Thousands of individuals in Texas seeking support are disconnecting from the state’s suicide hotline during their calls every month, as call centers grapple with a $7 million funding shortfall alongside an escalating suicide rate in the state.
The 988 hotline — a federally mandated service operated by the state — links those in crisis to trained counselors. This service plays a vital role in the mental health care landscape, addressing situations that may not require a 911 response. Although this hotline has recorded significant usage since its inception two years ago, its financial backing is dwindling, resulting in added strain on a workforce already facing shortages, creating a scenario that is challenging to sustain.
Jennifer Battle, who oversees the 988 system at the Harris Center for Mental Health and IDD, voiced concerns about the level of service being offered. “We are stretched to the limit,” she said. “To adequately serve Texas’ needs, we require increased funding to hire more personnel and enhance our service capacity.”
Since its launch in 2022, Texas’ five 988 call centers have fielded over 380,000 calls, positioning them as one of the busiest in the nation, as noted by the National Alliance on Mental Illness Texas. Approximately one-third of these calls originated from January to June of this year.
At present, fewer than 85% of calls made to the 988 hotline in Texas are answered by in-state centers, necessitating reliance on approximately 200 backup centers nationwide. Though progress has been made from a 40% in-state answer rate in 2021 following the transition to the 988 hotline, the current performance still falls short of the desired 90% target established by Vibrant Emotional Health, the national 988 hotline administrator.
The likelihood of a caller hanging up increases significantly with each transfer that occurs. From January to August, around 18,500 calls to the Texas 988 system were abandoned. In August, over 12% — or 2,446 calls — were dropped, placing Texas alongside Tennessee for the fifth highest abandonment rate nationally.
Across the five Texas centers, a total of 166 staff members manage the incoming calls, texts, and online chats through the 988 service. In May, this workload translated to an average of 95 calls handled per staff member, with typical calls lasting around 15 minutes.
To implement the text and chat features fully within the state’s 988 service, it would require the number of crisis counselors to at least double. Additionally, the program needs an extra $7 million; while projections suggest operating costs for the year stand at $21 million, the state has allocated only $14 million in the 2024 fiscal year, according to the mental health alliance.
In the previous year, the Texas Health and Human Services Commission urged for enhanced resources for the crisis call centers, yet this year’s legislative proceedings did not tackle the scaling up of 988 capacity.
As the new legislative session approaches on January 14, Sen. José Menéndez from San Antonio has introduced Senate Bill 188 with the goal of establishing a stable funding source for the 988 hotline through a state trust fund similar to the existing provisions for 911 funding. This fund would be sustained by a surcharge on cellphone bills, enabling call centers to expand their services, improve counselor compensation, and ensure technology upgrades are in place, according to advocacy groups.
“Twenty states now have enacted some form of legislation regarding 988 funding,” noted Galvan. “This trust fund is designed to equate 988 funding parity with the 911 system and treat all emergency services with the same significance.”
For comparison, Florida operates 13 centers to manage its 988 calls, whereas Texas has only five.
These funding constraints come at a time when Texas is experiencing a 37% increase in suicide rates from 2000 to 2022.
“It is essential for Texas to enhance support so that when individuals face a mental health crisis, immediate help is accessible,” Galvan emphasized.
When a person reaches out to 988, the process often begins with the straightforward greeting, “Hello, this is 988. How can I help you?” For many, this simple opening sparks a crucial conversation that could potentially save lives.
Crisis counselors may begin by asking challenging questions such as, “Are you contemplating suicide today?” According to Battle, a seasoned social worker, such direct inquiries can prompt reflection in callers who may not have been able to voice their feelings of despair before.
Upon contacting a 988 center, callers are greeted by an automated system that allows them to choose from several options, including resources for veterans and LGBTQI+ youth. Based on their selection, transfers may occur to organizations that can better address their needs.
If callers opt out of these selections, they are typically routed to their nearest 988 call center. However, if no one is available there, they are forwarded to other centers until they eventually connect with a crisis counselor, often prolonging the wait time and increasing the chances of disconnection.
When connected, counselors navigate conversations to assess the risk level of the caller’s situation. They strive to maintain an empathetic and nonjudgmental stance, guiding callers through calming techniques and breathing exercises.
“Many of our callers experience thoughts of suicide intermittently, yet do not have a defined plan or means to act on it. They often feel overwhelmed and may express a wish to escape their current reality,” Battle explained. “This is when we intervene with meaningful conversation.”
Battle reported that over 80% of callers may not be experiencing an active crisis; rather, they merely need someone to listen. An additional 10% may need referral services such as mobile crisis intervention, with only 1% to 2% requiring police involvement due to immediate danger.
At times, calls may conclude without a favorable outcome, which can weigh heavily on crisis counselors, who must be prepared for the next call.
Battle recalls a particularly intense experience from her pre-988 days when she connected with a suicidal individual on the brink of tragedy. Through skillful communication, she was able to talk the person down from harm as a train approached.
After the call ended, she was simply left to gather herself before preparing for the next potential life-or-death situation.
To mitigate staff turnover, which is a widespread issue in mental health services, Battle’s agency offers various forms of support to counselors, including debriefing opportunities after intense calls and flexible working arrangements.
“There are numerous strategies we employ to ensure our crisis counselors are supported during their demanding roles,” Battle affirmed.
Her center serves a vast area, covering 59 counties, and deals with a monthly average of 6,000 calls. While the center has an impressive call answer rate of 80%, it struggles similarly with incoming texts, responding to only a fraction of those received.
“The state’s targets are ambitious, and we aspire to meet them. However, when funding only covers half of what is necessary, we are consistently overachieving based on our resource limitations,” Battle explained.
In contrast with the established funding and personnel dedicated to 911 services, the framework surrounding the 988 hotline remains underdeveloped.
Despite crisis intervention being essential emergency services received by many, Texas has yet to permit Medicaid reimbursement for these vital services, which hampers sustainability for 988 call centers relying on federal support.
With the American Rescue Plan having provided initial funding to establish the 988 hotline, officials are now faced with the impending end of these funds, raising questions about future state financial responsibility for these call centers.
Advocacy groups believe Medicaid should be expanded to include coverage for crisis intervention, mirroring the approach implemented by numerous other states.
As discussions unfold regarding the agenda for SB 188, set to generate funding through a modest telecommunications fee, there is cautious optimism that Texas can cultivate a more reliable support structure for both the 988 hotline and broader crisis response services.
“Recognizing the urgency for enhancing our crisis intervention system is clear, yet much progress remains to be made,” Galvan expressed. “This approach doesn’t tap into general state revenue but suggests a sustainable funding solution.”
Despite ongoing challenges and the emotional toll inherent to crisis counseling, Battle reassured Texans grappling with crisis that help is always available, regardless of funding status.
“I never claim we save lives; rather, individuals choose to save their own lives. Everyone has the agency to make that decision for themselves, and we can play a meaningful role in their journey of recovery,” Battle stated. “We aspire to be part of the narrative that encourages a decision for life.”