When North Dakotans in a mental-health crisis call a main hotline, some are directed to a national backup center.

Officials say as demand soars, local answering capacity needs more support, with lingering questions about the rural impact.

An interim legislative committee heard testimony this week about the state of North Dakota's 988 Suicide and Crisis Lifeline.

Jennifer Illich, executive director of FirstLink, the nonprofit that oversees the service, said FirstLink’s call volume has increased substantially.

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There were more than 15,000 calls last year, compared with roughly 2,800 in 2020. Staffing limitations mean national assistance comes into play.

"What's going on right now is when people call 988, they might fall through the cracks 'cause they're not getting FirstLink, they're not getting the local response, they're going to the backup center," Illich said.

Illich said backup call takers are vital, but can't replicate North Dakota's continuum of care for these situations.

Given North Dakota's rural backdrop, a committee member asked if FirstLink could secure aid under the federal Rural Transformation Health Program, with states now administering grants. Illich said FirstLink applied but wasn't confident it would be chosen, underscoring the need for enhanced state aid next session.

Illich said a local staffer answering the call can put a mobile crisis response team in play. That's considered crucial in rural areas where someone lacking transportation can't access a mental-health provider.

Illich credited the state for its efforts so far but warned about complacency.

"And those investments only work, though, if we have enough helpline specialists sitting in our office to answer the phone lines when people are calling us," Illich said.

Illich estimates FirstLink needs an additional 26 full-time staff members to reach an acceptable local response level.

Other states have adopted new telecommunication fees to close funding gaps for call networks, but so far, North Dakota has resisted that move. Skeptics were worried about overburdening consumers, but supporters contend it's a small price to pay to prevent suicides.