Funding the Lifeline: How States Are Sustaining 988 and Transforming Crisis Care
The launch of the 988 Suicide & Crisis Lifeline marked an important federal milestone as suicide rates continue to rise in the country. Researchers, Sachini Bandara, PhD, MS, and Elizabeth Stuart, PhD, AM, are leading a national study to uncover how state-level financing decisions shape 988 Lifeline services.
With suicide rates rising nationwide, access to fast, responsive mental health care is more urgent than ever. In 2020, federal legislation launched the 988 Suicide Lifeline number which marked a major step forward for mental health access. The simple, three-digit number connects Americans in crisis to a trained counselor through text and call. However, one critical piece of the law remained unresolved: How would states fund the lifeline?
A team of researchers is examining this financial piece of the 988 Lifeline. Sachini Bandara, PhD, MS, Assistant Professor in the Department of Mental Health and Director of Training at the Center for Mental Health and Addiction Policy (CMAP), is working alongside Elizabeth Staurt, PhD, AM, Professor in the Department of Biostatistics and former co-director of CMAP, to lead a national study on how states finance 988 and how it affects mental health outcomes.
Before entering academia, Bandara worked in the advocacy world, where she witnessed how policies could transform lives. Her interests in mental health policy were sparked during her doctoral work under the mentorship of a CMAP founder.
Stuart, who is a biostatistician by training, has always been drawn to the methodological challenges of evaluating large-scale systems. She started off her career working in education research before pivoting into mental health, attracted by the complexity and opportunity for impact at the population level.
Their work on the 988 study takes a deep dive into how states finance the 988 Lifeline. Although 988 was federally mandated, it came without federal funding for state call centers. This left many states scrambling to figure out how to sustain and expand their crisis systems. Some states passed legislation to fund 988 through cell phone surcharges, others turned to state general funds or grants. Focusing on this financial gap, Bandara and Stuart aim to understand how different state-level funding strategies impact caller experience, system performance, and mental health outcomes.
They use a mixed-methods approach, combining legal mapping and qualitative analysis to examine the policies and financing strategies states have implemented to support 988. On the quantitative side, they analyze multiple datasets, including data from Vibrant Emotional Health and hospitalization records, to assess metrics such as call duration and call abandonment rates. The team is collaborating with researchers at New York University (NYU), who bring valuable methodological expertise to help design innovative and rigorous study approaches. Postdoctoral fellows and students are also actively contributing to the work.
Suicide prevention is a national priority. The 988 Lifeline stands as a critical public mental health resource. Yet, most people are unaware of the financial decisions shaping its delivery. Understanding which funding strategies support the most effective, accessible crisis care could inform both state and federal efforts moving forward.
Currently, the team is working to link state financing levels and policies to key outcomes. They hope to deliver evidence-based insights that states can use to strengthen their 988 systems.
Stay Connected
For more updates, follow the Center for Mental Health and Addiction Policy (CMAP) or reach out directly to Sachini Bandara (sbandar2@jhu.edu) or Liz Stuart (estuart@jhu.edu).