4 - (IOP 22) Policy Stakeholders Perceptions of Acceptability and Feasibility of Policy Strategies for Financing the Implementation of the 988 Suicide and Crisis Lifeline

The 988 Suicide and Crisis Lifeline, launched in July 2022, has the potential to expand access to evidence-based interventions for individuals experiencing suicidality and behavioral health crises, as well as promote linkages to EBPs in community settings (SAMHSA, 2025). States have broad discretion regarding how they fund 988 and state legislators are actively considering a range of policy strategies to sustainably finance 988 implementation. Given the variability in perceptions of policy implementation (Purtle et al., 2024), it may be important to use audience segmentation techniques to identify subgroups among stakeholders and tailor financing policies based on the subgroups’ perceptions. This study aimed to 1) identify subgroups of mental health crisis system stakeholders based on their roles in 988 implementation and 2) evaluate whether stakeholders’ perceptions of the acceptability and feasibility of financing strategies differ by group.
384 crisis system stakeholders—including 988 call center directors, public crisis system leaders, and suicide prevention professionals—completed an online survey in summer 2024. Participants rated the acceptability and feasibility of four policy implementation strategies for sustainable 988 funding (Proctor et al., 2013; Raghavan et al., 2007): organizational (e.g., state-funded trainings), regulatory (e.g., linking funding to quality metrics), political (e.g., directing funds to service organizations), and social/societal (e.g., reducing stigma to increase crisis service utilization). Additionally, respondents reported their involvement in six 988 implementation activities (e.g., overseeing crisis call center services, strategic crisis system planning). Latent class analyses were used to identify stakeholder groups, and ANOVAs were conducted to examine differences in strategy ratings across groups.
Three subgroups emerged (BIC = 2096.65): 1) call center supervisors (66%), 2) financially and advocacy-oriented stakeholders (20%), and 3) stakeholders engaged in all aspects of 988 implementation (14%). Social/societal strategies received the highest acceptability (M = 15.88, SD = 3.99) and feasibility (M = 14.39, SD = 4.23) ratings. In contrast, regulatory strategies were rated lowest in acceptability (M = 12.33, SD = 4.06) and feasibility (M = 11.90, SD = 4.07). Call center supervisors perceived organizational financing strategies as significantly less acceptable than other groups (p <.001), and they rated regulatory strategies as less acceptable than highly engaged stakeholders (p=.033). No significant differences emerged for other strategies.
Findings suggest that social/societal strategies are perceived as the most viable for 988 implementation, while regulatory strategies are less favorably viewed, particularly by call center supervisors. This study highlights the need for tailored policy approaches that align with stakeholder roles and priorities to optimize 988 implementation outcomes. Understanding stakeholder perspectives can inform the development of financing strategies that enhance crisis response system sustainability and accessibility, ultimately supporting the widespread adoption of evidence-based crisis interventions.