Funding for Suicide Prevention and Crisis Services in US State Budgets

Importance: States have autonomy in developing suicide prevention and crisis service infrastructure, but little is known about the magnitude of funding for suicide prevention and crisis services and how it has changed over time or varies across the US. Objectives: To quantify funding explicitly allocated for suicide prevention and crisis services in enacted state budgets and assess differences in budget allocations over time, across US Census regions, among states with varying suicide rates, and among states that have vs have not enacted 988 telecom fee legislation. Design, Setting, and Participants: This repeated cross-sectional state-year panel study included the enacted budgets of every US state and the District of Columbia for fiscal years 2021 to 2026. Exposures: Year, US Census region, state suicide rate quartile, and state 988 telecom fee enactment status. Main Outcome and Measures: The primary outcome was state per capita annual funding explicitly allocated for suicide prevention and crisis services. The secondary outcome was the percentage of each state's total annual budget allocated for suicide prevention and crisis services. Results: Across 306 enacted state budgets, the mean (SD) annual per capita budget amount explicitly allocated for suicide prevention and crisis services was $3.63 ($8.23) and the mean (SD) annual percentage of the total state budget allocated was 0.054% (0.111%). Annual mean state per capita funding for suicide prevention and crisis services increased significantly during the study period (eg, state mean [SD] budget, $1.05 [$2.04] in 2021 vs $6.55 [$12.76] per capita in 2025; B [SE]: $0.96 [$0.31]; 95% CI, $0.34-$1.57; P = .003), as did annual percentage budget allocations (B [SE]: 0.010 [0.004] percentage points; 95% CI, 0.004-0.021 percentage points; P = .005). Unadjusted mean (SD) state-level per capita allocations for suicide prevention and crisis services were highest among states in the Western Census region ($7.19 [$14.52]) and lowest among states in Southern ($2.12 [$3.56]) and Midwestern ($2.07 [$3.12]) regions. There was no significant association between state suicide death rate quartile and state per capita or percentage budget allocations for suicide prevention and crisis services. The mean (SD) state-level per capita allocation for suicide prevention and crisis services was more than twice as large in states that had enacted a 988 telecom fee in the prior year or earlier than in states that had not ($7.73 [$5.32] vs $3.13 [$8.38]; P = .003). Conclusions and Relevance: This repeated cross-sectional state-year panel study found that funding explicitly allocated for suicide prevention and crisis services in state budgets has increased over time, but was larger in states that have enacted a 988 telecom fee. These findings suggest that 988 telecom fees could be a promising legislative approach to finance suicide prevention and crisis service initiatives.