State funding explicitly dedicated to suicide prevention and crisis services increased substantially from fiscal years 2021 through 2026, and states that had enacted 988 telecom fees allocated more than twice as much per capita as states without such fees.
Researchers conducted a repeated cross-sectional state-year panel study of 306 enacted budgets from all 50 states and the District of Columbia for fiscal years 2021 through 2026. The researchers systematically reviewed the documents for funding explicitly dedicated to suicide prevention or mental health crisis programs, services, or infrastructure, including crisis hotlines, mobile crisis teams, and crisis stabilization centers. Supplemental budgets and appropriations not listed in enacted state budgets were excluded.
The primary outcome was annual per-capita state funding explicitly allocated for suicide prevention and crisis services, with the percentage of each state's total annual budget devoted to these services as the secondary outcome. Researchers assessed differences over time and according to US Census region, age-adjusted state suicide death rate quartile, and whether a state had enacted 988 telecom-fee legislation in the calendar year prior to the start of the fiscal year.
Across the 306 budgets, a cumulative $7.25 billion was explicitly allocated for suicide prevention and crisis services. Mean annual funding was $3.63 per capita, and 22% of state-year observations explicitly allocated $0 to these services. Mean per-capita funding increased from $1.05 in 2021 to a peak of $6.55 in 2025 before reaching $4.51 in 2026, with a statistically significant upward trend across the study period. There was also a statistically significant increase over time in the percentage of state budgets allocated to suicide prevention and crisis services.
As of July 2026, 12 states had enacted 988 telecom-fee legislation. States that had enacted a 988 telecom fee in the prior calendar year or earlier allocated a mean $7.73 per capita to suicide prevention and crisis services, more than twice the $3.13 allocated in states that had not enacted a fee. States with enacted fees also devoted a significantly greater percentage of their total budgets to these services.
Regional differences were not statistically significant after accounting for repeated observations within states.
Funding also did not appear to vary according to state suicide death rate quartile. Researchers found no statistically significant association between a state's age-adjusted suicide death rate quartile in the calendar year prior to the fiscal year and either its per-capita allocation or the percentage of its budget dedicated to suicide prevention and crisis services.
The study had several limitations. It captured only funding explicitly allocated to suicide prevention and crisis services in state budgets and excluded city and county funding, general mental health funding, and Medicaid funding for crisis services, meaning the estimates likely underestimated total state-level investment. Differences in the specificity of state budget categories limited comparisons between individual states. The analysis also examined budgeted amounts rather than actual expenditures, which may be lower. Finally, the study could not assess whether funding was associated with subsequent changes in suicide mortality because state suicide rates were measured before the corresponding fiscal years.
The observational findings do not establish that the fees caused higher allocations. “Telecom fees for 988 could be a sustainable and critical strategy to earmark funding for suicide prevention and crisis services,” wrote lead study author Jonathan Purtle, DrPH, of the School of Global Public Health at New York University, and colleagues.
The study was funded by the National Institute of Mental Health. Cantor, Pomeranz, and Stuart reported financial relationships outside the submitted work. No other disclosures were reported.
Source: JAMA Network Open
