States Are Spending More on Suicide Prevention, but the Gap Between Budgets Remains Wide

Suicide remains one of the leading causes of death in the United States, and for years policymakers, public health researchers, and mental health advocates have debated how the country should pay for the crisis infrastructure needed to respond to it. A new study led by researchers at New York University’s School of Global Public Health offers the most detailed picture yet of how that picture has changed at the state level. Published in JAMA Network Open, the analysis of state budgets from 2021 through 2026 finds that funding for suicide prevention and mental health crisis services has grown substantially over the past five years, even as the amount each state invests varies dramatically across regions and funding mechanisms. The study also provides empirical support for a policy idea that advocates have long championed: small telecommunications fees added to monthly phone bills appear to be an effective and sustainable way to finance 988, the national suicide and crisis lifeline that launched in 2022.

The 988 Suicide and Crisis Lifeline was designed to solve a fundamental access problem. Before its launch, people experiencing a mental health crisis had to navigate a ten-digit hotline number, and capacity varied widely. The three-digit dialing code allows anyone in the country to call, text, or chat with trained counselors through a single, easy-to-remember number. When people contact 988, they are routed to local crisis call centers, and those centers depend heavily on funding from individual states. How states raise that money has become one of the central policy questions surrounding the lifeline’s long-term sustainability, because the federal government established the number but left most of the financing responsibility to the states themselves.

Most states finance 988 and related crisis services through their general budget appropriations, the ordinary pool of tax revenue that legislators allocate each year. But twelve states have taken a different approach, creating dedicated telecom fees modeled on the mechanism that has long paid for 911 emergency services in many states. These fees are deliberately small and flat, for example thirty cents per cell phone line per month, spread across millions of subscribers. The study’s lead author, Jonathan Purtle, professor of public health policy and management at NYU School of Global Public Health, noted that mental health advocates have recommended telecom fees to fund 988, but until now it has not been fully understood whether they are making a difference. The answer, he said, is empirically yes, because states that have these telecom fees put more money toward funding suicide prevention.

To reach that conclusion, the research team examined annual state budgets, which may include both state and federal funds, for all fifty states and Washington, DC, across six fiscal years from 2021 through 2026. The researchers looked at what each state allocated specifically for suicide prevention and mental health crisis services, and then analyzed whether those allocations varied according to a range of state-level factors, including geography, budget structure, and the presence of a dedicated fee. This budget-based approach is methodologically demanding because states organize their finances in very different ways, and the authors are careful to acknowledge the limits of comparing line items across fifty-one distinct budgeting systems.

The headline finding is a clear upward trend. Average state spending on suicide prevention and crisis services rose from $1.05 per resident in 2021 to $6.55 per resident in 2025, more than a sixfold increase in per-capita investment in just four years. The proportion of states’ annual budgets devoted to suicide prevention likewise increased, from 0.022 percent of overall spending to 0.079 percent. Those percentages may look tiny, but they represent a meaningful shift in how state governments prioritize crisis response, and they coincide with the period during which 988 launched and public and policymaker attention to mental health crises intensified nationwide.

The regional patterns in the data are striking. Spending was highest in Western states, which invested an average of $7.19 per person per year, followed by the Northeast at $3.44, the South at $2.12, and the Midwest at $2.07. That means residents of the average Western state enjoyed roughly three and a half times the crisis-service investment of residents of the average Midwestern state. Even more consequential for policy debates, the researchers found that spending was twice as large in states that had enacted telecom fees compared with states that relied on other mechanisms. Purtle observed that this finding suggests telecom fees are a promising strategy to enhance crisis service infrastructure, giving legislators who are weighing such fees concrete evidence that the mechanism is associated with substantially higher investment.

One of the study’s more sobering findings concerns the relationship between need and spending. The researchers examined whether states with higher suicide rates are spending more money on suicide prevention and found that this was not necessarily the case. In other words, the states where the problem is most acute are not automatically the states investing the most in response. That mismatch matters because suicide risk is not evenly distributed across the population. Veterans, for example, die by suicide at more than double the rate of nonveterans, and the Department of Veterans Affairs spends $177 per veteran per year on suicide prevention, a figure that underscores just how modest state-level investments remain even after five years of growth.

The authors are careful about the caveats that surround their estimates. Because each state structures its budget differently, and not every state has specific line items or fees for suicide prevention, the classification process is conservative. If a state budgeted for broader mental health programs but did not specify how much of that funding would support suicide prevention and crisis services, the researchers did not count that state as funding suicide prevention that year. Purtle acknowledged that as a result, the study’s findings are likely an underestimate of what states actually spend. For readers, that means the true investment picture may be somewhat brighter than the headline numbers suggest, but it also means the study measures only explicit, designated commitments, which is precisely what advocates say is needed to guarantee stable crisis-line capacity.

The research arrives at a moment when early evidence suggests the 988 system may be having an effect. Emerging research is beginning to show a decline in suicide rates since the launch of 988, although that work has not yet explored whether the decline varies among states, which would be the crucial test of whether state-level funding decisions translate into lives saved. Purtle’s ongoing research program aims to answer exactly that question, examining whether state-level funding for 988 actually reduces suicide deaths and, in particular, whether telecom fees move the needle as a policy solution. If subsequent studies confirm that fee-financed states see larger declines, the twelve states with fees could become models for the rest of the country.

The study was conducted by a team spanning several leading institutions. In addition to Purtle, the authors include Michal Weiss and Jennifer Pomeranz of NYU School of Global Public Health, Ryan McBain and Jonathan Cantor of RAND, and Sachini Bandara, Fernanda Montoya, and Elizabeth Stuart of the Johns Hopkins Bloomberg School of Public Health. The research was funded by the National Institute of Mental Health under grant R01 MH131649, and the authors note that the content is solely their responsibility and does not necessarily represent the official views of the National Institutes of Health. For the growing community of crisis-center operators, state legislators, and advocates watching 988’s development, the study’s message is twofold: state investment in suicide prevention is rising faster than at any point in recent memory, but dedicated, fee-based financing mechanisms appear to be the most reliable way to turn that momentum into durable, well-funded crisis infrastructure that reaches everyone who dials three digits in their darkest moment.

Subject of Research: State-level budget allocations for suicide prevention and 988 crisis services in the United States, including the role of dedicated telecommunications fees

Article Title: State funding for suicide prevention has increased in recent years

Article References: State funding for suicide prevention has increased in recent years. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: suicide prevention, 988 lifeline, state budgets, mental health crisis services, telecom fees, health policy, JAMA Network Open, NYU, public health funding, crisis intervention, state government spending, veterans suicide risk