Assessing the Impact of Telehealth Policy Expansion on 988 Suicide & Crisis Calls Nationally
This study found that states adopting the Psychology Interjurisdictional Compact (PSYPACT) to expand telehealth provider reach experienced approximately 12% higher 988 Suicide & Crisis Lifeline call volumes between 2022 and 2024, suggesting that policies facilitating cross-state telemental health access may strengthen engagement with crisis services.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the United States, a growing number of people are turning to a single, three-digit phone number when they feel overwhelmed by a mental health crisis. Launched nationally in 2022, this service connects callers to trained counselors who can offer immediate support, safety planning, and referrals to local care. While the system was designed to be a lifeline, its success depends on a complex web of factors: public awareness, the availability of counselors, and the policies that govern how mental health professionals can work across state lines. For years, a licensed psychologist in one state could not legally treat a patient in another without navigating a maze of separate licenses, a barrier that made it difficult to provide consistent care, especially in rural areas where specialists are scarce. To address this, a growing number of states have joined a compact agreement that allows psychologists to practice across borders more easily, much like a driver's license recognized in multiple states. At the same time, laws have evolved to allow patients to receive care over the phone without needing a video connection, a crucial adjustment for those without high-speed internet. Understanding how these policy shifts affect the flow of people seeking help is vital, not just for counting calls, but for ensuring that the system is ready to meet the needs of a population in distress.
A team of researchers set out to examine the relationship between these expanding telehealth policies and the volume of calls reaching the crisis line. They analyzed data from every state and the District of Columbia over a three-year period, from 2022 through 2024, looking at the number of calls, texts, and chats that were successfully routed to a crisis center each month. The researchers focused specifically on two types of policy changes: states joining the compact that allows psychologists to work across state lines, and states adopting rules that allow Medicaid to pay for mental health visits conducted over the phone without video. By comparing months when these policies were active against months when they were not, while accounting for factors like population size, unemployment rates, and the availability of internet, the team sought to see if the rules themselves were driving changes in how many people reached out for help.
The analysis revealed a clear pattern: in months when a state had adopted the agreement allowing psychologists to practice across borders, the volume of calls to the crisis line was higher. Specifically, the data showed that call volumes were approximately twelve percent higher during months when these policies were in effect compared to months when they were not. This finding suggests that making it easier for mental health professionals to work across state lines may be encouraging more people to engage with crisis services, perhaps because these professionals are referring patients to the line or because patients feel more supported by a system that feels more accessible. The researchers also found that states which allowed Medicaid to reimburse for audio-only phone visits saw a nine percent increase in call volumes during the months those policies were active. This indicates that removing barriers to telephone-based care may also be helping more people connect with the system.
Interestingly, the study found that these policy changes did not reduce the number of calls, a possibility the researchers had considered. They initially wondered that if people had better access to regular therapy through telehealth, they might need the crisis line less often. Instead, the data suggested the opposite: expanding access to care appears to strengthen the connection to crisis resources rather than replace them. The study also noted a steady, national rise in call volumes over the three years, regardless of specific state policies, which likely reflects a growing public awareness of the number and a normalization of seeking help. While the researchers could not determine the specific reasons for every individual call or whether the policies changed the quality of the care received, the evidence points to a system where broader access to mental health professionals and flexible communication methods are linked to increased engagement with crisis support. The findings suggest that as states continue to modernize their rules for mental health care, these changes may have a direct and positive impact on how many people feel comfortable reaching out when they are in crisis.
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