The Impact of Suicide Hotlines on Health: Evidence from 988 Implementation

This paper examines the impact of the National Suicide Hotline Designation Act, which introduced the universal 988 calling code and earmarked federal funding to suicide crisis call centers in July 2022. We use a difference-in-differences design that leverages pre-existing cross-state variation in crisis line capacity gaps, measured by the number of pre-988 calls routed to a state but not answered in-state. The rollout substantially improved crisis line operations in states with larger baseline capacity gaps: these states answered more calls in-state and increased their in-state answer rates. However, these operational gains did not translate into detectable reductions in suicide mortality. The mortality estimates are precise enough to rule out even modest short-run reductions. We also find no statistically significant improvements in broader population mental health outcomes. These findings suggest that expanding crisis line capacity alone may be insufficient to reduce suicide deaths.