HLTH 349 Week 7 Article Review 4 Example

Three Digits Are Not Enough: A Review of Staffing Shortages at 988 Suicide and Crisis Lifeline Centers

Introduction

In July 2022, the United States launched 988, a three-digit number that routes anyone struggling with suicidal thoughts, emotional distress or drug and alcohol problems to trained counselors by phone, text or online chat. A short number only helps if someone answers, and answers quickly, because a person in crisis who waits on hold may hang up. When local centers cannot answer, calls roll over to national backup centers, which may know little about local help. Matthews et al. (2026) surveyed the centers that answer 988 contacts to learn whether they have the staff to do so.

Summary

The authors surveyed leaders of all 206 centers in the national 988 network between May and July 2025 and received responses from 159, a 77% response rate. Among centers answering the question, 71% reported being understaffed, and 89% reported difficulty obtaining funding to hire. Centers that allowed remote work had more trouble finding funding but less trouble recruiting, and centers staffed entirely by paid workers had more difficulty recruiting than those that used at least some volunteers. The findings suggest that funding, more than willing workers, limits capacity. The authors also linked responses to administrative data on whether each state had adopted a dedicated 988 telecommunications fee, an approach that gives centers a predictable source of money rather than relying on year-to-year grants. Many centers also answer other lines, such as local crisis numbers, stretching the same staff further.

Discussion

McKenzie et al. (2018) describe community mental health services as a network meant to provide care close to where people live, and they note that these services have long been underfunded compared with other parts of the health care system. Their account of how the system is organized helps explain the problem: crisis lines are funded by a patchwork of federal grants, state budgets and local fees rather than by insurance, so their staffing depends on whatever money each state provides. A national phone number creates a national promise, but the people who keep it are paid for state by state. Public use adds another challenge. Harris et al. (2026) surveyed 1,090 adults and found that only 18% would contact 988 for a substance use problem, although no cost, immediate support while waiting for treatment and avoiding stigma were common reasons people might call. If more people learn to use 988 for substance use, demand on understaffed centers will grow. A limitation of the staffing study is that it surveyed leaders rather than measuring wait times or caller outcomes directly.

Conclusion

This article shows that 988's success depends on stable funding for the centers behind it. States can help by adopting dedicated telecommunications fees, as several have, and by pairing awareness campaigns with the staffing needed to answer every contact. Public health agencies should also track answer rates and follow-up for each state, so that the promise of 988 can be measured rather than assumed. A crisis line that is advertised widely but answered slowly could teach people that calling does not help.

References

Harris, B. R., Sekar, A., Avripas, S., Hinkle, J., & McPherson, T. L. (2026). Motivators, barriers, and likelihood of contacting 988 for substance use support: Implications for marketing, promotion, and practice. Substance Use & Addiction Journal. Advance online publication. https://doi.org/10.1177/29767342261458554

Matthews, S., Holliday, S. B., Slover, R., Liu, J., Breslau, J., Purtle, J., Kilambi, V., Schuler, M. S., Ramchand, R., Cantor, J., & McBain, R. K. (2026). Workforce and staffing at 988 Suicide & Crisis Lifeline centers. JAMA Network Open, 9(5), e2610789. https://doi.org/10.1001/jamanetworkopen.2026.10789

McKenzie, J. F., Pinger, R. R., & Seabert, D. M. (2018). An introduction to community & public health (9th ed.). Jones & Bartlett Learning.