• Posted July 17, 2023

How Much of a Difference Is 988 Making a Year After Its Launch?

The national 988 Suicide & Crisis Lifeline has hit its one-year anniversary, and it appears that the public is increasingly turning to the number in times of darkness.

The most recent statistics show a substantial increase in call volume, with nearly 160,000 more crisis calls, chats and texts in May 2023 compared to May 2022 -- two months before 988's activation on July 16.

Compared to a year before, calls answered in May increased by 45%; chats answered increased by 52%; and texts answered increased by 938%, according to 988 performance stats monitored by the federal Substance Abuse and Mental Health Services Administration.

Overall, 988 operators have answered more than 2.3 million calls and nearly 600,000 texts in the past year, Chuck Ingoglia, president and CEO of the National Council for Mental Wellbeing, said in a council news release.

"It was a great idea to begin with and has delivered a lot of its promise already,"said Dr. Petros Levounis, president of the American Psychiatric Association. "More and more people know about 988, and what's truly great about it is when you call 988, you get a human being to talk with you, not a robot but a trained person who knows how to deal with crisis."

But experts say more progress needs to be made for 988 to reach its full potential.

Most Americans are unfamiliar with the hotline

About 4 out of 5 Americans (82%) remain largely unfamiliar with 988, according to a new poll from the National Alliance on Mental Illness.

"If we collectively want to help people in crisis -- and save lives -- 988 cannot be the best kept secret,"NAMI Chief Executive Officer Daniel Gillison Jr. said in an organization news release. "Thankfully, the data show more people are beginning to become aware of this important resource -- but not nearly enough."

Officials also want to make sure the 988 system is ready to deal with any future increases in calls, not only by having sufficient staff but by having a solid system of mental health clinics ready to take referrals.

"It's important to have a system in place where they can refer you,"said Mary-Catherine Bohan, vice president of outpatient and ambulatory services at Rutgers University Behavioral Health Care in New Jersey. "The wait times in traditional programs across the country are very long and it's disheartening if somebody is in crisis, if they have to wait even a day or two to get the care that they need."

The 988 Suicide & Crisis Lifeline is an outgrowth of the National Suicide Prevention Lifeline, which until last summer had a 10-digit phone number.

At the same time, the Lifeline broadened the help it offers to include not just people who are suicidal, but also those who are having a mental health crisis.

The mental health crisis triggered by the COVID-19 pandemic required such a response, experts said.

More than 48,000 people died by suicide in 2021, up 36% from the year before, according to the U.S. Centers for Disease Control and Prevention.

Further, suicide was the second leading cause of death for people between 10 and 34 years of age and fifth for 35- to 54-year-olds.

Helping before people reach their breaking point

Broadening the scope of the service was aimed at offering people help well before they reach that breaking point, said Mark Graham, executive director of the Rutgers University Behavioral Health Care National Call Center.

"People are seeing it's more than a suicide crisis line. It's a mental health crisis line or mental health line. If you're not suicidal, you can still call that line and get help,"Graham said. "Because if you help somebody when they're struggling mental health-wise, then you're getting ahead of it before they potentially get to that point of crisis."

Unfortunately, the NAMI poll found there is widespread ignorance about 988.

More than 1 in 3 Americans (36%) polled last month had never heard of the 988 Lifeline, and another 31% had heard of it but knew no more about it.

Most also had misconceptions about what to expect if they call 988:

• 53% didn't know the line connects a caller to needed services and support.
• 53% didn't know the line can de-escalate a situation where a person is suicidal.
• 64% didn't know that people in a drug or alcohol crisis can use the line.
• 21% falsely think that a 988 call always results in someone being sent to a hospital, and another 70% didn't know one way or the other.
• 20% falsely thought that 988 callers must disclose personal information to receive support, and 72% didn't know one way or the other.
• 14% falsely thought that a 988 call always leads to someone showing up in-person on your doorstep, and 74% didn't know one way or the other.

The 988 crisis line is, in fact, anonymous, and much of the time the help is provided through the phone call itself, experts said.

Staff is stretched as calls surge

The 988 number routes calls to local and regional centers staffed by trained personnel, and there are concerns that crisis line staff is being stretched thin as the number of calls increases.

"It's a very stressful job as you can imagine, answering crisis calls one after the other,"Graham said. "During a shift, that gets hard. If we have more staff, you can break some staff away for training and reduce the caseload for the staff, which reduces their stress and their challenges."

But funding for 988 remains shaky.

So far, only six U.S. states have comprehensive laws to ensure 988 funding, Ingoglia noted. States can choose to fund 988 services through legislation that lets phone companies collect fees from customers.

Further, the federal funding that helped create the 988 line isn't guaranteed to continue.

"We need to have permanent funding for 988,"Levounis said. "We're delighted that the federal government funded the initial phase of the project, but we need staffing, and we need this to be something that lives in perpetuity."

Mental health experts say there also needs to be increased funding for Certified Community Behavioral Health Clinics (CCBHC), the system to which people are referred if they need more help than can be provided during their 988 call.

The current system of CCBHCs was set up as part of a federal pilot project to improve mental health services, but the clinics have not yet been adopted as a permanent program, Bohan said.

"There's a lot of effort in terms of getting the CCBHCs established in federal law,"she said.

What the future holds

Such follow-up services are critical to those most in need, Levounis said.

"It's one thing to tell people that I'm going to be there for you and we're going to have services to address your needs, and a different thing to be truthful about that and really have the services that people need on the other side,"Levounis said. "So it's a matter of infrastructure, it's a matter of workforce building, and we owe it to our people in need to supply these services."

Although these obstacles are daunting, Graham is optimistic that they will be overcome given the mental health needs in the United States.

"Remember when 911 came out many years ago, it was a slow start, but once it got going, they're busy as can be now because everyone knows about it,"he said. "That same thing's going to happen to 988, so we need to get in front of the staffing so we don't overwhelm the existing staff. We want to keep them, retain them and build that early on before the volume continues to go up, which it will."

More information

The Substance Abuse and Mental Health Services Administration has more on the 988 Suicide & Crisis Lifeline.

SOURCES: Petros Levounis, MD, MA, president, American Psychiatric Association and professor and chair, psychiatry, Rutgers New Jersey Medical School, Newark, N.J.; Mary-Catherine Bohan, MSW, vice president, outpatient and ambulatory services, Rutgers University Behavioral Health Care, Piscataway, N.J.; Mark Graham, MBA, executive director, Rutgers University Behavioral Health Care National Call Center, Piscataway, N.J.; National Council for Mental Wellbeing, news release, July 11, 2023