 30%). North Carolina had the highest reported number of crisis line contacts from 13 to 17 year olds at 12%, with other states in the single digits for youth and teens.
In addition, all states reporting by age show higher crisis line contacts for emerging and young adults. For example, in Colorado, 14% of contacts were from individuals aged 18 to 25 years old and 24% of contacts from individuals aged 26 to 29 years old while South Dakota had 23.7% of contacts from 20 to 29 year olds. Looking at the available state-level data, crisis line contacts typically began to taper off though middle age and reduce to single digits for those over age 60, though there may be several explanations for this, including mental health stigma or lack of awareness of the crisis line.
Finally, we were also interested in whether insurance status or income information were included in state dashboards. According to our review, no state dashboards included income information. In addition, insurance status was only included by Louisiana. According to Louisiana’s dashboard, of individuals reporting insurance status to the crisis line, nearly 81% were insured. However, those reporting insurance status represented only about a quarter of all contacts making it difficult to draw conclusions from the data.
Crisis call conversations may not always be the best suited to gather demographic or insurance status data, however, some states have still worked to employ Medicaid funds to support their crisis centers including through Medicaid administrative funds such as in Georgia and in systems like Arizona’s which employs a billing code for behavioral health hotline services. Funding, particularly sustainable funding, for 988 crisis lines remains a critical question for states. The National Association of Mental Health Program Directors created a toolkit that includes model legislation to help states establish a trust fund for 988-related activities, such as implementing the crisis line, provision of its services, staffing, data collection, quality improvement activities, and administration and oversight. The money in these trusts is raised through statewide fees, which are also established in the model legislation, state appropriations, grants, and available federal funding.
Publicly available state-level 988 data, particularly if standardized, can help researchers and policymakers gain a better understanding of crisis line performance and the behavioral health service needs specific to the state. The dashboards posted by the ten states in our search are a great starting point, and hopefully other states will follow suit by posting the data they are able to collect.
Select a state:
Did we miss your state dashboard? Please send our way! We’d love to add it to our list.
***The national mental health crisis line is 988. Calls to the previous 11-digit number for the National Suicide Prevention Lifeline [1-800-273-8255 (TALK)] will be routed in the same manner as calls to 988. If you or someone you know is experiencing a mental health crisis, support is available 24/7 via call, text, and chat.
