Starting Saturday, Minnesotans and others struggling with thoughts of suicide or other mental health crises will be able to get immediate help by calling or texting a three-digit number, 988.

The nationwide shift to 988, years in the making, is considered one of the most significant steps to respond to people in mental health distress in decades. The hope is that 988 will become as easy to remember in times of emergency as 911, help ease the stigma of seeking mental health help, limit armed law enforcement interventions in mental health emergencies — and save more lives.

As with the existing suicide hotline, operators will be trained in how to counsel callers and be ready to dispatch mobile crisis teams and others specially trained in mental health. The new code will replace the 11-digit National Suicide Prevention Lifelineat 1-800-273-8255 — though that number will continue to function and direct people to resources.

"It's a very transformative point," said Emily Lindeman, a suicide prevention coordinator at the Minnesota Department of Health. "In a moment of crisis, it's really hard to remember that 1-800 number. This really gives an opportunity for people to reach out and connect with crisis supports in that moment of need."

But there are concerns about whether Minnesota and other states are equipped to handle the expected increase in people seeking help. Many call centers operate on tight budgets and have only just started to ramp up staffing to accommodate the likely surge in calls and texts via 988. When local centers cannot pick up, calls are bounced to national backup centers, where responders are less likely to be familiar with local resources and wait times can be much longer for those in crisis, according to mental health advocates and call center operators.

The state Legislature this spring failed to approve a special telephone surcharge that would have enabled call centers across the state to expand their crisis response capacity. The measure would have generated $18.7 million through 2024 — money that would have helped Minnesota's four suicide hotline centers hire and train more staff. Currently, the centers handle nearly 34,000 calls per year. It is projected that could increase to more than 53,000 calls — and chat and text messages are expected to grow exponentially, according to Vibrant Emotional Health, which oversees the national suicide prevention network.

Without the new state funding, call centers could be strained to meet demand. State health officials said the biggest impact is that Minnesota's four suicide call-in centers likely will have to route more calls and texts outside the state. Already, about one-quarter of Minnesota calls to the suicide prevention hotline are redirected to one of eight backup centers in other states — a rate that has improved from recent years but which mental health advocates consider too high.

"Someone picking up a call in Oklahoma or Pennsylvania is not necessarily going to be looped into our crisis system," said Shannah Mulvihill, executive director of Mental Health Minnesota, a St. Paul nonprofit. "When there are lifesaving measures that need to be taken, that's much more difficult to do from another state."

As it stands, the national crisis hotline is handled by a patchwork of more than 200 call centers across the county with varying levels of staffing and knowledge of local resources. A counselor in another state may be less aware, for instance, that Minnesota has a robust network of 24-hour, mobile crisis teams across the state that can provide psychiatric services to people in their homes, according to call center operators.

"When calls are re-routed to centers out of state, Minnesota callers in crisis often wait two to three times longer, receive fewer linkages to effective local care and are more likely to abandon their calls," according to a National Suicide Prevention Lifeline report.

Resources under stress

Even before the 988 rollout, the nation's infrastructure for handling crisis calls was being stretched by the surging number of people needing mental health services. Young people, in particular, have been reporting higher rates of depression and thoughts of suicide — problems that intensified during the pandemic.

Last December, the U.S. surgeon general issued a rare public advisory warning of a "devastating" mental health crisis among teenagers. Nationwide, more than 4 in 10 teens reported feeling "persistently sad or hopeless," and 1 in 5 said they've contemplated suicide, according to a 2021 federal survey.

Yet, many states remain unprepared for the 988 launch. When Congress passed the 2020 law creating the hotline, they left it to individual states to determine how to design and fund response systems. Many lawmakers were wary of adding a surcharge seen as a tax on telecommunications providers. A recent national survey by the Rand Corp. interviewed 180 behavioral health program directors nationwide and found that only 16% said their agencies had developed a budget to support the 988 transition.

Benjamin Miller, a psychologist and president of the Well Being Trust, a national foundation advocating for mental health, fears the lack of investment in local call centers ahead of the 988 rollout could create an "extremely intense backlog" of calls at the national backup centers — potentially resulting in life-threatening waits. Even a 60-second wait, he said, can be too long for someone contemplating suicide.

"We could end up with 50 different versions of bad," Miller warned. "This [hotline] was meant to be an opportunity to enhance our infrastructure to respond to people in crisis, but unfortunately that hasn't happened yet."

For now, many crisis call centers are operating on shoestring budgets with limited capacity to hire more staff.

FirstLink of Fargo, N.D., handles calls to the suicide prevention hotline for a broad swath of territory that includes all of North Dakota and 17 counties in far western Minnesota.

The call center and its 20 staff members operate out of a small, windowless basement near a hair salon and an Olive Garden. The desks are wobbly and the counselors crammed into tight spaces just several feet apart. The agency plans to hire two more full-time staff in the coming weeks to handle the influx of 988 calls, but recruiting for work in such a high-stress environment can be challenging, said Jennifer Illich, FirstLink's executive director.

Even when qualified candidates are found, it can take a month or longer to train a counselor to respond to crisis calls, say call center operators. Mental health emergencies require nuanced responses that emphasize understanding and empathy. They also require counselors to be able to think quickly and ask direct questions, such as whether a person has access to guns — the leading method of suicide in Minnesota.

"It's a really rewarding job, but it can be challenging to take these calls day after day," Illich said. "Every minute that a person waits while they're in crisis is too long."

Where to find help

If you or someone you know is struggling with suicidal thoughts, call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or, starting Saturday, call 988. You can also text HOME to 741741 to connect with a Crisis Text Line counselor.