As of May 2024, the 988 Suicide and Crisis Lifeline received a monthly average of 654,000 calls, text and chats, compared to 355,000 contacts when the service launched in July 2022.
For providers operating within the system, the growing demand increasingly reflects broader social and economic instability alongside behavioral health needs.
Becky Stoll, executive vice president of crisis services at Nashville, Tenn.-based Centerstone, told Becker’s many crisis contacts now involve social determinants of health, including housing instability, food insecurity and employment challenges, in addition to mental health concerns.
Centerstone operates 988 lifeline services across 20 Tennessee counties as a primary provider and provides backup coverage in Nashville and Memphis. The organization also covers 86 Illinois counties — including statewide backup coverage — and 17 Missouri counties.
It also serves as a national backup center for chat and text contacts, handling roughly 12,000 to 13,000 interactions each month. In 2025, the organization managed 305,207 contacts across calls, chats and texts, maintained an average answer speed of 12 seconds and completed 16,380 post-crisis follow-up contacts.
Ms. Stoll said the shift has changed the nature of crisis response work inside lifeline operations.
“Therapy is fine, but if I can’t put diapers on my kid, or I don’t have a job or I don’t have a home, who’s going to therapy?” she said. “We’ve really had to fundamentally change and broaden the lens for staff on what they can expect and what we should be providing.”
Scaling such operations has required more specialized staffing structures, particularly as chat and text usage expands, which she said can last roughly three times longer than phone calls, typically 15 minutes for calls and 45 minutes for chats and texts. Staff complete a 120-hour onboarding process that includes training for calls, chat and texts.
The organization places an emphasis on well-being and recently released employee wellness guidelines focused on workforce sustainability across the crisis continuum with the emotional intensity and unpredictability of crisis response work.
A Centerstone literature review examining the neurobiological impacts of acute stress found crisis events can impair cognitive processing and decision-making, potentially limiting a person’s ability to engage with referrals or services after a crisis encounter. The review also noted that repeated, acute stress may reduce self-efficacy and increase barriers to accessing care.
Ms. Stoll said answering a crisis contact is only part of the care continuum. Maintaining continuity after the immediate crisis resolves remains a larger challenge.
Follow-up care — including helping individuals navigate appointments and social service systems — is a critical component of the continuum, though reimbursement mechanisms remain inconsistent. Ms. Stoll described individuals as needing a “wingman” for post-crisis care.
“We wrote a guide. It’ll tell you exactly how to, but it takes human capital to do it,” she said. “CMS did come out with a couple of codes last year, January 2025, where you can bill, but it’s hard to get the insurance companies to recognize the codes, agree to pay the codes or put the codes in your contract so you can bill them.”
Although federal funding for 988 has remained in place, Ms. Stoll said rising volume will require additional federal or state support to maintain capacity.
“States do have the option to impose a fee, not a tax, on cell phones, to help cover the cost of that. You can go to NAMI’s website and you’ll see all the states that have it, but it is a way to generate money that goes specifically to 988.”
The next phase of 988 will likely require continued investment not only in crisis response capacity, but also in workforce support, continuity of care and broader community resource navigation.
“People being in crisis, not just for mental health issues, is huge,” Ms. Stoll said. “This industry itself is very thankful that the funding has remained.”
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
