Two years after the debut of the national 988 mental health hotline, Missouri is answering 94% of callers in-state, while Illinois answers 74%, according to a report released this month by the mental health nonprofit Inseparable.
Although Missouri has one of the highest response rates in the nation, the report found both Missouri and Illinois fall short in their ability to respond to mental health crises in-person and lack treatment options for people who need psychiatric care.
“We really had a really strong crisis system to begin with,” said Bart Andrews, chief clinical officer at Behavioral Health Response, the organization that operates 988 in eastern Missouri. “And we were able to layer 988, right on top of that, and it made a huge difference. So we're way ahead of a lot of other states, no doubt.”
Missouri was the first state to have a funded statewide crisis system, he said.
The 988 hotline debuted in 2022 after federal lawmakers funded a nationwide, three-digit suicide and mental health lifeline. The number replaced a patchwork of local crisis lines and a longer ten-digit national crisis line. Proponents said they wanted the 988 number to be as easy to remember as 911.
When people in crisis dial 988, their call is routed to local response centers based on their phone’s area code. Overflow centers can answer calls if a local center is at capacity. Callers are connected to a worker that can provide support, counseling and guidance. People also can text 988 or chat with a crisis worker online.
The federal government reports more than 20 million people have used the line in the first two years of its existence. However, researchers said it’s still difficult to tell if states with higher answer rates have experienced a drop in suicides.
“It makes it difficult to compare, because certain states have a lot more access to certain kinds of services and other states have very limited access to those services,” said Ryan Lindsay, a professor at Washington University who is among a group of researchers that studied the state’s 988 rollout. “With not a lot of consistency across states… It's a very difficult question.”
For example, some states may have more mental health providers that accept patients on Medicaid, he said.
The Inseparable report suggests Missouri would need nearly 50 mobile response teams and about 300 short-term beds for people in mental health distress to meet the state’s needs. Illinois would need nearly 700 residential beds and about 100 mobile response units.
The Washington University researchers also found counselors at crisis response lines have reported frustration with abusive callers and the limitations of their job. Crisis counselors aren’t able to address a person’s unemployment or lack of housing, they said.
Long-term funding for the call line is uncertain for many states. The federal department of Health and Human Services invested hundreds of millions of dollars in the initial debut of the line, but states are required to come up with long-term funding to keep it operating. Some states have instituted telecommunications surcharges similar to ones that fund 911 dispatchers to finance the hotlines.
Neither Illinois nor Missouri have a telecom surcharge to support 988.
“Having the sustainability of dollars…is a challenge for many organizations to figure out,” Lindsay said. “A lot of funding comes in like a block or in a certain amount of time, and then they lose that funding.”
That means workers get hired but soon could be laid off, he said.
Andrews said he would like to see a surcharge model support 988 indefinitely.
“Missouri is not particularly a big fan of fee increases or tax increases,” he said. “[But] I think it's more sustainable, long-term, and less politically challenged. It would be a huge political challenge to get a like that institute, but if there was bipartisan support for that, that would be amazing.”
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