Why I’m Thinking About the Future of Crisis Support, And Why You Should Too

By Jaime Costello, MPH, Director of Programs, National Council on Problem Gambling

Understanding where we’re headed helps us build something stronger together. 

Lately, I’ve been zooming out and paying more attention to the helpline world as a whole. Not because I’m losing focus on problem gambling. The more I watch what’s happening with 988, federal funding, technology, and the behavioral health workforce, the more clearly I can see what’s coming for the National Problem Gambling Helpline™.

I’m sharing this because I know how much you care about the National Problem Gambling Helpline™, and because these trends aren’t abstract. They show up in our contact volume, our staffing conversations, our training plans, and the way we think about access and equity.

So, in plain terms, here’s what I’m watching, and what I think it means for our work.

1. More People Need Help, and We’re Already Short on Helpers 

A few numbers have been sticking with me: a quarter of Americans are projected to need behavioral health treatment by 2026.¹ Demand for these services is expected to jump 62% by 2036, while we’re facing a projected 13% decline in healthcare staffing.² Contact centers everywhere are being asked to do more with less. That squeeze is becoming the new normal. 

I think about this every time I look at the 2026 Q1 numbers for the National Problem Gambling Helpline™: 52,644 contacts in just three months. 

As legal gambling continues expanding into new states and new formats, that number could grow. The question isn’t if more people will need us, it’s whether we’ll be ready when they do. 

What this means for our network:
This is why I’m so focused on the behind-the-scenes work that isn’t always flashy. Think technology upgrades, quality assurance, training, and vendor coordination. Those aren’t “extras.” They’re the pieces that let us respond well when volume spikes: when a state launches sports betting, when awareness campaigns land, or when someone finally reaches out at 2 am on a random Tuesday. 

The work we’re doing now (1-800-MY-RESET, upgraded data systems, and the quality improvement roadmap) is about readiness. We shouldn’t be playing catch-up after demand outgrows capacity. We need a system that’s steady under pressure, so when someone reaches out, they get timely, high-quality support.

2. 988 Shows What’s Possible and What It Takes 

If you want a case study in rapid change, look at 988. Since July 2022, the network has answered over 13 million contacts. Before launch, 70% of calls were disconnected, meaning people in crisis couldn’t even get through. By May 2025, 91% of contacts were being answered.³ Most states in the 988 network now answer at least 80% of calls in-state, up from just 23 states before launch. That kind of improvement doesn’t happen by accident. 

At the same time, there’s a catch: only 18% of adults have even heard of 988.⁴ Among Black, Hispanic, and Asian adults, and among people who don’t speak English well, awareness is even lower. You can build the most sophisticated infrastructure in the world, but if people don’t know it exists or don’t feel it’s meant for them, it won’t reach the people it’s supposed to serve. 

There’s another lesson here too. The FCC recently required georouting for 988 calls and texts. Georouting routes a call or text based on where someone actually is, not based on the area code that their phone number is connected to.⁵ That’s a technical detail with real implications for how we could configure our network with federal, and FCC, support. And the elimination of the specialized 988 service for LGBTQ+ young people, which previously handled 10% of all contacts, is a painful reminder that progress isn’t linear. We can lose ground on equity even as we expand access overall.⁶ 

What I take from this:
Strong infrastructure only helps if people know it’s there and trust it enough to use it. That’s why it matters when states promote 1-800-MY-RESET, when industry partners update responsible gambling messaging, or when the number shows up on a website, a billboard, or a stadium screen. Those touches add up. 

And equity has to be part of how we judge whether we’re succeeding. Who’s reaching us, and who never makes it to us? Where might gambling harm be high but helpline use is low? Language Line gives us 240+ languages, but availability isn’t the same as accessibility. The point is to keep checking ourselves, and to change course when the data (or the community feedback) tells us we’re falling short.

3. The Federal Funding Rollercoaster Is Real, and It’s Scary 

In January 2026, a lot of organizations got a jolt: SAMHSA sent termination letters canceling approximately 2,800 grants totaling more than $2 billion.⁷ Within hours, providers across the country were laying off staff, canceling trainings, and shutting down programs. The grants were restored 24 hours later after massive public outcry, but that whiplash did real damage to stability and morale. 

And it wasn’t hypothetical. It actually happened. Even though 988 funding wasn’t affected, the signal was hard to miss: even congressionally appropriated funding can be vulnerable. SAMHSA itself has faced significant workforce reductions and organizational restructuring.⁸ The ground is shifting under the entire behavioral health sector. 

The practical takeaway:
We cannot rely on a single funding source. Our model includes foundation grants like the one we received from the NFL Foundation, industry partnerships, and philanthropic support. That diversification isn’t inefficient; it’s what keeps us stable when the political winds shift. 

This is also why I’m grateful for the relationships we’re building with funders and stakeholders. The case study we created about how national coordination protected access during our transition from 1-800-522-4700 to 1-800-MY-RESET isn’t just a feel-good story; it’s proof of value. When federal funding gets shaky, those relationships are what keep programs steady. So, we’ll keep showing impact, keep making the case, and keep earning the kind of long-term investment this work requires. 

4. AI Is Coming! But People Still Need People

AI comes up in almost every behavioral health conversation right now, sometimes with real substance, sometimes as buzzwords. Machine learning, chatbots, natural language processing… there is promise here for diagnostic support, crisis prediction, and resource matching. I’m not dismissing that. 

But here’s the finding that stopped me cold: approximately half of people surveyed said they’d be less likely to use a helpline if automation were introduced.²

That’s a clear message. When people are in crisis, when they feel shame, when they’re scared, they want to talk to another human being who understands. Technology that displaces that connection doesn’t just miss the point; it can actively drive people away. 

Where I land (and what I hear from leaders I trust) is pretty simple: use AI to help specialists do their jobs better, not to replace the specialists themselves. 

How this shows up in our work:
I love that we’re using technology strategically. Our partnership with ReflexAI to offer phone, text, and chat simulation training lets specialists practice difficult conversations in realistic scenarios before they’re live with someone in crisis. Our new Education & Training Hub will make training accessible to our whole network, barrier free. These tools make our people more effective. 

And when someone calls, texts, or chats with the National Problem Gambling Helpline™, what they’re looking for is a trained human. Someone who can hear the tremor in a voice, pick up on what’s not being said, and respond with compassion instead of a script. That human connection is the point. Tech can strengthen it, but it shouldn’t be a substitute for it. 

5. Burnout Is Breaking the People Who Hold This System Together

The workforce strain isn’t new, but it’s getting harder to ignore: half of behavioral health providers are experiencing burnout.¹⁰ About 122 million Americans live in areas with mental health provider shortages.¹¹ For 24/7/365 helpline operations, that reality is especially unforgiving. How do you keep round-the-clock coverage and protect the wellbeing of the people doing this work? 

What I’m seeing from organizations that are holding up well is a willingness to redesign the job, not just push people to “self-care.” They’re leaning into team-based care, creating peer support roles, and treating staff mental health as part of quality assurance not as an afterthought. 

What we need to keep front and center:
Our specialists aren’t just answering phones. They’re holding space for people in some of the darkest moments of their lives. They’re doing suicide screenings, navigating complex referrals, managing their own emotional responses while staying present for the caller. That takes a toll, even when the work is meaningful. 

Our quality improvement roadmap can’t stop at call metrics. It also has to address the conditions that let specialists do excellent work without sacrificing their own mental health. And we should say this plainly: the expertise across our network is real. These aren’t entry-level call center jobs; they’re trained professionals providing life-changing interventions. Paying fairly, supporting wellbeing, and treating the role with the respect it deserves is how we keep the system strong. 

6. We Can’t Address Gambling in Isolation from Everything Else 

One of the most important shifts I’m seeing across behavioral health is this: we’re finally naming what people have lived for years. You can’t address a mental health crisis without also paying attention to housing instability, food insecurity, transportation barriers, or social isolation. Social drivers of health are becoming central to how programs are designed, funded, and evaluated, particularly through Medicaid and state waiver programs.¹² For helplines, that pushes us beyond simple information and referral. It’s warm handoffs and active navigation. It’s meeting someone in the context of their whole life, not just the presenting problem. 

Why this matters on the ground:
Our own data tells this story. In Q1 of 2026 alone, 82.54% of contacts were motivated by financial struggles. Over a quarter mentioned mental health concerns. Nearly 30% were dealing with relationship problems. Some reported suicidal thoughts. These aren’t separate issues that happen to co-occur. They’re interconnected dimensions of the same crisis. 

When someone reaches out about their gambling, they’re often really reaching out about the wreckage gambling has caused in every corner of their life. Our model of connecting people to treatment, peer support, and community resources already reflects this reality. But we can go deeper. 

Are we equipping our specialists to navigate social needs alongside gambling-specific referrals? Are we building partnerships with organizations that address housing, legal aid, financial counseling, family services? Are we thinking about gambling harm as a public health issue embedded in people’s social and economic lives, not just an individual behavioral problem? 

The future of effective helpline work is integrated, not siloed. If we build for that now through training, partnerships, and referral pathways, we can lead the integration instead of racing to catch up later. 

Why I Wanted to Share All This:

The helpline field is at a turning point. Demand is rising, resources are strained, technology is evolving faster than we can evaluate it, federal policy is unstable, and workforce burnout is real. These aren’t abstract trends. They’re the conditions we’re navigating every single day. 

But here’s what gives me hope: we’re not navigating them alone, and we’re not starting from scratch. The National Problem Gambling Helpline™ has infrastructure, partnerships, data systems, and, most importantly, the people who genuinely care about this work. Every contact center we work with, every system we strengthen, every partner we join forces with, and every person we connect to help is part of building something resilient enough to last. 

The helpline modernization work we’re doing right now (1-800-MY-RESET, enhanced data dashboards, quality improvement, expanded training capacity) isn’t just about meeting today’s needs. It’s about being ready for the pressures coming in 2030, 2035, 2040. It’s about building a helpline that can grow and adapt without losing the human heart of what makes it work. 

I care deeply about this work. I know you do too. Understanding the bigger picture helps us make smarter decisions, advocate more effectively, and build something truly worth sustaining. 

Thank you for caring alongside me.

References 

1. Health Resources and Services Administration. State of the Behavioral Health Workforce, 2025. Published December 2, 2025. Accessed May 4, 2026. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/Behavioral-Health-Workforce-Brief-2025.pdf 
2. Health Resources and Services Administration. Health Workforce Projections. Accessed May 4, 2026. https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand 
3. 988 Suicide & Crisis Lifeline. About 988. Accessed May 4, 2026. https://988lifeline.org/about/ 
4. KFF. 988 Suicide & Crisis Lifeline: Two Years After Launch. Published August 9, 2025. Accessed May 4, 2026. https://www.kff.org/mental-health/988-suicide-crisis-lifeline-two-years-after-launch/ 
5. Federal Communications Commission. FCC Adopts Rules Requiring Georouting for All Wireless Calls to 988. Published October 18, 2024. Accessed May 4, 2026. https://www.fcc.gov/document/fcc-adopts-rules-requiring-georouting-all-wireless-calls-988-0; Federal Communications Commission. FCC Adopts Rules Requiring Georouting for Texts to 988. Published July 24, 2025. Accessed May 4, 2026. https://www.fcc.gov/document/fcc-adopts-rules-requiring-georouting-texts-988-0 
6. KFF. Growing Uncertainty About the Future of the 988 Suicide and Crisis Lifeline’s LGBTQI+ Service. Published August 9, 2025. Accessed May 4, 2026. https://www.kff.org/lgbtq/growing-uncertainty-about-the-future-of-the-988-suicide-and-crisis-lifelines-lgbtqi-service/ 
7. National Council for Mental Wellbeing. Statement on Cuts by SAMHSA. Published January 14, 2026. Accessed May 4, 2026. https://www.thenationalcouncil.org/news/statement-on-cuts-samhsa/ 
8. Behavioral Health Business. Without Warning SAMHSA Cuts $2B in Grants, ‘Destabilizing’ Many SUD Programs. Published January 15, 2026. Accessed May 4, 2026. https://bhbusiness.com/2026/01/14/without-warning-samhsa-cuts-2b-in-grants-destabilizing-many-sud-programs/ 
9. Batterham PJ, Sunderland M, Carragher N, Calear AL. Consumer Perspectives on the Use of Artificial Intelligence Technology and Automation in Crisis Support Services: Mixed Methods Study. JMIR Ment Health. 2022;9(8):e modest. Published August 5, 2022. Accessed May 4, 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC9391967/ 
10. The Council of State Governments. Mental Health Matters: Addressing Behavioral Health Workforce Shortages. Published October 10, 2024. Accessed May 4, 2026. https://www.csg.org/2024/10/10/mental-health-matters-addressing-behavioral-health-workforce-shortages/ 
11. Health Resources and Services Administration. Designated Health Professional Shortage Areas Statistics. Accessed May 4, 2026. https://data.hrsa.gov/default/generatehpsaquarterlyreport 
12. Health Resources and Services Administration. State of the Behavioral Health Workforce, 2025. Published December 2, 2025. Accessed May 4, 2026. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/Behavioral-Health-Workforce-Brief-2025.pdf