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    9-8-8: State of the Lifeline

    Aug 23 2022

    By Collin Shumate, M.D.,
    APAF Public Psychiatry Fellow,
    Resident at University of California Davis

    Introducing the new and improved 988 Suicide and Crisis Lifeline!

    For nearly two years, mental health specialists across America have been eagerly—perhaps nervously—anticipating the transition to a shorter, simpler suicide lifeline number. On July 16, 2022 the new-and-improved 988 Suicide and Crisis Lifeline was launched! It is now active across the United States, available to Americans by calling 988, texting 988, or by using the Live Chat feature on the 988 website. The previous number, 1-800-273-8255, will continue to operate as well and will direct callers to the same call centers. By accessing these resources, people in mental health crises can connect with peer supporters and other mental health specialists staffing the call centers who help provide support and even link community members to follow up with local mental health resources.

    The importance of this rollout cannot be understated. Suicide is a leading cause of death in the United States. The CDC estimates that one person died by suicide every 11 minutes in 2020. Suicide is an epidemic that the American Psychiatric Association (APA), the APA Foundation, and many other mental health organizations are working tirelessly to prevent.

    My first two blogs (988: What to Expect and 988: What Is Happening) discuss the lead up to and the roll out of 988. While mental health advocates were hoping that the rollout of 988 would lead to improved mental health outcomes and fewer interactions with police for nonviolent mental health crises, behavioral health directors also warned that the implementation may be bumpy.

    How did the launch of 988 go?

    On July 16, 2022 the lifeline website launched, and phone calls to 988 began to be directed to call centers. The service launched with relatively little fanfare, given concerns that the call spike might overwhelm call centers. The website and phone line launched with special resources for Spanish speakers and the phone line also has interpreters for 200+ languages. Special resources for several minority populations, including racial and ethnic minorities, LGBTQ+ individuals, veterans, individuals with neurodivergence, and those who are deaf or hard of hearing are available.

    Early reports suggested that calls increased by 45% during the first week after the switch to 988 from the previous, longer number, and a 66% increase compared to the same week in July last year. The U.S. Department of Health and Human Services expects the volume of calls to double in the first year after launch. While most news coverage of the rollout was positive, some mental health advocates voiced concerns that calling 988 could result in involvement of law enforcement, and some expressed lingering mistrust in the Black community amidst national outrage over police brutality.

    Prior to the rollout of 988, emergency services were dispatched to about 2% of the callers to the suicide lifeline. The executive director of the hotline has stated that 988 will update its policies to require supervisors to review all calls that result in the use of emergency services. Additionally, counselors will receive training on alternatives to law enforcement involvement, and the consequences callers can face when police respond.

    What more needs to be done?

    Over the next few years, states will have to adjust the funding mechanisms for the 988 Suicide and Crisis Lifeline and scale up their services to meet the need of their communities. Some states, like California, are on the cusp of passing legislation to fund 988 long-term. The #ReimagineCrisis website has a helpful map with information about state legislation to implement 988, in addition to providing model legislation for lawmakers throughout the country. As a mental health workforce and as American citizens, we will need to advocate to our legislatures to implement this crucial legislation.

    Additionally, states will need to work to implement the Crisis Continuum of Care to optimize emergency clinical care for community members in mental health crises and divert as many community members as possible from interactions with law enforcement. At the moment, the ideal continuum of crisis services are only available in limited portions of the country. For those interested in learning more about the crisis response, the #ReimagineCrisis website has helpful information about the need for crisis services.

    As a mental health workforce, we will likely need to adapt our messaging to community members based on the initial experiences with the lifeline. We will also need to continue to advocate for improvements based on the lessons we learn over the next few years.

    While this will be my last blog about 988, the APA and other mental health organizations will continue to discuss and promote 988 over the coming years. Two psychiatrists and APA members, Dr. John Palmieri and Dr. Eric Rafla-Yuan, discussed 988 in a newly released Mentally Healthy Nation” podcast episode. Check APA's website and the 988 Suicide and Crisis Lifeline website for more updates! Thanks for reading!