Texas’ Suicide Hotline, Overburdened and Underfunded, Could Get Support from a Proposed Bill.

By Madeline De Figueiredox

Reporting Texas

Each month, thousands of Texans reach out for support in difficult moments by dialing 988, the National Suicide and Crisis Lifeline. But, for some, their calls are met with long wait times and multiple transfers to out-of-state centers.

Texas faces a $7 million shortfall in funding for the 988 system, which officials say has left a growing number of callers without immediate, in-state support. According to the National Alliance on Mental Illness Texas, in the state fiscal year 2024, Health and Human Services allocated $14 million for 988 services, but Vibrant Emotional Health, the administrator of 988, estimated $21 million is needed to operate the state’s five call centers. While impact is difficult to measure, since its national launch in July 2022, 988 has received over 14 million calls, texts, or chats.

“Considering that suicide is the second leading cause of death for young people in Texas, making sure 988 services are strong and accessible is crucial,” said Rebecca Fowler, director of public policy and government affairs at Mental Health America of Greater Houston. “To keep up with the growing demand for services, Texas needs a lot more crisis counselors, at least double the current number of 166.”

Texas Senate Bill 188, sponsored by Sens. José Menéndez and Judith Zaffirini, seeks to establish a 988 service fee on telecommunications connections to fund mental health crisis services, similar to the fee for 911 services. Revenue from the fees would help pay for the operation and maintenance of the 988 system.

Fowler said that the proposed fee would be 5-10 cents per mobile phone line each month, providing a sustainable funding source for mental health crisis services without burdening individuals.

In the latest data from August 2024, only 83% of 988 calls were answered within the state, with around 200 backup centers across the country handling the remainder. In the same month, approximately 2,500 of 988 calls from Texas, or 12%, were abandoned – making Texas the state with the fifth highest rate of abandonment in the country.

“Currently, 988 operates entirely on federal funding, and without supplemental state support, its ability to serve Texans in need is at risk due to a $7 million deficit. Like physical health, mental health care is health care, and Texas must treat it as such,” said Sen. Judith Zaffirini, who is co-sponsoring the bill. “988 faces an uncertain future without additional funding. SB 188 would help address 988’s deficit and ensure it can continue serving Texans in crisis through immediate and effective mental health support.”

Launched nationally in July 2022, the 988 Suicide and Crisis Lifeline aims to provide rapid mental health support anytime of the day.

“First and foremost we are a listening ear,” said Nicole Warren, the 24/7 crisis helpline practice administrator at Integral Care in Austin, one of Texas’ five call centers. “We are available to listen to folks, to be present with folks and to share space with folks who are having a difficult moment.”

But rising demand has outpaced the state’s ability to meet staffing, funding and resource needs. From 2000 to 2022, Texas’ overall suicide mortality increased by 36.7%, with young people particularly affected. The rate for those aged 20 to 24 in Texas lept by 56.9%.

“Since its rollout in Texas in 2022, the 988 system has seen a 30% increase in call volume, demonstrating the growing reliance on this life-saving service,” said Christine Busse, the peer policy fellow with the NAMI Texas. Between May 2022 and May 2024, call volume in Texas increased by 34%.

From January to June 2024, Texas 988 centers responded to nearly 104,000 calls. As Texas Health and Human Services prepares to launch a public awareness campaign for 988, Busse said advocates are expecting even greater strain on the system.

“As the campaign prepares to roll out in the coming weeks, we are anticipating another increase in the call volume which will further strain the already-limited resources,” Busse said. “This is adding urgency to the need for strategic investment in Texas for 988 call centers.”

Beyond the issues of long wait times and call transfers, Warren emphasized the critical importance of in-state answers for effective support and resource-sharing.

“It’s best if a Texas center is answering a Texas call because we know the resources, we are familiar with the system, we are familiar with how local mental health authorities operate and we can give the caller that information,” she said.

Advocates warn that gaps in in-state support and services could put those seeking support in more precarious situations.

“For a lot of people, 988 is their first contact with a counselor or care provider because of the nature of the 24/7 resource,” said Carson Domey, the chair of the Texas Public Policy Committee for American Foundation for Suicide Prevention. “When people have the courage to take the step and get help, we don’t know how hard it might have been for them to make that call. For them to be sitting on hold for hours or to not have their calls answered is honestly a disgrace.”

Fowler said that the failure to access 988 services could worsen individuals’ mental health crises and make them turn to other emergency systems that cannot offer the same level of support.

“If calls, texts or chats go unanswered, it leaves people who are already in distress without the help they need,” Fowler said. “Without 988’s quick support, many individuals in crisis might end up relying on emergency services, like going to the ER or calling 911, but these systems aren’t always equipped to handle mental health emergencies properly.”

Domey said that SB 188 offers a path for not only the sustainable operations of 988 but a more robust network of care for people in crisis.

“These are people who want to seek help and we should be able to meet them where they are and to provide them with care,” Domey said. “988 has done such remarkable work and saved so many lives… we need to make sure every call gets an answer because every single call deserves an answer.