The past few years have created an epidemic of mental anguish.

The World Health Organization states that the "prevalence of depression and anxiety have increased by 25 percent" since COVID-19 emerged. Fatal substance abuse keeps breaking records in the U.S. and the tri-state area. And while suicide technically declined nationwide during the first year of the pandemic, self-harm is still a leading cause of injury and death — with 46,000 fatalities in 2020.

Starting Saturday, people in crisis will have a new way to reach out for help. The national 988 mental health crisis number is rolling out as a lifeline for people who need emergency counseling.

But access to the hotline’s services may be limited in some places.

The federal government provided a huge sum – $400 million — to help local governments build out the call centers. Places like New York and New Jersey also added millions of dollars through their fiscal budgets. Other states haven’t added this backing, which means their residents’ calls could be rerouted here.

WNYC host Tiffany Hanssen spoke with Jonathan Purtle, a health policy professor at New York University and director of policy research at their Global Center for Implementation Science. He has studied how call center support for 988’s predecessor — the National Suicide Prevention Lifeline — has varied state-to-state.

The interview has been lightly edited for clarity.

First, I want to talk broadly about how the system works. The 9-8-8 hotline is modeled after 9-1-1. But when New Yorkers call, who is on the other end of the line?

When a person dials 988, they're gonna get the same services as they would've received when they called what was previously 1-800-SUICIDE prevention hotline number. You'll be routed locally based on your area code to a crisis call center, ideally within the state.

First, you'll hear some automated prompts, one asking you if you would like services in Spanish; another asking you if you are a veteran.

If the answer is yes to either of those, you'll be routed to the veteran- or Spanish-language call centers. Otherwise, you'll be routed to a call center within the state.

As long as the wait time isn't too long, you'll be connected to someone in the state who will get a sense of what's going on and how they can help you.

If the wait time is too long, you'll be routed to a call center in another state that has capacity to receive your call quickly.

Let's talk about the regional roll out: New York and New Jersey have both received state funding for the program, right? Where does that funding come from?

So they both came from the general budget. In New Jersey, a law recently passed that's gonna put about $13 million to call centers within the state in this fiscal year and another $16 million for mobile crisis response teams.

In New York State, there'll be $35 million coming this fiscal year with an increase to $60 million moving forward. So these dollars will come from just general state budgets, not from the federal government or not from any sort of set fee.

It sounds like pretty robust funding. Does that mean the program is going to be working really well when it launches?

We will see. It's robust funding for now, and robust really depends upon how much the transition to 988 increases demand for lifeline services.

There are national estimates that call volume will increase between 1 million calls nationally in this first year to up to 12 million. We really don't know because there isn't really anything to compare it to. It could be sufficient funding. It may not.

Moving forward, it’s important to think of a real sustainable funding mechanism. The federal law that created 988 recommends that states pass what's called user fee legislation.

This would be a flat fee of, say maybe, 30 cents a month on every cellphone plan in the state, which would go to financing the 988 and a mental health crisis response system.

This is similar to how 911 systems are financed. That’s what's being perceived as the gold standard right now.

But only four states thus far have made user fees for 988: Washington state, Virginia, Nevada and Colorado.

You mentioned what the federal government has to say about funding. Did they provide some local support as well?

They have provided some local support for this initial rollout, a couple hundred million dollars, which will be good.

Most recently in the recent gun violence prevention bill, there was some funding for 988 rollout. The Substance Abuse and Mental Health Services Administration at the federal level has provided some money with implementation support and helping states get their systems bolstered and set up.

There was a major piece of federal legislation called the 988 implementation act. That was all about funding that had about over $1 billion in funding to bolster the crisis response systems and support 988 rollout. But that bill didn't pass or really go anywhere in the House.

So what does this uneven funding across states mean specifically for New Yorkers, if anything?

I think both New York and New Jersey are better off than many, or I'd say, most states in terms of the amount of dollars that have been given this fiscal year by the state legislatures.

But we will see because we really don't know how much demand is going to go up.