The new three-digit suicide hotline number, 988, came out of the gates with a huge marketing blitz this summer, nearly two years after the National Suicide Hotline Designation Act became law. Posters, magnets, stickers, and social media campaigns urged people who are in a crisis or worried about a loved one to dial the easy-to-remember number, just like they would dial 911 for emergencies related to physical health.
And so far, it seems to be successful in terms of reaching more people who could use emergency mental health support.
The 988 Suicide and Crisis Lifeline received more than 96,000 calls, texts, and chats the week it went live in July, compared with the more than 66,000 it received the week before, when the hotline could be reached at 1-800-273-8255 — a 45% increase in volume. (The longer number is still available as well.)
In August, the 988 Lifeline answered 152,000 more calls, chats, and texts than the former hotline did in August 2021. It’s faster too: On average, a call is answered after 42 seconds, down from 2.5 minutes.
“The numbers of calls have gone up, and the wait time has gone down. That’s exactly what is happening, and that was our goal,” said April Naturale, the 988 interim executive director at Vibrant Emotional Health, the nonprofit group that runs the line for the Substance Abuse and Mental Health Services Administration.
Here are some important things to know before you dial 988, as well as what it’s like to make the call.
You have choices
When you call 988, you’ll hear an automated greeting that lists different options, including a connection to the Veterans Crisis Line (press 1), Spanish-language services (press 2), or a service for LGBTQ people under 25 (press 3).
If you press one of those three numbers, you will be transferred to a specific crisis line that caters to that group of people; all other calls will be routed to the nearest crisis center based on your area code.
Everyone who answers your call has been trained, but not everyone is a professional
Some counselors who answer the phone are paid; others do so on a volunteer basis.
Anyone who answers your 988 call has been trained by Vibrant Emotional Health, but not everyone is a licensed mental health professional.
“These are highly trained crisis counselors,” Naturale said. “They get extensive training in order for their crisis center to be part of the Lifeline.”
The Lifeline is made up of a network of over 200 independently owned and operated local centers. Extensive training involves a minimum of 40 hours of coursework that includes learning about the evidence-based practices that are known to prevent suicide, she said.
You’re only as local as your area code
Let’s say you moved to Brooklyn 20 years ago but never got around to changing your mobile number (it happens). If you call 988, you’ll be sent to a local call center that’s in the area code where you used to live, explained Anthony Wood, the interim CEO, and COO of the American Association of Suicidology, a Washington, DC, group that helps certify crisis call centers.
“The hotline can’t geotarget yet,” he said. This may be good for privacy reasons because operators can’t find you unless you tell them where you are, but it may make it harder for you to access local resources.
“The Omaha call center wants to help, but they don’t know what services are available in Brooklyn, so it’s not the most efficient way to do it,” Wood said.
The lines may be understaffed
COVID-19 spurred the Great Resignation with record numbers of employees quitting their jobs. Many companies, including crisis centers, are still struggling to find — and keep — good help.
Making matters worse, local crisis centers need even more counselors to handle the consistently high volume of calls to 988, Wood said.
“Funding for crisis workers has improved dramatically, but more staff will need to be recruited and trained, and that all costs money,” he said. The question is where funding should come from.
The Biden administration has invested more than $400 million in crisis centers and other mental health services to support the 988 system, but now states must figure out how to pay for additional staffing and resources.
“Some moved fast and added taxes to telecommunications bills, and other states are still struggling,” he said. Unless and until these centers are staffed up, demand could easily outpace supply.
Video calls will be an option for people with a hearing impairment
As of now, 988 serves people who use TTY, or teletypewriter, a device or mode on compatible cellphones that help people who are deaf or have a hearing impairment or speech disability make phone calls.
People can also dial 711 to be automatically connected to a TTY-based telecommunications relay service and then reach the hotline, but a video pilot program is in the works, Naturale said.
“Most folks who are deaf or hard of hearing have moved to video phones as it is easier and more of a connected way to communicate,” Naturale said.
Texts and chats are currently only available in English
A texting pilot program for those who speak Spanish is in the works, Naturale said. But texting may only further tax the relatively small staff at crisis centers, Wood said.
“Texts take a lot more time than a phone call,” he explains. Texting conversations may wax and wane when the caller gets distracted, so it takes much longer to develop a rapport.
“The text responder has to do a lot of work to figure out a person’s level of distress,” Wood said. “This doubles the demand of time that a phone call takes.”
While texts or chats are in English only, there are over 250 languages available via a translation service if you call the number.
Plans to expand services to tribal communities are underway
It’s known that Native Americans and Alaska Natives are at higher risk of suicide compared with other people in the US.
Now, a new $35 million grant aims to better support these populations by providing more culturally competent, trained 988 counselors, Naturale said.
The police may get involved if you call
This is known as a live rescue. While it is rare, it can happen. New York City-based mental health advocate Liz Winston made the mistake of voluntarily going to an emergency room in a vulnerable moment, thinking healthcare workers would offer mental health services and treat her with dignity and respect. They didn’t.
People who land in an emergency room or psychiatric hospital “lose their legal right to decline medication, wear their own clothing, and leave the hospital if they are disturbed by the conditions or the behavior of the staff,” she said.
They should also be prepared for potentially steep medical charges associated with an emergency room or hospital visit. Her Instagram post warning people not to call 988 went viral.
Winston has since received many messages from people who called the Suicide Prevention Lifeline or 911 and were brought to the emergency room for 72 hours or more, she said.
Less than 2% of calls involve police or mobile crisis teams, Naturale said.
She noted that “it would be an “imminent danger situation” in which the crisis counselor is worried for the safety of the person on the call. Wood added, “In these cases, live rescue can save your life, and this is why all accredited centers must have the capacity to do live rescue.”
You don’t need to be at rock bottom to call
The counselors who staff the Lifeline are skilled in suicide prevention as well as dealing with substance abuse issues, self-harm, depression, anxiety, and other mental and behavioral health issues.
It’s also for concerned friends and family to use if they are worried about a loved one.
“If you ever wonder if you should call, you should call,” said Thea Gallagher, a clinical psychologist at New York University Langone Health in New York City. “People tend to downplay their mental health and seek help when it is too late,” she said.
You won’t be abandoned
Many people contemplate suicide due to a lack of food, financial issues, and housing insecurity.
“The 988 lifeline is focused on emotional and behavioral needs,” Wood said.
Some centers may be more keyed into resources to help callers with such basic needs, but others will refer callers to 211 for help.
There are more than 200 agencies across the United States that you can reach by calling 211. People looking for help meeting basic needs like housing, food, transportation, and healthcare can access this network via calls, web chats, and text messages.
“No accredited center will abandon a caller,” Wood said.
“At the core, people who answer are going to listen and offer suggestions and/or connect you with available services to help address your needs,” said William Zimmermann, the program manager for the New Jersey Suicide Prevention Hopeline (855-654-6735).
“Some callers just need to be heard, and others may need more,” said Zimmermann, who is also the manager for the national 988 backup center at Rutgers University Behavioral Health Care in New Brunswick, New Jersey. (Lifeline centers have contracts with backup centers that take calls when the system is undergoing maintenance.)
The LGBTQ+ line is now available
As of Sept. 30, the LGBTQ+ pilot program has been up and running.
“This is a special population that we are especially concerned about,” Naturale said. The Trevor Project is running the pilot program, but other queer and trans rights groups will soon be involved. This should be a really good thing, said Jack Lam, an mental health counselor in Manhattan Beach, California, who specializes in caring for queer teens and adults.
“A lot of these lines have been staffed by volunteers who may not be trained in cultural competency or humility, and there have been issues with racist or homophobic or transphobic remarks,” they said.
There are other options
If you don’t want to call the hotline, there are other “warm lines” that are free, peer-run resources for callers whose issues may not be at a crisis point, Lam said.
“Call a hotline in an emergency and a warm line if you just need someone to vent or someone to bounce a problem off of,” they said.
Dial 988 in the US to reach the National Suicide Prevention Lifeline. The Trevor Project, which provides help and suicide-prevention resources for LGBTQ youth, is 1-866-488-7386. Find other international suicide helplines at Befrienders Worldwide (befrienders.org). ●