Minnesota sees surge in mental crisis calls after switch to 988, straining call centers

Tens of thousands of Minnesotans have sought emergency help through the new 988 mental crisis hotline, surpassing expectations and spurring calls for greater state funding of the life-saving service.

The new 24-hour hotline has received over 30,000 calls, texts and chat messages since it was launched last July. That far exceeds inquiries to the old 10-digit suicide hotline. Statewide, monthly call volumes have increased 31%, while texts have soared more than 500% — with Minnesota's crisis call centers reporting a sharp rise in contacts by adolescents under duress and people seeking ongoing emotional support.

The three-digit number was rolled out during a period of rising mental illness, in Minnesota and nationally, and is already being hailed as a pivotal enhancement to the crisis response system.

New federal data shows that calls to the three-digit number are answered more quickly and locally than the old number. People used to wait minutes to reach a counselor. In January, the average response time to calls was 11 seconds. What's more, the share of calls answered by trained specialists in Minnesota, rather than by call center staff in other states, has roughly doubled since the new number launched — enabling more people in crisis to be connected to mental health services where they live.

"It's abundantly clear that this new [hotline] is faster, simpler and more approachable, which is ultimately saving lives," said Patrick Rhone, a consultant who lives in St. Paul and is president of the board of Mental Health Minnesota. "You can find the right people with as few steps as possible."

Yet the growing popularity of 988 is posing a predicament for Minnesota's four crisis call centers.

Even before the new number went live, these nonprofit centers were straining to meet the demand for crisis services, often relying on a mix of volunteers and paid counselors. These centers are now receiving a greater diversity of inquiries — a reflection of 988's broader mission and appeal. From its inception, the 988 hotline was billed as a service for anyone in emotional distress or in need of mental health support, and not just for those contemplating suicide or threatening to harm themselves.

"People are calling for more reasons than ever before, which is great because that means they are getting help before those suicidal thoughts arrive," said Jennifer Illich, executive director of FirstLink, of Fargo, which handles calls to the 988 hotline for all of North Dakota and 17 counties in far western Minnesota. "But it's a struggle keeping up."

Hundreds of millions of dollars in federal grants have enabled the nation's 200 crisis call centers to expand their capacity. Yet that funding infusion is set to dry up within the next two years, potentially undermining the progress. A coalition of 40 mental health organizations in Minnesota and some state lawmakers are calling for more long-term, sustained funding for the 988 hotline through a new surcharge on phone bills.

Rep. Jessica Hanson, DFL-Burnsville, has introduced a bill that would impose a monthly fee of 12 to 25 cents on all phone lines and would appear on customers' bills, which is similar to how 911 is funded. The proposed fee is projected to bring in at least $9.8 million annually to cover the cost of staffing the 988 hotline and to enable Minnesota's call centers to respond to more chat and text messages. At least four other states have enacted similar legislation creating telecom fees to maintain 988.

As it stands, Minnesota's crisis call centers respond almost exclusively to phone calls, because they lack the staffing to answer the vast majority of texts and chat messages. That means that thousands of these messages are being redirected to backup centers in other states, where responders are less likely to be familiar with local resources, and wait times can be much longer. A counselor in another state may not be aware, for instance, that Minnesota has a robust network of mobile crisis response teams in all 87 counties that make visits to people's homes, crisis responders say.

"Right now we are facing a significant youth mental health crisis ... and if we're serious about addressing that, then we have to be able to respond to texts and chats," said Shannah Mulvihill, executive director of Mental Health Minnesota.

Thanks to the infusion of federal funding, the rate of crisis calls answered in Minnesota has increased from 43% in 2021 to 87% in December 2022, according to Vibrant Emotional Health, which tracks answer rates by state. Still, the federal government recommends that at least 90% of calls to the crisis line be answered in state.

"To hear from someone in your own community, who intimately knows the services that are available close to home, is absolutely critical," Hanson said.

The Greater Twin Cities United Way handles the largest volume of 988 calls in the state, covering a 14-county area that includes the Twin Cities metro area.

Carolina De Los Rios, the nonprofit's senior program officer for mental health and suicide prevention, said the federal and state funding for the 988 hotline has enabled her team of crisis responders to double to 20. Even so, her team has had to adapt to the hotline's broader appeal, and to the greater number of calls from people with more complex mental health problems.

Since the 988 launch, a higher percentage of callers are turning to the crisis hotline for regular support because they can't get adequate therapy in their communities, she said. Nearly 80% of the calls handled by the Greater Twin Cities United Way are classified as "emotional support" calls, she said, while about 11% of calls are from people who are contemplating suicide.

"We have a significant number of people who call us several times a day, every day of the week, and that's very hard for us to see," De Los Rios said. "Obviously, they are relying on [the 988 hotline] because they are not getting what they need, which is long-term care for their mental health."

Call center administrators say more state funding would enable them to expand their capacity for follow-up calls — a service that is vital to keeping people alive. People who call 988 and consent to follow-up calls can receive periodic check-ups from crisis counselors. Follow-up care has been shown to be highly effective: A 2018 national study found that nearly 80% of people who received follow-up calls through crisis hotlines said the intervention kept them from killing themselves.

"Dialing 988 made it easier, but it can still be a lot of work for someone who is exhausted and depressed," said Illich of FirstLink. "It means a lot to people when we pick up the phone and call them."