TOPLINE

State per capita funding explicitly allocated for suicide prevention and crisis services increased significantly over fiscal years, from $1.05 in 2021 to a peak of $6.55 in 2025, before declining to $4.51 in 2026. States that enacted a 988 telecom fee allocated more than twice as much funding per capita as states that did not enact such fees.

METHODOLOGY

• Researchers conducted a repeated cross-sectional state-year panel study analyzing 306 enacted state budgets from fiscal years 2021 to 2026 across all 50 US states and the District of Columbia.
• Data were obtained from the National Association of State Budget Officers website and state websites, the US Census Bureau, the CDC's WONDER website, and the National Alliance on Mental Illness.
• 1150 budget line items explicitly allocated for suicide prevention and crisis services were identified through a systematic review of enacted state budgets, with funding amounts summed to calculate total annual state budget allocations.
• State per capita annual funding allocated specifically for suicide prevention and crisis services was the primary outcome, while secondary outcomes included the percentage allocated for these services from each state's total annual budget.
• Differences in budget allocations were assessed over time, across US Census regions, among states with varying suicide rates, and between states that did and did not enact 988 telecom fee legislation in the prior year.

TAKEAWAY

• Annual mean state per capita funding for suicide prevention and crisis services increased significantly from 2021 to 2026 (unstandardized regression coefficient [B], $0.96; P = .003), as did annual percentage budget allocations (B, 0.010 percentage points; P = .005).
• The highest per capita allocations for suicide prevention and crisis services were in states in the Western Census region (mean $7.19) and the lowest allocations were in Southern (mean $2.12) and Midwestern (mean $2.07) regions, with similar trends in mean percentage budget allocations for suicide prevention and crisis services; however, the differences were not statistically significant after adjusting for state-level clustering.
• There were no significant links between the percentage of the budget allocations for these services or the mean state-level per capita and a state's age-adjusted suicide death rate quartile for the previous calendar year.
• The mean state-level per capita allocation for suicide prevention and crisis services was more than twofold higher in states that enacted a 988 telecom fee in the prior year than in states that did not ($7.73 vs $3.13; P = .003), and the mean state-level percentage budget allocation was also significantly higher (0.089% vs 0.050%; P = .04).

IN PRACTICE

"These findings suggest that funding for suicide prevention and crisis services has increased over time, but the magnitude of amount and increase varies among states with and without 988 telecom fees," the authors wrote.

SOURCE

The study was led by Jonathan Purtle, DrPH, School of Global Public Health, New York University, New York City. It was published online on September 11 in JAMA Network Open.

LIMITATIONS

The study potentially underestimated the extent of state-level investments in suicide prevention and crisis services and did not include city and county funding, state funding for mental health services in general, or Medicaid funding for crisis services, which differed across states. The study was limited in its ability to compare funding between individual states or characterize funding for specific suicide prevention programs and crisis services. The study focused on funds budgeted rather than actual expenditures, which could often be less than budgeted amounts. Additionally, the state suicide rates were lagged prior to fiscal years.

DISCLOSURES

The study was funded by the National Institute of Mental Health. Disclosure information for the study authors is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.