Can the 988 Crisis Lifeline Keep Up With Demand Amid Ongoing Staffing Shortages?

The US national crisis hotline, 988, was contacted over 18 million times since its launch in July of 2022; however, despite its necessity, many centers are struggling to recruit and retain staff and funding, according to a new study published in JAMA Network Open.¹

The study, published in May, when Mental Health Awareness Month is observed, underscores the importance of resources aimed at addressing stigma surrounding mental health and the people needed to make these resources effective, efficient, and accessible to the masses. The number of contacts to the hotline has nearly doubled since its launch in 2022,¹ with recent research linking it to an 11% drop in youth suicide deaths,² thus further emphasizing its societal significance. Earlier this year, abrupt funding cuts from the Substance Abuse and Mental Health Services Administration (SAMHSA) were issued by the Trump administration, impacting the youth service line aimed at LGBTQ+ individuals who called.³ Despite its value and billions of dollars in federal spending, many centers still face staff retention hurdles.¹

SAMHSA, within HHS, received approximately $8.5 billion in fiscal years 2020 and 2021, awarding $8.3 billion to recipients supporting projects involving community mental health services and programs. Additionally, $1.6 billion was awarded to create and support the 988 Lifeline from fiscal year 2021 through July 2025.⁴

However, given the exceedingly high contact volume, states were encouraged to establish telecommunication fees to finance and support the crisis services. As of October 2025, 12 states and 1 US territory have enacted legislation to fund the centers through these fees.¹

What Does The Current Staffing Landscape Look Like?

To further understand the impact funding has on 988 Lifeline centers’ administrative and staffing needs, researchers assessed respondents on the modalities offered, where non-988 lines were answered, whether counselors were volunteers or paid, the number of full-time counselors, and whether they were required to work in-person or remotely.

In regard to staffing difficulty, centers were categorized into 4 domains: adequate staffing for volume of contacts received, acquiring funding to hire staff, recruiting staff, and retaining staff.

The survey was completed by 159 of 206 centers located in 47 US states and territories, 25 of which were located in states with a 988 telecommunications fee at the time of the survey.

Staffing per center varied from 1 to 309 counselors, with a mean of 34. On a typical shift, the mean number of counselors on duty was 9. Almost all but one center reported that their center employed paid personnel as counselors, of which 77% only employed paid personnel. A quarter (40 of 159) reported a mix of paid and volunteer counselors, with a mean of 75% being paid.

In regard to work arrangements, 60% of centers allowed remote work either full-time or on a hybrid schedule. The remaining 40% had counselors work in-person only.

Where Are There Persistent Staffing Shortages?

Furthermore, only 29% of centers reported that their centers were fully staffed, with the most prominent staffing challenges reported being acquiring resources (89%), followed by difficulty adequately staffing for their contact volume (87%), and then difficulty recruiting (81%) and retaining (79%).

The survey also showed that centers allowing remote work had a higher odds of reporting difficulty acquiring resources to hire when compared with those without remote work options (94% [89 of 95] vs 81% [50 of 62]; odds ratio [OR] 3.40; 95% CI, 1.21-9.68; P = .02).

However, when assessing for recruitment difficulties, centers that allowed remote work had lower odds of reporting difficulty when compared with those without remote work (76% [72 of 95] vs 89% [55 of 62]; OR, 0.39; 95% CI, 0.14-0.98; P = .04). Whereas centers with all paid staffs had a higher odds of reporting difficulty recruiting when compared with centers that used volunteers (86% [102 of 118] vs 66% [27 of 41]; OR, 3.28; 95% CI, 1.42-7.60; P = .006).

“This study’s findings reinforce the concern that the sizeable increase in the number of contacts to 988 may come into conflict with a strained crisis workforce,” the study authors wrote. “Future research is needed to determine if staffing shortfalls have implications for 988 Lifeline service quality, response times, and staff well-being.”

The study is limited by self-reported data, potential bias, and a cross-sectional design that limits generalizability and precision. Still, it provides the first national snapshot of 988 staffing and highlights the need for system-level policy solutions.

“Continued efforts to implement and evaluate sustainable funding models, improve operational efficiencies, and develop innovative recruitment strategies to strengthen the 988 Lifeline workforce are needed to sustain the accessibility and quality of crisis care,” the study authors concluded.

References

1. Matthews S, Holiday SB, Slover R, et al. Workforces and staffing at 988 suicide & crisis Lifeline centers. JAMA Network Open. 2026;9(5):e2610789. doi:10.1001/jamanetworkopen.2026.10789

2. Grossi G. 988 Lifeline launch linked to 11% drop in youth suicide deaths. AJMC^®. April 22, 2026. Accessed May 5, 2026. https://www.ajmc.com/view/988-lifeline-launch-linked-to-11-drop-in-youth-suicide-deaths

3. Grossi G. Trump terminates hundreds of SAMHSA grants, threatening mental health, addiction services nationwide. AJMC. January 14, 2026. Accessed May 5, 2026. https://www.ajmc.com/view/trump-terminates-hundreds-of-samhsa-grants-threatening-mental-health-addiction-services-nationwide

4. Office USGA. U.S. GAO. Behavioral Health: Reported Funding for COVID-19 and 988 Suicide & Crisis Lifeline, 2020-2025. February 26, 2026. Accessed May 5, 2026. https://www.gao.gov/products/gao-26-107915