State Funding for Suicide Prevention and Crisis Services Climbs Sharply From 2021 to 2026

State budgets allocated significantly more funding for suicide prevention and crisis services in recent years than in 2021, according to a new repeated cross-sectional study.¹ States that enacted 988 telecom fee legislation invested more than twice as much per capita than states that did not.

The study, led by Jonathan Purtle, DrPH, of the New York University School of Global Public Health, examined every enacted state budget (all 50 states and the District of Columbia) for fiscal years 2021 through 2026, totaling 306 state-year budget observations. Investigators systematically reviewed each budget document for terms including suicide, 988, 9-8-8, and crisis, then identified 1150 individual line items explicitly dedicated to suicide prevention and mental health crisis service programs, systems, or infrastructure, using the Substance Abuse and Mental Health Services Administration's National Guidelines for a Behavioral Health Coordinated System of Crisis Care to determine inclusion.

The study's primary outcome was per capita annual state funding explicitly allocated for suicide prevention and crisis services. The secondary outcome was that funding as a percentage of each state's total annual budget.

Rising State Investment

Across the 306 enacted budgets, states spent a combined $7,245,066,907 explicitly on suicide prevention and crisis services from fiscal years 2021 to 2026. The mean per capita allocation was $3.63 (SD, $8.23; median, $0.87), and the mean share of total state budgets was 0.054% (SD, 0.111%; median, 0.014%). In 66 of the 306 state-years (21.6%), states allocated $0 to these categories.

Annual mean per capita funding increased significantly over the study period (B [SE], $0.96 [$0.31]; 95% CI, $0.34-$1.57; P=.003), climbing from a mean of $1.05 per capita in 2021 to a high of $6.55 in 2025 before falling to $4.51 in 2026. The percentage of state budgets dedicated to suicide prevention and crisis services followed a similar trajectory, rising from a mean of 0.022% in 2021 to 0.079% in 2025 (B [SE], 0.010 [0.004] percentage points; 95% CI, 0.004-0.021; P=.005).

Funding was highest, on average, among states in the Western census region ($7.19 per capita) and lowest among states in the Southern ($2.12) and Midwestern ($2.07) regions, though these regional differences were not statistically significant after adjusting for state-level clustering. The study also found no significant association between a state's age-adjusted suicide death rate quartile and its per capita or percentage budget allocation for suicide prevention and crisis services.

988 Telecom Fee Association

States that had enacted 988 telecom fee legislation in the calendar year prior to the start of the fiscal year allocated substantially more funding than states that had not. Mean per capita allocation was $7.73 (SD, $5.32) in states with an enacted fee, compared with $3.13 (SD, $8.38) in states without one (P=.003). The percentage-of-budget measure showed the same pattern: 0.089% (SD, 0.061%) vs 0.050% (SD, 0.115%; P=.04). As of July 2026, 12 states had enacted 988 telecom fee legislation to help finance 988 call center operations and other crisis services; these fees are flat charges added to phone bills, commonly around 30 cents per line per month, regardless of 988 usage. Sensitivity analyses using generalized estimating equation models produced similar results.²

"These findings suggest that funding for suicide prevention and crisis services has increased over time, but the magnitude of amount and increase varies among states with and without 988 telecom fees," wrote the study authors, adding that 988 telecom fees "could be a promising legislative approach to finance suicide prevention and crisis service initiatives."

The authors noted that the increases likely reflect growing federal investment in crisis service infrastructure since the 988 Suicide and Crisis Lifeline launched nationally back in July 2022, as well as increased policymaker and public attention to suicide and mental health crises. They also pointed out that despite the upward trend, the magnitude of state investment remains modest: the highest annual mean state-level per capita funding observed, $6.55 in 2025, is less than 5% of what the US Department of Veterans Affairs allocated per veteran for suicide prevention in 2024 (about $177 per veteran), even though the suicide death rate among veterans is more than double that of nonveterans.³

The authors also suggested that the regional concentration of funding in Western states may be related to regional differences in political partisanship, citing prior research showing that attitudes toward 988 and crisis hotlines tend to be more favorable among Democrats than Republicans, both among the public and among state legislators.

Study Limitations

The analysis was limited to funding explicitly allocated in state budgets; it did not capture city or county funding, general state mental health appropriations, or Medicaid funding for crisis services, all of which vary by state. As a result, the authors said the study likely underestimates true state-level investment in suicide prevention and crisis services, and by an amount that may vary across states. States also differ in how specifically they itemize spending in their budgets, limiting state-to-state comparisons. The study measured budgeted rather than expended amounts, which are often lower than what is appropriated, and suicide rates were lagged by design, so the study could not assess associations between funding and subsequent changes in suicide deaths.

References

1. Purtle J, Ortego JC, Bandara S, et al. Implementation of the 988 Suicide & Crisis Lifeline at the state-level: estimating costs of increased call demand at lifeline centers and quantifying state financing. J Ment Health Policy Econ. 2023;26(2):85-95.

2. Kuntz L, Santarsiero C. The whole continuum of behavioral health care: reintroduction of the 988 Implementation Act. Psychiatric Times. August 21, 2023. https://www.psychiatrictimes.com/view/the-whole-continuum-of-behavioral-health-care-reintroduction-of-the-988-implementation-act

3. Kuntz L. Crisis services struggle to meet increased need generated from launch of 988. Psychiatric Times. January 29, 2025. https://www.psychiatrictimes.com/view/crisis-services-struggle-to-meet-increased-need-generated-from-launch-of-988