It’s finally official: as of last weekend, 988, the new, shorter number to the National Suicide Prevention Lifeline, is live and available nationwide. It’s been a long road to get here, spanning several years and two different presidential administrations. Now that the new number is active, the big question is, “Now what?”
Initially kickstarted by the National Suicide Hotline Designation Act of 2020, this new number has always had the potential to not only save lives, but revolutionize the way our nation addresses and treats mental health, substance misuse, and suicide prevention.
Yet, there hasn’t been any real organized drive or cohesive plan to ensure its success. Funding, implementation, and public education were largely left up to the discretion of state leaders – some of whom acted quickly, but many of whom had not even entertained legislation about 988 as recently as last month. Nonetheless, we’ve persevered, and anyone who needs to call or text the crisis line can now do so and get through. Over the past week, I’ve had many conversations about 988’s rollout. Below I want to share some of the most commonly asked questions I’ve received, in hopes it may answer any lingering questions you may still have about the new number.
988: What does it mean and how is it going to work?
In a crisis, every moment counts. On the surface, 988 is simply a shorter, easier-to-remember number to connect to the National Suicide Prevention Lifeline, which has been operational for years, but with the longer number of 1-800-273-8255. Now that the number is shorter, people calling for themselves or others should be able to recall and dial more quickly, similar to the way we all know to dial 9-1-1 in a medical emergency.
However, 988 is so much more than just that easy to remember new number. There’s a continuum for crisis services that begins with callers being routed to trained crisis responder who can ask the right questions to de-escalate a crisis situation, or potentially dispatch a mobile crisis unit to the caller’s location, if an in-person, on the ground response is necessary. It’s an opportunity to meet a health care crisis with a health care response rather than having police show up and potentially do more harm than good. This is the deeper work that’s going to take time.
Why is there a focus on moving away from a law enforcement response to these types of calls?
The simple answer is that police officers generally do not have the proper training to appropriately deal with people who are experiencing mental health crises. These are people whose condition may make them act erratically or irrationally, and to an untrained observer could seem aggressive or even dangerous. We have seen too many instances where police officers interpreted this behavior as threatening and used excessive or even deadly force when it wasn’t necessary.
Alternatively, even in situations that don’t escalate to violence, police may simply detain the person in crisis and take them to a hospital or to jail, neither of which are equipped to properly treat mental health conditions. In fact, too many people are arrested for their mental health! Having a trained crisis counselor and/or mental health expert respond to these situations would not only take an undue burden off the police, but likely result in a much better health outcome for the individual in crisis.
How can 988 reform the mental health care system?
The research is clear, mental health is inseparable from our overall health and well-being. Yet for decades we have considered people who struggle with mental health and addiction as somehow anomalous, deviant, or otherwise outside the norm. We couldn’t be further from the truth. We’ve seen some positive progress, but at a policy level, things have moved at a snail’s pace. With the proper funding and infrastructure, 988 can act like a mental health care “Trojan Horse,” as I have described – not only providing a more targeted mental health response and treatment for those in crisis, but also ensuring broader and more equitable access for people and communities that have been historically marginalized.
How are you feeling about the launch of the new hotline?
The reality is, the launch of 988 has been a massive undertaking, and everyone involved at every stage should be applauded for their role. I think it would have benefitted from more coordinated federal and state leadership and guidance, but I also can’t minimize the exceptional work that has already been done to get us here. I see 988 as a work in progress, and its nationwide launch as less of a culmination and more of an exciting new beginning in expanding mental health care. That being said, in the words of Will Rogers, “Even if you are on the right track, you’ll get run over if you just sit there.”
Why do we need a new form of funding when the National Suicide Prevention Lifeline was already funded?
The National Suicide Prevention Lifeline was founded to be just that, a lifeline for people who reached the point where they were considering ending their lives. 988 is intended as a much broader crisis hotline. People can call and get counseling through those same kinds of dark thoughts, but also people can call if they see a family member having more acute psychiatric needs, or if they have a friend who is spiraling into addiction. It takes sustainable funding to hire and train the kinds of knowledgeable counselors needed to effectively respond to a wide range of calls, as well as set up the mobile response units and mental health treatment/receiving facilities needed to get people the care they may need.
Without state legislation, what could happen when calls go unanswered at the hotline?
In a perfect world, anyone who calls, texts, or sends an online chat message to 988 would be instantaneously connected to someone who could help them. Unfortunately, we don’t live in a perfect world, and, at least for the moment, the truth is that a lot of callers will be routed to a call queue until a crisis responder is available. It breaks my heart, because there will undoubtedly be people who cannot afford to wait on hold for minutes, let alone hours. For those we may lose their trust and confidence in I 988. My hope is that the inevitable wait times don’t irreparably harm the public’s trust and belief in the system.
How will staffing shortages impact the rollout and success of 988?
Trained responders are a crucial component of 988’s effectiveness. Fewer staff members available to field calls obviously translates to longer wait times for callers in crisis. As such, it behooves state legislatures to provide the funding necessary to hire and train as many crisis counselors and call center staff as possible in order to contend with the predicted surge in calls now that 988 is live. Pay them for the critical work they do. When baristas can make more than a crisis counselor we may need to reconsider how we recruit those to come and work in a field that’s challenging but oh so rewarding. There’s nothing better than saving a life – and that’s the promise of 988.