Three questions should loom over the continued expansion of 988—the National Suicide Prevention Hotline: Is it saving lives? What is its expansion doing to an already supply-constrained behavioral health workforce? And what other approaches to suicide prevention are being crowded out as public dollars, workers, and institutional capacity flow into the 988 system?
Federal and state governments don’t seem particularly eager to answer them. On the first question, which relates to the central aim of the expansion, the honest answer is that we don’t exactly know. The best new evidence suggests we should be worried.
An August 2026 NBER working paper found that 988 substantially expanded crisis-line operations, but no detectable reduction in suicide mortality. Its estimates were precise enough to rule out even modest short-run reductions. It also found no improvement in broader measures of population mental health. Long-run effects remain uncertain.
A person in crisis can get real relief from a 988 call, and the counselors and volunteers doing that work deserve credit, and a system that puts their effort where it counts most. But helping individual callers in certain crises and reducing suicide deaths across the population may not be the same thing.
Build First, Evaluate Later
Four years ago, the federal government launched 988. SAMHSA received about $1.6 billion to create and support the Lifeline from fiscal year 2021 through July 2025. Since 2022, states have spent more than $3.9 billion building 24/7 crisis systems around it: mobile crisis teams, stabilization programs, and other services.
That’s a centralized production system built around one model of crisis care, on the assumption that the model works and its costs are justified. The infrastructure came first. Some of the most informative evidence about its effects is arriving afterward. Research published in JAMA suggested some population-level promise, though its design likely offers weaker causal evidence than the NBER study.
Suicide prevention is not simply a single intervention, or set of defined interventions, that governments can simply scale up.
People reach crises through different pathways, face different circumstances, and may respond to very different forms of help. Suicide is a relatively rare outcome even among people experiencing suicidal thoughts or behaviors, which makes it hard to study and harder to prevent. Effective prevention may depend on how resources are combined, organized, and delivered—and on approaches that have not yet been discovered. What works will keep changing, too. Keeping up requires capacity and freedom to compete.
You Can’t Hire People Who Don’t Exist
988 is expanding into a workforce that can’t staff what already exists. The NASMHPD Research Institute (NRI) reported in August that 39 of 40 responding states have crisis-services workforce shortages. In thirteen, shortages in at least one crisis setting reached what NRI calls “catastrophic”: persistent service disruptions, long delays, and difficulty keeping operations running around the clock. It’s getting worse, too. Eleven states that reported moderate shortages in 2023 reported catastrophic ones in 2026.
The pressure seems to at least partly come from the expansion itself. According to NRI, contacts to 988, mobile crisis dispatches, and crisis stabilization visits rose from about 4 million in 2022 to more than 9.7 million in 2025, and the workforce has not kept pace. Shortages are most widespread in mobile crisis teams and other crisis stabilization settings. Those are the very services 988 is supposed to connect people to.
The call centers are short, too. Federal 988 grants explicitly fund states to recruit and hire behavioral health workers for local 988 call centers, yet eight states report catastrophic shortages at those centers. The people they’re hiring, including master’s-level social workers and licensed clinicians, are likely the same ones NRI lists as hardest to find. And they come from a pool that’s already short.
No one has measured what employment roles 988’s new hires came from, which is itself part of the problem. But, in the short run, the supply of clinicians is roughly fixed, partly because of the government. A licensed clinical social worker staffing a mobile crisis team is not seeing patients at somewhere like a community mental health center where suicide prevention may also happen through long-term outpatient therapy for those living with serious mental illness.
The Cost Nobody Counts
This may be a classic case of centralized planning under uncertainty: billions committed before evidence, and scarce labor allocated by government funding rather than discovery and competition. The real price may be the suicide prevention experiments we didn’t run because the money and the clinicians were already spoken for.
There is tremendous uncertainty around how to prevent suicide. That’s precisely why allocating billions of public dollars and scarce clinical labor to one national architecture should make us uncomfortable. Under uncertainty, we need competing approaches, different institutions trying different things, and resources that can move toward what proves effective.
Any additional public spending makes the system harder to reconsider. If advocates of 988 try to redefine success around metrics like potential emergency room diversions, those claims deserve the same rigorous evaluation, including potential harm and opportunity costs.
None of this means shutting down 988 tomorrow. Crisis lines will likely have a role in any future system as they’ve had before governments got involved, and abruptly dismantling infrastructure people now rely on would create costs of its own. But policymakers should stop treating continued expansion as the default.
We may need more humility, experimentation and discovery. Right now, we’re building as if we already have the answer.
